"BusinessYear","StateCode","IssuerId","SourceName","ImportDate","MarketCoverage","DentalOnlyPlan","TIN","StandardComponentId","PlanMarketingName","HIOSProductId","HPID","NetworkId","ServiceAreaId","FormularyId","IsNewPlan","PlanType","MetalLevel","DesignType","UniquePlanDesign","QHPNonQHPTypeId","IsNoticeRequiredForPregnancy","IsReferralRequiredForSpecialist","SpecialistRequiringReferral","PlanLevelExclusions","IndianPlanVariationEstimatedAdvancedPaymentAmountPerEnrollee","CompositeRatingOffered","ChildOnlyOffering","ChildOnlyPlanId","WellnessProgramOffered","DiseaseManagementProgramsOffered","EHBPercentTotalPremium","EHBPediatricDentalApportionmentQuantity","IsGuaranteedRate","PlanEffectiveDate","PlanExpirationDate","OutOfCountryCoverage","OutOfCountryCoverageDescription","OutOfServiceAreaCoverage","OutOfServiceAreaCoverageDescription","NationalNetwork","URLForEnrollmentPayment","FormularyURL","PlanId","PlanVariantMarketingName","CSRVariationType","IssuerActuarialValue","AVCalculatorOutputNumber","MedicalDrugDeductiblesIntegrated","MedicalDrugMaximumOutofPocketIntegrated","MultipleInNetworkTiers","FirstTierUtilization","SecondTierUtilization","SBCHavingaBabyDeductible","SBCHavingaBabyCopayment","SBCHavingaBabyCoinsurance","SBCHavingaBabyLimit","SBCHavingDiabetesDeductible","SBCHavingDiabetesCopayment","SBCHavingDiabetesCoinsurance","SBCHavingDiabetesLimit","SBCHavingSimplefractureDeductible","SBCHavingSimplefractureCopayment","SBCHavingSimplefractureCoinsurance","SBCHavingSimplefractureLimit","SpecialtyDrugMaximumCoinsurance","InpatientCopaymentMaximumDays","BeginPrimaryCareCostSharingAfterNumberOfVisits","BeginPrimaryCareDeductibleCoinsuranceAfterNumberOfCopays","MEHBInnTier1IndividualMOOP","MEHBInnTier1FamilyPerPersonMOOP","MEHBInnTier1FamilyPerGroupMOOP","MEHBInnTier2IndividualMOOP","MEHBInnTier2FamilyPerPersonMOOP","MEHBInnTier2FamilyPerGroupMOOP","MEHBOutOfNetIndividualMOOP","MEHBOutOfNetFamilyPerPersonMOOP","MEHBOutOfNetFamilyPerGroupMOOP","MEHBCombInnOonIndividualMOOP","MEHBCombInnOonFamilyPerPersonMOOP","MEHBCombInnOonFamilyPerGroupMOOP","DEHBInnTier1IndividualMOOP","DEHBInnTier1FamilyPerPersonMOOP","DEHBInnTier1FamilyPerGroupMOOP","DEHBInnTier2IndividualMOOP","DEHBInnTier2FamilyPerPersonMOOP","DEHBInnTier2FamilyPerGroupMOOP","DEHBOutOfNetIndividualMOOP","DEHBOutOfNetFamilyPerPersonMOOP","DEHBOutOfNetFamilyPerGroupMOOP","DEHBCombInnOonIndividualMOOP","DEHBCombInnOonFamilyPerPersonMOOP","DEHBCombInnOonFamilyPerGroupMOOP","TEHBInnTier1IndividualMOOP","TEHBInnTier1FamilyPerPersonMOOP","TEHBInnTier1FamilyPerGroupMOOP","TEHBInnTier2IndividualMOOP","TEHBInnTier2FamilyPerPersonMOOP","TEHBInnTier2FamilyPerGroupMOOP","TEHBOutOfNetIndividualMOOP","TEHBOutOfNetFamilyPerPersonMOOP","TEHBOutOfNetFamilyPerGroupMOOP","TEHBCombInnOonIndividualMOOP","TEHBCombInnOonFamilyPerPersonMOOP","TEHBCombInnOonFamilyPerGroupMOOP","MEHBDedInnTier1Individual","MEHBDedInnTier1FamilyPerPerson","MEHBDedInnTier1FamilyPerGroup","MEHBDedInnTier1Coinsurance","MEHBDedInnTier2Individual","MEHBDedInnTier2FamilyPerPerson","MEHBDedInnTier2FamilyPerGroup","MEHBDedInnTier2Coinsurance","MEHBDedOutOfNetIndividual","MEHBDedOutOfNetFamilyPerPerson","MEHBDedOutOfNetFamilyPerGroup","MEHBDedCombInnOonIndividual","MEHBDedCombInnOonFamilyPerPerson","MEHBDedCombInnOonFamilyPerGroup","DEHBDedInnTier1Individual","DEHBDedInnTier1FamilyPerPerson","DEHBDedInnTier1FamilyPerGroup","DEHBDedInnTier1Coinsurance","DEHBDedInnTier2Individual","DEHBDedInnTier2FamilyPerPerson","DEHBDedInnTier2FamilyPerGroup","DEHBDedInnTier2Coinsurance","DEHBDedOutOfNetIndividual","DEHBDedOutOfNetFamilyPerPerson","DEHBDedOutOfNetFamilyPerGroup","DEHBDedCombInnOonIndividual","DEHBDedCombInnOonFamilyPerPerson","DEHBDedCombInnOonFamilyPerGroup","TEHBDedInnTier1Individual","TEHBDedInnTier1FamilyPerPerson","TEHBDedInnTier1FamilyPerGroup","TEHBDedInnTier1Coinsurance","TEHBDedInnTier2Individual","TEHBDedInnTier2FamilyPerPerson","TEHBDedInnTier2FamilyPerGroup","TEHBDedInnTier2Coinsurance","TEHBDedOutOfNetIndividual","TEHBDedOutOfNetFamilyPerPerson","TEHBDedOutOfNetFamilyPerGroup","TEHBDedCombInnOonIndividual","TEHBDedCombInnOonFamilyPerPerson","TEHBDedCombInnOonFamilyPerGroup","IsHSAEligible","HSAOrHRAEmployerContribution","HSAOrHRAEmployerContributionAmount","URLForSummaryofBenefitsCoverage","PlanBrochure"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0090001","Delta Dental Premier 1000, 80*/80/50, 50","21989AK009",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Providers treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0090001-01","Delta Dental Premier 1000, 80*/80/50, 50","Standard High On Exchange Plan","85.54%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier1000_80_SG_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0090002","Delta Dental Premier 1500, 80*/80/50, 50","21989AK009",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Providers treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0090002-00","Delta Dental Premier 1500, 80*/80/50, 50","Standard High Off Exchange Plan","85.54%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier1500_80_SG_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","Individual","Yes","93-0438772","21989AK0030001","Delta Dental Premier Plan","21989AK003",,"AKN001","AKS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","providers treated as out of network","Yes","national network","Yes",,"","21989AK0030001-00","Delta Dental Premier Plan","Standard Low Off Exchange Plan","71.69%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremierPlan_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0130001","Delta Dental Premier, +2000, 100*/80/50, 50, PF","21989AK013",,"AKN001","AKS001",,"New","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Providers treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0130001-00","Delta Dental Premier, +2000, 100*/80/50, 50, PF","Standard High Off Exchange Plan","85.54%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier2000_PF2_SG_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0130002","Delta Dental Premier, +2500, 100*/80/50, 50, PF","21989AK013",,"AKN001","AKS001",,"New","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Providers treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0130002-00","Delta Dental Premier, +2500, 100*/80/50, 50, PF","Standard High Off Exchange Plan","85.54%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier2500_PF2_SG_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","Individual","Yes","93-0438772","21989AK0030001","Delta Dental Premier Plan","21989AK003",,"AKN001","AKS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","providers treated as out of network","Yes","national network","Yes",,"","21989AK0030001-01","Delta Dental Premier Plan","Standard Low On Exchange Plan","71.69%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremierPlan_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","Individual","Yes","93-0438772","21989AK0050001","Delta Dental PPO 1000 Plan","21989AK005",,"AKN002","AKS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","National Network","Yes","Providers treated as out of network","Yes",,"","21989AK0050001-00","Delta Dental PPO 1000 Plan","Standard High Off Exchange Plan","83.95%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1000Plan_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0080001","Delta Dental Premier 1000, 100*/80/50, 50","21989AK008",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Providers treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0080001-00","Delta Dental Premier 1000, 100*/80/50, 50","Standard High Off Exchange Plan","85.54%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier1000_100_SG_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0080002","Delta Dental Premier 1500, 100*/80/50, 50","21989AK008",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Providers treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0080002-00","Delta Dental Premier 1500, 100*/80/50, 50","Standard High Off Exchange Plan","85.54%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier1500_100_SG_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","Individual","Yes","93-0438772","21989AK0050001","Delta Dental PPO 1000 Plan","21989AK005",,"AKN002","AKS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","National Network","Yes","Providers treated as out of network","Yes",,"","21989AK0050001-01","Delta Dental PPO 1000 Plan","Standard High On Exchange Plan","83.95%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1000Plan_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0080003","Delta Dental Premier 2000, 100*/80/50, 50","21989AK008",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Providers treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0080003-00","Delta Dental Premier 2000, 100*/80/50, 50","Standard High Off Exchange Plan","85.54%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier2000_100_SG_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0090001","Delta Dental Premier 1000, 80*/80/50, 50","21989AK009",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Providers treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0090001-00","Delta Dental Premier 1000, 80*/80/50, 50","Standard High Off Exchange Plan","85.54%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier1000_80_SG_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","Individual","Yes","93-0438772","21989AK0050002","Delta Dental PPO 1500 Plan","21989AK005",,"AKN002","AKS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","providers treated as out of network","Yes","National Netwok","Yes",,"","21989AK0050002-00","Delta Dental PPO 1500 Plan","Standard High Off Exchange Plan","83.95%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1500Plan_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","Individual","Yes","93-0438772","21989AK0050002","Delta Dental PPO 1500 Plan","21989AK005",,"AKN002","AKS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","providers treated as out of network","Yes","National Netwok","Yes",,"","21989AK0050002-01","Delta Dental PPO 1500 Plan","Standard High On Exchange Plan","83.95%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1500Plan_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","Individual","Yes","93-0438772","21989AK0070001","Delta Dental Premier Healthy Smiles","21989AK007",,"AKN001","AKS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Providers are treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0070001-00","Delta Dental Premier Healthy Smiles","Standard Low Off Exchange Plan","71.69%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremierHealthySmilesPlan_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0090002","Delta Dental Premier 1500, 80*/80/50, 50","21989AK009",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Providers treated as out-of-network.","Yes","National Network","Yes",,"","21989AK0090002-01","Delta Dental Premier 1500, 80*/80/50, 50","Standard High On Exchange Plan","85.54%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier1500_80_SG_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0090003","Delta Dental Premier 2000, 80*/80/50, 50","21989AK009",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0090003-00","Delta Dental Premier 2000, 80*/80/50, 50","Standard High Off Exchange Plan","85.54%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier2000_80_SG_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0100001","Delta Dental PPO 1000, 100*/90/50, 50","21989AK010",,"AKN002","AKS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0100001-00","Delta Dental PPO 1000, 100*/90/50, 50","Standard High Off Exchange Plan","85.86%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPPO1000_100_SG_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0100002","Delta Dental PPO 1500, 100*/90/50, 50","21989AK010",,"AKN002","AKS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0100002-00","Delta Dental PPO 1500, 100*/90/50, 50","Standard High Off Exchange Plan","85.86%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPPO1500_100_SG_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0100003","Delta Dental PPO 2000, 100*/90/50, 50","21989AK010",,"AKN002","AKS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0100003-00","Delta Dental PPO 2000, 100*/90/50, 50","Standard High Off Exchange Plan","85.86%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPPO2000_100_SG_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0110001","Delta Dental Premier Radiant Smiles Plan","21989AK011",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0110001-00","Delta Dental Premier Radiant Smiles Plan","Standard High Off Exchange Plan","85.54%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierRadiantSmilesPlan_SG_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0140001","Delta Dental Premier, Voluntary, 1000, 100*/80/50, 50","21989AK014",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0140001-00","Delta Dental Premier, Voluntary, 1000, 100*/80/50, 50","Standard High Off Exchange Plan","85.54%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierVoluntary1000_100_SG_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0140002","Delta Dental Premier, Voluntary, 1500, 100*/80/50, 50","21989AK014",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0140002-00","Delta Dental Premier, Voluntary, 1500, 100*/80/50, 50","Standard High Off Exchange Plan","85.54%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierVoluntary1500_100_SG_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0150001","Delta Dental Premier, Voluntary, 1000, 80*/80/50, 50","21989AK015",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0150001-00","Delta Dental Premier, Voluntary, 1000, 80*/80/50, 50","Standard High Off Exchange Plan","85.54%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierVoluntary1000_80_SG_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0150002","Delta Dental Premier, Voluntary, 1500, 80*/80/50, 50","21989AK015",,"AKN001","AKS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0150002-00","Delta Dental Premier, Voluntary, 1500, 80*/80/50, 50","Standard High Off Exchange Plan","85.54%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierVoluntary1500_80_SG_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0160001","Delta Dental PPO, Voluntary, 1000, 100*/90/50, 50","21989AK016",,"AKN002","AKS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0160001-00","Delta Dental PPO, Voluntary, 1000, 100*/90/50, 50","Standard High Off Exchange Plan","85.86%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPPOVoluntary1000_100_SG_2018_AK.pdf"
"2018","AK","21989","HIOS","2017-09-26 02:21:16","SHOP (Small Group)","Yes","93-0438772","21989AK0160002","Delta Dental PPO, Voluntary, 1500, 100*/90/50, 50","21989AK016",,"AKN002","AKS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Providers treated as out-of-network","Yes","National Network","Yes",,"","21989AK0160002-00","Delta Dental PPO, Voluntary, 1500, 100*/90/50, 50","Standard High Off Exchange Plan","85.86%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPPOVoluntary1500_100_SG_2018_AK.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540003","Premera Blue Cross Preferred Plus Gold 1500","38344AK054",,"AKN001","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M4/","38344AK0540003-00","Premera Blue Cross Preferred Plus Gold 1500","Standard Gold Off Exchange Plan",,"0.762817066105984","Yes","Yes","No","100%",,"$1,500","$90","$3,300","$60","$200","$2,300","$0","$20","$1,500","$200","$40","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"$3,000","$3000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/042161_2018.pdf","https://www.premera.com/documents/007528_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540003","Premera Blue Cross Preferred Plus Gold 1500","38344AK054",,"AKN001","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M4/","38344AK0540003-01","Premera Blue Cross Preferred Plus Gold 1500","Standard Gold On Exchange Plan",,"0.762817066105984","Yes","Yes","No","100%",,"$1,500","$90","$3,300","$60","$200","$2,300","$0","$20","$1,500","$200","$40","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"$3,000","$3000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/042162_2018.pdf","https://www.premera.com/documents/007528_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540003","Premera Blue Cross Preferred Plus Gold 1500","38344AK054",,"AKN001","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M4/","38344AK0540003-02","Premera Blue Cross Preferred Plus Gold 1500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.premera.com/documents/042163_2018.pdf","https://www.premera.com/documents/031040_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540003","Premera Blue Cross Preferred Plus Gold 1500","38344AK054",,"AKN001","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M4/","38344AK0540003-03","Premera Blue Cross Preferred Plus Gold 1500","Limited Cost Sharing Plan Variation",,"0.762817066105984","Yes","Yes","No","100%",,"$1,500","$90","$3,300","$60","$200","$2,300","$0","$20","$1,500","$200","$40","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"$3,000","$3000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/042164_2018.pdf","https://www.premera.com/documents/031040_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540006","Premera Blue Cross Preferred Plus Silver 4500","38344AK054",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M4/","38344AK0540006-00","Premera Blue Cross Preferred Plus Silver 4500","Standard Silver Off Exchange Plan",,"0.6861070149613","Yes","Yes","No","100%",,"$4,500","$100","$2,400","$60","$200","$2,700","$0","$20","$1,600","$200","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"$9,000","$9000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/042165_2018.pdf","https://www.premera.com/documents/007528_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540006","Premera Blue Cross Preferred Plus Silver 4500","38344AK054",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M4/","38344AK0540006-06","Premera Blue Cross Preferred Plus Silver 4500 CSR3","94% AV Level Silver Plan",,"0.932445334847469","Yes","Yes","No","100%",,"$300","$0","$400","$60","$100","$600","$0","$20","$300","$0","$400","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","30.00%",,,,,"$600","$600 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/042171_2018.pdf","https://www.premera.com/documents/007528_2018.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0700004","Endeavor Providence Silver 2500","73836AK070",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700004-00","Endeavor Providence Silver 2500","Standard Silver Off Exchange Plan",,"0.714196730520482","Yes","Yes","No","100%",,"$2,500","$40","$3,500","$300","$1,730","$1,900","$50","$60","$1,460","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver2500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver2500_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0700004","Endeavor Providence Silver 2500","73836AK070",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700004-01","Endeavor Providence Silver 2500","Standard Silver On Exchange Plan",,"0.714196730520482","Yes","Yes","No","100%",,"$2,500","$40","$3,500","$300","$1,730","$1,900","$50","$60","$1,460","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver2500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver2500_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710003","Endeavor Providence Silver 3000","73836AK071",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710003-00","Endeavor Providence Silver 3000","Standard Silver Off Exchange Plan",,"0.709104253993476","Yes","Yes","No","100%",,"$3,000","$40","$3,300","$300","$1,730","$1,900","$50","$60","$1,460","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver3000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver3000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710003","Endeavor Providence Silver 3000","73836AK071",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710003-01","Endeavor Providence Silver 3000","Standard Silver On Exchange Plan",,"0.709104253993476","Yes","Yes","No","100%",,"$3,000","$40","$3,300","$300","$1,730","$1,900","$50","$60","$1,460","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver3000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver3000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710004","Endeavor Providence Silver 4000","73836AK071",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710004-00","Endeavor Providence Silver 4000","Standard Silver Off Exchange Plan",,"0.700335102508777","Yes","Yes","No","100%",,"$4,000","$40","$2,900","$300","$1,730","$1,900","$50","$60","$1,460","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","35.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver4000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver4000_SG_2018_AK.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540009","Premera Blue Cross Preferred Plus Bronze 5250 HSA","38344AK054",,"AKN001","AKS001","AKF003","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/","38344AK0540009-03","Premera Blue Cross Preferred Plus Bronze 5250 HSA","Limited Cost Sharing Plan Variation",,"0.611095907187061","Yes","Yes","No","100%",,"$5,250","$0","$1,400","$60","$5,250","$0","$600","$20","$1,600","$0","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","30.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.premera.com/documents/042179_2018.pdf","https://www.premera.com/documents/031040_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540010","Premera Blue Cross Preferred Plus Silver 3000 HSA","38344AK054",,"AKN001","AKS001","AKF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/","38344AK0540010-00","Premera Blue Cross Preferred Plus Silver 3000 HSA","Standard Silver Off Exchange Plan",,"0.660349268025524","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$60","$3,000","$0","$1,300","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.premera.com/documents/042180_2018.pdf","https://www.premera.com/documents/007528_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540010","Premera Blue Cross Preferred Plus Silver 3000 HSA","38344AK054",,"AKN001","AKS001","AKF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/","38344AK0540010-01","Premera Blue Cross Preferred Plus Silver 3000 HSA","Standard Silver On Exchange Plan",,"0.660349268025524","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$60","$3,000","$0","$1,300","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.premera.com/documents/042181_2018.pdf","https://www.premera.com/documents/007528_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540010","Premera Blue Cross Preferred Plus Silver 3000 HSA","38344AK054",,"AKN001","AKS001","AKF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/","38344AK0540010-02","Premera Blue Cross Preferred Plus Silver 3000 HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.premera.com/documents/042182_2018.pdf","https://www.premera.com/documents/031040_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540006","Premera Blue Cross Preferred Plus Silver 4500","38344AK054",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M4/","38344AK0540006-01","Premera Blue Cross Preferred Plus Silver 4500","Standard Silver On Exchange Plan",,"0.6861070149613","Yes","Yes","No","100%",,"$4,500","$100","$2,400","$60","$200","$2,700","$0","$20","$1,600","$200","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"$9,000","$9000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/042166_2018.pdf","https://www.premera.com/documents/007528_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540006","Premera Blue Cross Preferred Plus Silver 4500","38344AK054",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M4/","38344AK0540006-02","Premera Blue Cross Preferred Plus Silver 4500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.premera.com/documents/042167_2018.pdf","https://www.premera.com/documents/031040_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540006","Premera Blue Cross Preferred Plus Silver 4500","38344AK054",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M4/","38344AK0540006-03","Premera Blue Cross Preferred Plus Silver 4500","Limited Cost Sharing Plan Variation",,"0.6861070149613","Yes","Yes","No","100%",,"$4,500","$100","$2,400","$60","$200","$2,700","$0","$20","$1,600","$200","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"$9,000","$9000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/042168_2018.pdf","https://www.premera.com/documents/031040_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540006","Premera Blue Cross Preferred Plus Silver 4500","38344AK054",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M4/","38344AK0540006-04","Premera Blue Cross Preferred Plus Silver 4500 CSR1","73% AV Level Silver Plan",,"0.720567785061421","Yes","Yes","No","100%",,"$4,000","$0","$1,900","$60","$200","$2,600","$0","$20","$1,600","$200","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/042169_2018.pdf","https://www.premera.com/documents/007528_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540006","Premera Blue Cross Preferred Plus Silver 4500","38344AK054",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M4/","38344AK0540006-05","Premera Blue Cross Preferred Plus Silver 4500 CSR2","87% AV Level Silver Plan",,"0.861036387008343","Yes","Yes","No","100%",,"$1,000","$0","$900","$60","$200","$1,700","$0","$20","$1,000","$90","$200","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30.00%",,,,,"$2,000","$2000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/042170_2018.pdf","https://www.premera.com/documents/007528_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540008","Premera Blue Cross Preferred Plus Bronze 6350","38344AK054",,"AKN001","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/","38344AK0540008-00","Premera Blue Cross Preferred Plus Bronze 6350","Standard Bronze Off Exchange Plan",,"0.615065144526133","Yes","Yes","No","100%",,"$6,350","$0","$1,000","$60","$200","$400","$1,800","$20","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","30.00%",,,,,"$12,700","$12700 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/042172_2018.pdf","https://www.premera.com/documents/007528_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540008","Premera Blue Cross Preferred Plus Bronze 6350","38344AK054",,"AKN001","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/","38344AK0540008-01","Premera Blue Cross Preferred Plus Bronze 6350","Standard Bronze On Exchange Plan",,"0.615065144526133","Yes","Yes","No","100%",,"$6,350","$0","$1,000","$60","$200","$400","$1,800","$20","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","30.00%",,,,,"$12,700","$12700 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/042173_2018.pdf","https://www.premera.com/documents/007528_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540008","Premera Blue Cross Preferred Plus Bronze 6350","38344AK054",,"AKN001","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/","38344AK0540008-02","Premera Blue Cross Preferred Plus Bronze 6350","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.premera.com/documents/042174_2018.pdf","https://www.premera.com/documents/031040_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540008","Premera Blue Cross Preferred Plus Bronze 6350","38344AK054",,"AKN001","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/","38344AK0540008-03","Premera Blue Cross Preferred Plus Bronze 6350","Limited Cost Sharing Plan Variation",,"0.615065144526133","Yes","Yes","No","100%",,"$6,350","$0","$1,000","$60","$200","$400","$1,800","$20","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","30.00%",,,,,"$12,700","$12700 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/042175_2018.pdf","https://www.premera.com/documents/031040_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540009","Premera Blue Cross Preferred Plus Bronze 5250 HSA","38344AK054",,"AKN001","AKS001","AKF003","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/","38344AK0540009-00","Premera Blue Cross Preferred Plus Bronze 5250 HSA","Standard Bronze Off Exchange Plan",,"0.611095907187061","Yes","Yes","No","100%",,"$5,250","$0","$1,400","$60","$5,250","$0","$600","$20","$1,600","$0","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","30.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.premera.com/documents/042176_2018.pdf","https://www.premera.com/documents/007528_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540009","Premera Blue Cross Preferred Plus Bronze 5250 HSA","38344AK054",,"AKN001","AKS001","AKF003","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/","38344AK0540009-01","Premera Blue Cross Preferred Plus Bronze 5250 HSA","Standard Bronze On Exchange Plan",,"0.611095907187061","Yes","Yes","No","100%",,"$5,250","$0","$1,400","$60","$5,250","$0","$600","$20","$1,600","$0","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","30.00%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.premera.com/documents/042177_2018.pdf","https://www.premera.com/documents/007528_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540009","Premera Blue Cross Preferred Plus Bronze 5250 HSA","38344AK054",,"AKN001","AKS001","AKF003","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/","38344AK0540009-02","Premera Blue Cross Preferred Plus Bronze 5250 HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.premera.com/documents/042178_2018.pdf","https://www.premera.com/documents/031040_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540010","Premera Blue Cross Preferred Plus Silver 3000 HSA","38344AK054",,"AKN001","AKS001","AKF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/","38344AK0540010-03","Premera Blue Cross Preferred Plus Silver 3000 HSA","Limited Cost Sharing Plan Variation",,"0.660349268025524","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$60","$3,000","$0","$1,300","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.premera.com/documents/042183_2018.pdf","https://www.premera.com/documents/031040_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540010","Premera Blue Cross Preferred Plus Silver 3000 HSA","38344AK054",,"AKN001","AKS001","AKF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/","38344AK0540010-04","Premera Blue Cross Preferred Plus Silver 3000 HSA","73% AV Level Silver Plan",,"0.720265739120936","Yes","Yes","No","100%",,"$2,700","$0","$1,100","$60","$2,700","$0","$1,100","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.premera.com/documents/042184_2018.pdf","https://www.premera.com/documents/007528_2018.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540010","Premera Blue Cross Preferred Plus Silver 3000 HSA","38344AK054",,"AKN001","AKS001","AKF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/","38344AK0540010-05","Premera Blue Cross Preferred Plus Silver 3000 HSA","87% AV Level Silver Plan",,"0.862239736974509","Yes","Yes","No","100%",,"$750","$0","$700","$60","$750","$0","$700","$20","$750","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/042185_2018.pdf","https://www.premera.com/documents/007528_2018.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0700009","Endeavor Select Silver 2500","73836AK070",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700009-00","Endeavor Select Silver 2500","Standard Silver Off Exchange Plan",,"0.714196730520482","Yes","Yes","No","100%",,"$2,500","$40","$3,500","$300","$1,730","$1,900","$50","$60","$1,460","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Silver2500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Silver2500_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0700009","Endeavor Select Silver 2500","73836AK070",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700009-01","Endeavor Select Silver 2500","Standard Silver On Exchange Plan",,"0.714196730520482","Yes","Yes","No","100%",,"$2,500","$40","$3,500","$300","$1,730","$1,900","$50","$60","$1,460","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Silver2500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Silver2500_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710007","Endeavor Select Silver 3000","73836AK071",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710007-00","Endeavor Select Silver 3000","Standard Silver Off Exchange Plan",,"0.709104253993476","Yes","Yes","No","100%",,"$3,000","$40","$3,300","$300","$1,730","$1,900","$50","$60","$1,460","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Silver3000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Silver3000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710007","Endeavor Select Silver 3000","73836AK071",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710007-01","Endeavor Select Silver 3000","Standard Silver On Exchange Plan",,"0.709104253993476","Yes","Yes","No","100%",,"$3,000","$40","$3,300","$300","$1,730","$1,900","$50","$60","$1,460","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Silver3000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Silver3000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710008","Endeavor Select Silver 4000","73836AK071",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710008-00","Endeavor Select Silver 4000","Standard Silver Off Exchange Plan",,"0.700335102508777","Yes","Yes","No","100%",,"$4,000","$40","$2,900","$300","$1,730","$1,900","$50","$60","$1,460","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","35.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Silver4000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Silver4000_SG_2018_AK.pdf"
"2018","AK","38344","HIOS","2017-11-01 02:20:20","Individual","No","91-0499247","38344AK0540010","Premera Blue Cross Preferred Plus Silver 3000 HSA","38344AK054",,"AKN001","AKS001","AKF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,"2018-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx","https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/","38344AK0540010-06","Premera Blue Cross Preferred Plus Silver 3000 HSA","94% AV Level Silver Plan",,"0.941596309661484","Yes","Yes","No","100%",,"$250","$0","$300","$60","$250","$0","$300","$20","$250","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/042186_2018.pdf","https://www.premera.com/documents/007528_2018.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0700001","Endeavor Providence Gold 500","73836AK070",,"AKN002","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700001-00","Endeavor Providence Gold 500","Standard Gold Off Exchange Plan",,"0.813083275924935","Yes","Yes","No","100%",,"$500","$40","$2,400","$300","$500","$1,100","$300","$60","$500","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Gold500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Gold500_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0700001","Endeavor Providence Gold 500","73836AK070",,"AKN002","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700001-01","Endeavor Providence Gold 500","Standard Gold On Exchange Plan",,"0.813083275924935","Yes","Yes","No","100%",,"$500","$40","$2,400","$300","$500","$1,100","$300","$60","$500","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Gold500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Gold500_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0700002","Endeavor Providence Gold 1000","73836AK070",,"AKN002","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700002-00","Endeavor Providence Gold 1000","Standard Gold Off Exchange Plan",,"0.802456117521072","Yes","Yes","No","100%",,"$1,000","$40","$2,300","$300","$1,000","$1,100","$200","$60","$1,000","$400","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Gold1000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Gold1000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0700002","Endeavor Providence Gold 1000","73836AK070",,"AKN002","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700002-01","Endeavor Providence Gold 1000","Standard Gold On Exchange Plan",,"0.802456117521072","Yes","Yes","No","100%",,"$1,000","$40","$2,300","$300","$1,000","$1,100","$200","$60","$1,000","$400","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Gold1000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Gold1000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0700003","Endeavor Providence Gold 1500","73836AK070",,"AKN002","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700003-00","Endeavor Providence Gold 1500","Standard Gold Off Exchange Plan",,"0.794060590932987","Yes","Yes","No","100%",,"$1,500","$40","$2,200","$300","$1,500","$1,100","$70","$60","$1,190","$400","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Gold1500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Gold1500_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0700003","Endeavor Providence Gold 1500","73836AK070",,"AKN002","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700003-01","Endeavor Providence Gold 1500","Standard Gold On Exchange Plan",,"0.794060590932987","Yes","Yes","No","100%",,"$1,500","$40","$2,200","$300","$1,500","$1,100","$70","$60","$1,190","$400","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Gold1500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Gold1500_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0700006","Endeavor Select Gold 500","73836AK070",,"AKN001","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700006-00","Endeavor Select Gold 500","Standard Gold Off Exchange Plan",,"0.813083275924935","Yes","Yes","No","100%",,"$500","$40","$2,400","$300","$500","$1,100","$300","$60","$500","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Gold500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Gold500_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0700006","Endeavor Select Gold 500","73836AK070",,"AKN001","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700006-01","Endeavor Select Gold 500","Standard Gold On Exchange Plan",,"0.813083275924935","Yes","Yes","No","100%",,"$500","$40","$2,400","$300","$500","$1,100","$300","$60","$500","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Gold500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Gold500_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0700007","Endeavor Select Gold 1000","73836AK070",,"AKN001","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700007-00","Endeavor Select Gold 1000","Standard Gold Off Exchange Plan",,"0.802456117521072","Yes","Yes","No","100%",,"$1,000","$40","$2,300","$300","$1,000","$1,100","$200","$60","$1,000","$400","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Gold1000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Gold1000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0700007","Endeavor Select Gold 1000","73836AK070",,"AKN001","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700007-01","Endeavor Select Gold 1000","Standard Gold On Exchange Plan",,"0.802456117521072","Yes","Yes","No","100%",,"$1,000","$40","$2,300","$300","$1,000","$1,100","$200","$60","$1,000","$400","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Gold1000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Gold1000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0700008","Endeavor Select Gold 1500","73836AK070",,"AKN001","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700008-00","Endeavor Select Gold 1500","Standard Gold Off Exchange Plan",,"0.794060590932987","Yes","Yes","No","100%",,"$1,500","$40","$2,200","$300","$1,500","$1,100","$70","$60","$1,190","$400","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Gold1500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Gold1500_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0700008","Endeavor Select Gold 1500","73836AK070",,"AKN001","AKS001","AKF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700008-01","Endeavor Select Gold 1500","Standard Gold On Exchange Plan",,"0.794060590932987","Yes","Yes","No","100%",,"$1,500","$40","$2,200","$300","$1,500","$1,100","$70","$60","$1,190","$400","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Gold1500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Gold1500_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710002","Endeavor Providence Silver 2000","73836AK071",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710002-00","Endeavor Providence Silver 2000","Standard Silver Off Exchange Plan",,"0.719996654103982","Yes","Yes","No","100%",,"$2,000","$40","$3,600","$300","$1,730","$1,900","$50","$60","$1,460","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver2000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver2000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710002","Endeavor Providence Silver 2000","73836AK071",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710002-01","Endeavor Providence Silver 2000","Standard Silver On Exchange Plan",,"0.719996654103982","Yes","Yes","No","100%",,"$2,000","$40","$3,600","$300","$1,730","$1,900","$50","$60","$1,460","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver2000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver2000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710004","Endeavor Providence Silver 4000","73836AK071",,"AKN002","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710004-01","Endeavor Providence Silver 4000","Standard Silver On Exchange Plan",,"0.700335102508777","Yes","Yes","No","100%",,"$4,000","$40","$2,900","$300","$1,730","$1,900","$50","$60","$1,460","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","35.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver4000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver4000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710006","Endeavor Select Silver 2000","73836AK071",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710006-00","Endeavor Select Silver 2000","Standard Silver Off Exchange Plan",,"0.719996654103982","Yes","Yes","No","100%",,"$2,000","$40","$3,600","$300","$1,730","$1,900","$50","$60","$1,460","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Silver2000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Silver2000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710006","Endeavor Select Silver 2000","73836AK071",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710006-01","Endeavor Select Silver 2000","Standard Silver On Exchange Plan",,"0.719996654103982","Yes","Yes","No","100%",,"$2,000","$40","$3,600","$300","$1,730","$1,900","$50","$60","$1,460","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Silver2000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Silver2000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710008","Endeavor Select Silver 4000","73836AK071",,"AKN001","AKS001","AKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710008-01","Endeavor Select Silver 4000","Standard Silver On Exchange Plan",,"0.700335102508777","Yes","Yes","No","100%",,"$4,000","$40","$2,900","$300","$1,730","$1,900","$50","$60","$1,460","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","35.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Silver4000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Silver4000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0810001","Endeavor Select Bronze 7350","73836AK081",,"AKN001","AKS001","AKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0810001-00","Endeavor Select Bronze 7350","Standard Bronze Off Exchange Plan",,"0.605988702838794","Yes","Yes","No","100%",,"$7,350","$0","$0","$300","$5,310","$800","$0","$60","$1,460","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Bronze7350_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Bronze7350_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0810001","Endeavor Select Bronze 7350","73836AK081",,"AKN001","AKS001","AKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0810001-01","Endeavor Select Bronze 7350","Standard Bronze On Exchange Plan",,"0.605988702838794","Yes","Yes","No","100%",,"$7,350","$0","$0","$300","$5,310","$800","$0","$60","$1,460","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Bronze7350_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Bronze7350_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0810002","Endeavor Providence Bronze 7350","73836AK081",,"AKN002","AKS001","AKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0810002-00","Endeavor Providence Bronze 7350","Standard Bronze Off Exchange Plan",,"0.605988702838794","Yes","Yes","No","100%",,"$7,350","$0","$0","$300","$5,310","$800","$0","$60","$1,460","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze7350_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze7350_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0810002","Endeavor Providence Bronze 7350","73836AK081",,"AKN002","AKS001","AKF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0810002-01","Endeavor Providence Bronze 7350","Standard Bronze On Exchange Plan",,"0.605988702838794","Yes","Yes","No","100%",,"$7,350","$0","$0","$300","$5,310","$800","$0","$60","$1,460","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze7350_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze7350_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0820001","Endeavor Select Bronze 4000","73836AK082",,"AKN001","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820001-00","Endeavor Select Bronze 4000","Standard Bronze Off Exchange Plan",,"0.605994164930765","Yes","Yes","No","100%",,"$4,000","$0","$3,400","$300","$4,000","$0","$1,300","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Bronze4000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Bronze4000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0820001","Endeavor Select Bronze 4000","73836AK082",,"AKN001","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820001-01","Endeavor Select Bronze 4000","Standard Bronze On Exchange Plan",,"0.605994164930765","Yes","Yes","No","100%",,"$4,000","$0","$3,400","$300","$4,000","$0","$1,300","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Bronze4000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Bronze4000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0820002","Endeavor Select Bronze 5000","73836AK082",,"AKN001","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820002-00","Endeavor Select Bronze 5000","Standard Bronze Off Exchange Plan",,"0.594096719929701","Yes","Yes","No","100%",,"$5,000","$0","$2,400","$300","$5,000","$0","$900","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Bronze5000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Bronze5000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0820002","Endeavor Select Bronze 5000","73836AK082",,"AKN001","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820002-01","Endeavor Select Bronze 5000","Standard Bronze On Exchange Plan",,"0.594096719929701","Yes","Yes","No","100%",,"$5,000","$0","$2,400","$300","$5,000","$0","$900","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Bronze5000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Bronze5000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0820003","Endeavor Providence Bronze 4000","73836AK082",,"AKN002","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820003-00","Endeavor Providence Bronze 4000","Standard Bronze Off Exchange Plan",,"0.605994164930765","Yes","Yes","No","100%",,"$4,000","$0","$3,400","$300","$4,000","$0","$1,300","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze4000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze4000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0820003","Endeavor Providence Bronze 4000","73836AK082",,"AKN002","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820003-01","Endeavor Providence Bronze 4000","Standard Bronze On Exchange Plan",,"0.605994164930765","Yes","Yes","No","100%",,"$4,000","$0","$3,400","$300","$4,000","$0","$1,300","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze4000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze4000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0820004","Endeavor Providence Bronze 5000","73836AK082",,"AKN002","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820004-00","Endeavor Providence Bronze 5000","Standard Bronze Off Exchange Plan",,"0.594096719929701","Yes","Yes","No","100%",,"$5,000","$0","$2,400","$300","$5,000","$0","$900","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze5000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze5000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0820004","Endeavor Providence Bronze 5000","73836AK082",,"AKN002","AKS001","AKF003","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820004-01","Endeavor Providence Bronze 5000","Standard Bronze On Exchange Plan",,"0.594096719929701","Yes","Yes","No","100%",,"$5,000","$0","$2,400","$300","$5,000","$0","$900","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze5000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze5000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0880001","Endeavor Select Silver HDHP 2000","73836AK088",,"AKN001","AKS001","AKF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880001-00","Endeavor Select Silver HDHP 2000","Standard Silver Off Exchange Plan",,"0.713552097848205","Yes","Yes","No","100%",,"$2,000","$0","$2,600","$300","$2,000","$0","$1,500","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","25.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Silver_HDHP_2000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Silver_HDHP_2000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0880001","Endeavor Select Silver HDHP 2000","73836AK088",,"AKN001","AKS001","AKF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880001-01","Endeavor Select Silver HDHP 2000","Standard Silver On Exchange Plan",,"0.713552097848205","Yes","Yes","No","100%",,"$2,000","$0","$2,600","$300","$2,000","$0","$1,500","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","25.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Silver_HDHP_2000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Silver_HDHP_2000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0880002","Endeavor Select Silver HDHP 2500","73836AK088",,"AKN001","AKS001","AKF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880002-00","Endeavor Select Silver HDHP 2500","Standard Silver Off Exchange Plan",,"0.697573394001666","Yes","Yes","No","100%",,"$2,500","$0","$2,500","$300","$2,500","$0","$1,300","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","25.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Silver_HDHP_2500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Silver_HDHP_2500_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0880002","Endeavor Select Silver HDHP 2500","73836AK088",,"AKN001","AKS001","AKF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880002-01","Endeavor Select Silver HDHP 2500","Standard Silver On Exchange Plan",,"0.697573394001666","Yes","Yes","No","100%",,"$2,500","$0","$2,500","$300","$2,500","$0","$1,300","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","25.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Silver_HDHP_2500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Silver_HDHP_2500_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0880003","Endeavor Providence Silver HDHP 2000","73836AK088",,"AKN002","AKS001","AKF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880003-00","Endeavor Providence Silver HDHP 2000","Standard Silver Off Exchange Plan",,"0.713552097848205","Yes","Yes","No","100%",,"$2,000","$0","$2,600","$300","$2,000","$0","$1,500","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","25.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver_HDHP_2000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver_HDHP_2000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0880003","Endeavor Providence Silver HDHP 2000","73836AK088",,"AKN002","AKS001","AKF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880003-01","Endeavor Providence Silver HDHP 2000","Standard Silver On Exchange Plan",,"0.713552097848205","Yes","Yes","No","100%",,"$2,000","$0","$2,600","$300","$2,000","$0","$1,500","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","25.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver_HDHP_2000_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver_HDHP_2000_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0880004","Endeavor Providence Silver HDHP 2500","73836AK088",,"AKN002","AKS001","AKF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880004-00","Endeavor Providence Silver HDHP 2500","Standard Silver Off Exchange Plan",,"0.697573394001666","Yes","Yes","No","100%",,"$2,500","$0","$2,500","$300","$2,500","$0","$1,300","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","25.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver_HDHP_2500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver_HDHP_2500_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0880004","Endeavor Providence Silver HDHP 2500","73836AK088",,"AKN002","AKS001","AKF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880004-01","Endeavor Providence Silver HDHP 2500","Standard Silver On Exchange Plan",,"0.697573394001666","Yes","Yes","No","100%",,"$2,500","$0","$2,500","$300","$2,500","$0","$1,300","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","25.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver_HDHP_2500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver_HDHP_2500_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710017","Endeavor Providence Bronze HDHP 3300","73836AK071",,"AKN002","AKS001","AKF007","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710017-00","Endeavor Providence Bronze HDHP 3300","Standard Bronze Off Exchange Plan",,"0.628286730114264","Yes","Yes","No","100%",,"$3,300","$0","$3,300","$300","$3,300","$0","$1,800","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","per person not applicable","$6600 per group","50.00%",,,,,"$9,900","per person not applicable","$19800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze_HDHP_3300_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze_HDHP_3300_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710017","Endeavor Providence Bronze HDHP 3300","73836AK071",,"AKN002","AKS001","AKF007","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710017-01","Endeavor Providence Bronze HDHP 3300","Standard Bronze On Exchange Plan",,"0.628286730114264","Yes","Yes","No","100%",,"$3,300","$0","$3,300","$300","$3,300","$0","$1,800","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","per person not applicable","$6600 per group","50.00%",,,,,"$9,900","per person not applicable","$19800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze_HDHP_3300_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze_HDHP_3300_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710018","Endeavor Select Bronze HDHP 3300","73836AK071",,"AKN001","AKS001","AKF007","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710018-00","Endeavor Select Bronze HDHP 3300","Standard Bronze Off Exchange Plan",,"0.628286730114264","Yes","Yes","No","100%",,"$3,300","$0","$3,300","$300","$3,300","$0","$1,800","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","per person not applicable","$6600 per group","50.00%",,,,,"$9,900","per person not applicable","$19800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Bronze_HDHP_3300_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Bronze_HDHP_3300_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710018","Endeavor Select Bronze HDHP 3300","73836AK071",,"AKN001","AKS001","AKF007","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710018-01","Endeavor Select Bronze HDHP 3300","Standard Bronze On Exchange Plan",,"0.628286730114264","Yes","Yes","No","100%",,"$3,300","$0","$3,300","$300","$3,300","$0","$1,800","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","per person not applicable","$6600 per group","50.00%",,,,,"$9,900","per person not applicable","$19800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Bronze_HDHP_3300_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Bronze_HDHP_3300_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710016","Endeavor Select Bronze 5500","73836AK071",,"AKN001","AKS001","AKF005","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710016-00","Endeavor Select Bronze 5500","Standard Bronze Off Exchange Plan",,"0.629149712590622","Yes","Yes","No","100%",,"$5,500","$0","$1,900","$300","$5,310","$400","$300","$60","$1,460","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Bronze5500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Bronze5500_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710016","Endeavor Select Bronze 5500","73836AK071",,"AKN001","AKS001","AKF005","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710016-01","Endeavor Select Bronze 5500","Standard Bronze On Exchange Plan",,"0.629149712590622","Yes","Yes","No","100%",,"$5,500","$0","$1,900","$300","$5,310","$400","$300","$60","$1,460","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Bronze5500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Bronze5500_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710015","Endeavor Providence Bronze 5500","73836AK071",,"AKN002","AKS001","AKF005","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710015-00","Endeavor Providence Bronze 5500","Standard Bronze Off Exchange Plan",,"0.629149712590622","Yes","Yes","No","100%",,"$5,500","$0","$1,900","$300","$5,310","$400","$300","$60","$1,460","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze5500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze5500_SG_2018_AK.pdf"
"2018","AK","73836","HIOS","2017-09-02 02:21:27","SHOP (Small Group)","No","93-0989307","73836AK0710015","Endeavor Providence Bronze 5500","73836AK071",,"AKN002","AKS001","AKF005","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710015-01","Endeavor Providence Bronze 5500","Standard Bronze On Exchange Plan",,"0.629149712590622","Yes","Yes","No","100%",,"$5,500","$0","$1,900","$300","$5,310","$400","$300","$60","$1,460","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze5500_SBC_SG_2018_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze5500_SG_2018_AK.pdf"
"2018","AK","74819","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","74819AK0010007","BESTDental Premium","74819AK001",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010007-00","BESTDental Premium","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AK","74819","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","74819AK0020003","BESTOne Advantage Gold","74819AK002",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ak/current/AK_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","AK","74819","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","74819AK0020003","BESTOne Advantage Gold","74819AK002",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ak/current/AK_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","AK","74819","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","74819AK0010007","BESTDental Premium","74819AK001",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010007-01","BESTDental Premium","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AK","74819","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","74819AK0010008","BESTDental Standard - H","74819AK001",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AK","74819","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","74819AK0020004","BESTOne Plus Gold","74819AK002",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ak/current/AK_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","AK","74819","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","74819AK0020004","BESTOne Plus Gold","74819AK002",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ak/current/AK_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","AK","74819","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","74819AK0010008","BESTDental Standard - H","74819AK001",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AK","74819","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","74819AK0010010","BESTDental Choice - H","74819AK001",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AK","74819","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","74819AK0010010","BESTDental Choice - H","74819AK001",,"AKN001","AKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AK","74819","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","74819AK0010009","BESTDental Standard - L","74819AK001",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AK","74819","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","74819AK0020005","BESTOne Plus Silver","74819AK002",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ak/current/AK_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","AK","74819","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","74819AK0020005","BESTOne Plus Silver","74819AK002",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ak/current/AK_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","AK","74819","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","74819AK0010009","BESTDental Standard - L","74819AK001",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AK","74819","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","74819AK0010011","BESTDental Choice - L","74819AK001",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AK","74819","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","74819AK0020006","BESTOne Basic Silver","74819AK002",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ak/current/AK_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","AK","74819","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","74819AK0020006","BESTOne Basic Silver","74819AK002",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ak/current/AK_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","AK","74819","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","74819AK0010011","BESTDental Choice - L","74819AK001",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AK","74819","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","74819AK0010012","BESTDental Value","74819AK001",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AK","74819","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","74819AK0010012","BESTDental Value","74819AK001",,"AKN001","AKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AL","12538","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","12538AL0020003","BESTOne Advantage Gold","12538AL002",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AL/current/AL_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","AL","12538","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","12538AL0010007","BESTDental Premium","12538AL001",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010007-00","BESTDental Premium","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/CURRENT/AL_BESTDental_Premium_Plan.pdf"
"2018","AL","12538","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","12538AL0010007","BESTDental Premium","12538AL001",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010007-01","BESTDental Premium","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/CURRENT/AL_BESTDental_Premium_Plan.pdf"
"2018","AL","12538","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","12538AL0020003","BESTOne Advantage Gold","12538AL002",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AL/current/AL_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","AL","12538","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","12538AL0020004","BESTOne Plus Gold","12538AL002",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AL/current/AL_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","AL","12538","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","12538AL0010008","BESTDental Standard - H","12538AL001",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/CURRENT/AL_BESTDental_Standard-H_Plan.pdf"
"2018","AL","12538","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","12538AL0010008","BESTDental Standard - H","12538AL001",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/CURRENT/AL_BESTDental_Standard-H_Plan.pdf"
"2018","AL","12538","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","12538AL0020004","BESTOne Plus Gold","12538AL002",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AL/current/AL_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","AL","12538","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","12538AL0010010","BESTDental Choice - H","12538AL001",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/CURRENT/AL_BESTDental_Choice-H_Plan.pdf"
"2018","AL","12538","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","12538AL0010010","BESTDental Choice - H","12538AL001",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/CURRENT/AL_BESTDental_Choice-H_Plan.pdf"
"2018","AL","12538","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","12538AL0010009","BESTDental Standard - L","12538AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Plus-Silver_Plan.pdf","","12538AL0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/CURRENT/AL_BESTDental_Standard-L_Plan.pdf"
"2018","AL","12538","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","12538AL0020005","BESTOne Plus Silver","12538AL002",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Plus-Silver_Plan.pdf","","12538AL0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AL/current/AL_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","AL","12538","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","12538AL0020005","BESTOne Plus Silver","12538AL002",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Plus-Silver_Plan.pdf","","12538AL0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AL/current/AL_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","AL","12538","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","12538AL0010009","BESTDental Standard - L","12538AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Plus-Silver_Plan.pdf","","12538AL0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/CURRENT/AL_BESTDental_Standard-L_Plan.pdf"
"2018","AL","12538","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","12538AL0010011","BESTDental Choice - L","12538AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Basic-Silver_Plan.pdf","","12538AL0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/CURRENT/AL_BESTDental_Choice-L_Plan.pdf"
"2018","AL","12538","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","12538AL0020006","BESTOne Basic Silver","12538AL002",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Basic-Silver_Plan.pdf","","12538AL0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AL/current/AL_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","AL","12538","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","12538AL0020006","BESTOne Basic Silver","12538AL002",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Basic-Silver_Plan.pdf","","12538AL0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AL/current/AL_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","AL","12538","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","12538AL0010011","BESTDental Choice - L","12538AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Basic-Silver_Plan.pdf","","12538AL0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/CURRENT/AL_BESTDental_Choice-L_Plan.pdf"
"2018","AL","12538","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","12538AL0010012","BESTDental Value","12538AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Basic-Silver_Plan.pdf","","12538AL0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/CURRENT/AL_BESTDental_Value_Plan.pdf"
"2018","AL","12538","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","12538AL0010012","BESTDental Value","12538AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Basic-Silver_Plan.pdf","","12538AL0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/al/CURRENT/AL_BESTDental_Value_Plan.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0370001","Blue Value Gold","46944AL037","7346243505","ALN001","ALS001","ALF005","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0370001-01","Blue Value Gold","Standard Gold On Exchange Plan","76.91%",,"No","Yes","Yes","95%","5%","$750","$600","$0","$60","$20","$800","$0","$400","$750","$100","$40","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018vgi.pdf","https://www.alabamablue.com/bb/2018vgi.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0370001","Blue Value Gold","46944AL037","7346243505","ALN001","ALS001","ALF005","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0370001-02","Blue Value Gold","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","95%","5%","$0","$0","$0","$60","$0","$0","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018vgi-nocost.pdf","https://www.alabamablue.com/bb/2018vgi-nocost.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0370001","Blue Value Gold","46944AL037","7346243505","ALN001","ALS001","ALF005","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0370001-03","Blue Value Gold","Limited Cost Sharing Plan Variation","76.91%",,"No","Yes","Yes","95%","5%","$750","$600","$0","$60","$20","$800","$0","$400","$750","$100","$40","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018vgi-limited.pdf","https://www.alabamablue.com/bb/2018vgi-limited.pdf"
"2018","AL","44580","HIOS","2017-08-08 02:20:26","Individual","Yes","39-1263473","44580AL0380002","Humana Dental Smart Choice - High","44580AL038",,"ALN001","ALS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9861","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","44580AL0380002-01","Humana Dental Smart Choice - High","Standard High On Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110224"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","SHOP (Small Group)","No","63-0103830","46944AL0340001","Blue Access Gold for Business","46944AL034","7346243505","ALN001","ALS001","ALF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9998",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_2.0.pdf","46944AL0340001-00","Blue Access Gold for Business","Standard Gold Off Exchange Plan","78.56%",,"No","Yes","Yes","95%","5%","$600","$500","$0","$60","$20","$700","$0","$400","$600","$100","$60","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20.00%","$600","$600 per person","$1200 per group","20.00%","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AlabamaBlue.com/b2018BlueAccessGold","https://www.AlabamaBlue.com/b2018BlueAccessGold"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0650001","Blue Cross Select Gold","46944AL065","7346243505","ALN001","ALS001","ALF201","New","PPO","Gold","Not Applicable","Yes","Both","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0650001-02","Blue Cross Select Gold","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","95%","5%","$0","$0","$0","$60","$0","$0","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018csg-nocost.pdf","https://www.alabamablue.com/bb/2018csg-nocost.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0650001","Blue Cross Select Gold","46944AL065","7346243505","ALN001","ALS001","ALF201","New","PPO","Gold","Not Applicable","Yes","Both","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0650001-03","Blue Cross Select Gold","Limited Cost Sharing Plan Variation","76.79%",,"No","Yes","Yes","95%","5%","$850","$600","$0","$60","$20","$700","$0","$400","$850","$100","$40","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","20.00%","$850","$850 per person","$1700 per group","20.00%","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018csg-limited.pdf","https://www.alabamablue.com/bb/2018csg-limited.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0660001","Blue Cross Select Silver","46944AL066","7346243505","ALN001","ALS001","ALF202","New","PPO","Silver","Not Applicable","Yes","Both","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0660001-00","Blue Cross Select Silver","Standard Silver Off Exchange Plan","70.18%",,"No","Yes","Yes","95%","5%","$2,600","$40","$1,800","$60","$20","$1,100","$0","$400","$1,300","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018css.pdf","https://www.alabamablue.com/bb/2018css.pdf"
"2018","AL","18756","HIOS","2017-05-25 02:20:18","SHOP (Small Group)","Yes","13-5581829","18756AL0140001","EHB Basic Dental Plan (Low)","18756AL014",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","18756AL0140001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AL","44580","HIOS","2017-08-08 02:20:26","Individual","Yes","39-1263473","44580AL0380001","Humana Dental Smart Choice - Low","44580AL038",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9877","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","44580AL0380001-01","Humana Dental Smart Choice - Low","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110237"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0370001","Blue Value Gold","46944AL037","7346243505","ALN001","ALS001","ALF005","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0370001-00","Blue Value Gold","Standard Gold Off Exchange Plan","76.91%",,"No","Yes","Yes","95%","5%","$750","$600","$0","$60","$20","$800","$0","$400","$750","$100","$40","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018vgi.pdf","https://www.alabamablue.com/bb/2018vgi.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","SHOP (Small Group)","No","63-0103830","46944AL0280001","Blue Choice Platinum for Business","46944AL028","7346243505","ALN001","ALS001","ALF002","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9986",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_2.0.pdf","46944AL0280001-00","Blue Choice Platinum for Business","Standard Platinum Off Exchange Plan","87.79%",,"No","Yes","No","100%",,"$0","$300","$0","$60","$20","$700","$0","$400","$100","$80","$200","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20.00%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AlabamaBlue.com/b2018BlueChoicePlatinum","https://www.AlabamaBlue.com/b2018BlueChoicePlatinum"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","Yes","63-0103830","46944AL0500001","Dental Blue Plus","46944AL050","7346243505","ALN002","ALS002",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Benefits are paid toward the lesser of the allowed amount or the dentist's actual charge for the service.","No","https://sso.bcbsal.org/sp/ACS.saml2","","46944AL0500001-01","Dental Blue Plus","Standard Low On Exchange Plan","69.34%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.AlabamaBlue.com/bb/2018dbp.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","SHOP (Small Group)","No","63-0103830","46944AL0280001","Blue Choice Platinum for Business","46944AL028","7346243505","ALN001","ALS001","ALF002","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9986",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_2.0.pdf","46944AL0280001-01","Blue Choice Platinum for Business","Standard Platinum On Exchange Plan","87.79%",,"No","Yes","No","100%",,"$0","$300","$0","$60","$20","$700","$0","$400","$100","$80","$200","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20.00%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AlabamaBlue.com/b2018BlueChoicePlatinum","https://www.AlabamaBlue.com/b2018BlueChoicePlatinum"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","SHOP (Small Group)","No","63-0103830","46944AL0340001","Blue Access Gold for Business","46944AL034","7346243505","ALN001","ALS001","ALF004","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9998",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_2.0.pdf","46944AL0340001-01","Blue Access Gold for Business","Standard Gold On Exchange Plan","78.56%",,"No","Yes","Yes","95%","5%","$600","$500","$0","$60","$20","$700","$0","$400","$600","$100","$60","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20.00%","$600","$600 per person","$1200 per group","20.00%","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AlabamaBlue.com/b2018BlueAccessGold","https://www.AlabamaBlue.com/b2018BlueAccessGold"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","SHOP (Small Group)","No","63-0103830","46944AL0310001","Blue HSA Gold for Business","46944AL031","7346243505","ALN001","ALS001","ALF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9998",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_2.0.pdf","46944AL0310001-00","Blue HSA Gold for Business","Standard Gold Off Exchange Plan",,"0.787435849256909","Yes","Yes","No","100%",,"$1,600","$0","$1,100","$60","$1,600","$0","$500","$400","$1,600","$0","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$3200 per person","$3200 per group","10.00%",,,,,"$1,600","$3200 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AlabamaBlue.com/b2018BlueHSAGold","https://www.AlabamaBlue.com/b2018BlueHSAGold"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0410001-00","Blue Value Silver","Standard Silver Off Exchange Plan","71.79%",,"No","Yes","Yes","95%","5%","$2,600","$40","$1,800","$60","$20","$1,100","$0","$400","$1,300","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","20.00%","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018vsi.pdf","https://www.alabamablue.com/bb/2018vsi.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0410001-01","Blue Value Silver","Standard Silver On Exchange Plan","71.79%",,"No","Yes","Yes","95%","5%","$2,600","$40","$1,800","$60","$20","$1,100","$0","$400","$1,300","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","20.00%","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018vsi.pdf","https://www.alabamablue.com/bb/2018vsi.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","SHOP (Small Group)","No","63-0103830","46944AL0310001","Blue HSA Gold for Business","46944AL031","7346243505","ALN001","ALS001","ALF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9998",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_2.0.pdf","46944AL0310001-01","Blue HSA Gold for Business","Standard Gold On Exchange Plan",,"0.787435849256909","Yes","Yes","No","100%",,"$1,600","$0","$1,100","$60","$1,600","$0","$500","$400","$1,600","$0","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$3200 per person","$3200 per group","10.00%",,,,,"$1,600","$3200 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AlabamaBlue.com/b2018BlueHSAGold","https://www.AlabamaBlue.com/b2018BlueHSAGold"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0410001-02","Blue Value Silver","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","95%","5%","$0","$0","$0","$60","$0","$0","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018vsi-nocost.pdf","https://www.alabamablue.com/bb/2018vsi-nocost.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0410001-03","Blue Value Silver","Limited Cost Sharing Plan Variation","71.79%",,"No","Yes","Yes","95%","5%","$2,600","$40","$1,800","$60","$20","$1,100","$0","$400","$1,300","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","20.00%","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018vsi-limited.pdf","https://www.alabamablue.com/bb/2018vsi-limited.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0410001-04","Blue Value Silver","73% AV Level Silver Plan","73.79%",,"No","Yes","Yes","95%","5%","$1,950","$40","$1,800","$60","$20","$1,100","$0","$400","$1,300","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,950","$1950 per person","$3900 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","20.00%","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018vsi-73.pdf","https://www.alabamablue.com/bb/2018vsi-73.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0410001-05","Blue Value Silver","87% AV Level Silver Plan","87.80%",,"No","Yes","Yes","95%","5%","$400","$0","$1,100","$60","$20","$800","$0","$400","$400","$100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","20.00%","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018vsi-87.pdf","https://www.alabamablue.com/bb/2018vsi-87.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0410001-06","Blue Value Silver","94% AV Level Silver Plan","94.74%",,"No","Yes","Yes","95%","5%","$100","$0","$500","$60","$20","$400","$0","$400","$100","$50","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","$550","$550 per person","$1100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","10.00%","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018vsi-94.pdf","https://www.alabamablue.com/bb/2018vsi-94.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","SHOP (Small Group)","No","63-0103830","46944AL0380001","Blue Secure Silver for Business","46944AL038","7346243505","ALN001","ALS001","ALF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9998",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0380001-00","Blue Secure Silver for Business","Standard Silver Off Exchange Plan","71.81%",,"No","Yes","Yes","95%","5%","$2,600","$800","$0","$60","$20","$1,000","$0","$400","$1,300","$200","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20.00%","$2,600","$2600 per person","$5200 per group","20.00%","$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AlabamaBlue.com/b2018BlueSecureSilver","https://www.AlabamaBlue.com/b2018BlueSecureSilver"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","SHOP (Small Group)","No","63-0103830","46944AL0380001","Blue Secure Silver for Business","46944AL038","7346243505","ALN001","ALS001","ALF008","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9998",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0380001-01","Blue Secure Silver for Business","Standard Silver On Exchange Plan","71.81%",,"No","Yes","Yes","95%","5%","$2,600","$800","$0","$60","$20","$1,000","$0","$400","$1,300","$200","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20.00%","$2,600","$2600 per person","$5200 per group","20.00%","$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AlabamaBlue.com/b2018BlueSecureSilver","https://www.AlabamaBlue.com/b2018BlueSecureSilver"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","SHOP (Small Group)","No","63-0103830","46944AL0430001","Blue Saver Bronze for Business","46944AL043","7346243505","ALN001","ALS001","ALF010","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9998",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0430001-00","Blue Saver Bronze for Business","Standard Bronze Off Exchange Plan","61.07%",,"Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$600","$1,000","$0","$400","$1,400","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.AlabamaBlue.com/b2018BlueSaverBronze","https://www.AlabamaBlue.com/b2018BlueSaverBronze"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0560001","Blue HSA Bronze","46944AL056","7346243505","ALN001","ALS001","ALF015","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0560001-00","Blue HSA Bronze","Standard Bronze Off Exchange Plan",,"0.607614102297021","Yes","Yes","No","100%",,"$6,450","$0","$0","$60","$6,450","$0","$0","$400","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0.00%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.alabamablue.com/sb/2018hbi.pdf","https://www.alabamablue.com/bb/2018hbi.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0560001","Blue HSA Bronze","46944AL056","7346243505","ALN001","ALS001","ALF015","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0560001-01","Blue HSA Bronze","Standard Bronze On Exchange Plan",,"0.607614102297021","Yes","Yes","No","100%",,"$6,450","$0","$0","$60","$6,450","$0","$0","$400","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0.00%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.alabamablue.com/sb/2018hbi.pdf","https://www.alabamablue.com/bb/2018hbi.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","SHOP (Small Group)","No","63-0103830","46944AL0430001","Blue Saver Bronze for Business","46944AL043","7346243505","ALN001","ALS001","ALF010","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9998",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0430001-01","Blue Saver Bronze for Business","Standard Bronze On Exchange Plan","61.07%",,"Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$600","$1,000","$0","$400","$1,400","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.AlabamaBlue.com/b2018BlueSaverBronze","https://www.AlabamaBlue.com/b2018BlueSaverBronze"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0560001","Blue HSA Bronze","46944AL056","7346243505","ALN001","ALS001","ALF015","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0560001-02","Blue HSA Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.alabamablue.com/sb/2018hbi-nocost.pdf","https://www.alabamablue.com/bb/2018hbi-nocost.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0560001","Blue HSA Bronze","46944AL056","7346243505","ALN001","ALS001","ALF015","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0560001-03","Blue HSA Bronze","Limited Cost Sharing Plan Variation",,"0.607614102297021","Yes","Yes","No","100%",,"$6,450","$0","$0","$60","$6,450","$0","$0","$400","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0.00%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.alabamablue.com/sb/2018hbi-limited.pdf","https://www.alabamablue.com/bb/2018hbi-limited.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0460001","Blue Saver Bronze","46944AL046","7346243505","ALN001","ALS001","ALF011","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0460001-00","Blue Saver Bronze","Standard Bronze Off Exchange Plan","61.08%",,"Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$600","$1,100","$0","$400","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.alabamablue.com/sb/2018sbi.pdf","https://www.alabamablue.com/bb/2018sbi.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","SHOP (Small Group)","No","63-0103830","46944AL0570001","Blue HSA Bronze for Business","46944AL057","7346243505","ALN001","ALS001","ALF016","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9998",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0570001-00","Blue HSA Bronze for Business","Standard Bronze Off Exchange Plan",,"0.607614102297021","Yes","Yes","No","100%",,"$6,450","$0","$0","$0","$6,450","$0","$0","$400","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0.00%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AlabamaBlue.com/b2018BlueHSABronze","https://www.AlabamaBlue.com/b2018BlueHSABronze"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","SHOP (Small Group)","No","63-0103830","46944AL0570001","Blue HSA Bronze for Business","46944AL057","7346243505","ALN001","ALS001","ALF016","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9998",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0570001-01","Blue HSA Bronze for Business","Standard Bronze On Exchange Plan",,"0.607614102297021","Yes","Yes","No","100%",,"$6,450","$0","$0","$0","$6,450","$0","$0","$400","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0.00%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AlabamaBlue.com/b2018BlueHSABronze","https://www.AlabamaBlue.com/b2018BlueHSABronze"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0460001","Blue Saver Bronze","46944AL046","7346243505","ALN001","ALS001","ALF011","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0460001-01","Blue Saver Bronze","Standard Bronze On Exchange Plan","61.08%",,"Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$600","$1,100","$0","$400","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.alabamablue.com/sb/2018sbi.pdf","https://www.alabamablue.com/bb/2018sbi.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0460001","Blue Saver Bronze","46944AL046","7346243505","ALN001","ALS001","ALF011","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0460001-02","Blue Saver Bronze","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.alabamablue.com/sb/2018sbi-nocost.pdf","https://www.alabamablue.com/bb/2018sbi-nocost.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0460001","Blue Saver Bronze","46944AL046","7346243505","ALN001","ALS001","ALF011","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0460001-03","Blue Saver Bronze","Limited Cost Sharing Plan Variation","61.08%",,"Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$600","$1,100","$0","$400","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.alabamablue.com/sb/2018sbi-limited.pdf","https://www.alabamablue.com/bb/2018sbi-limited.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0470001","Blue Protect","46944AL047","7346243505","ALN001","ALS001","ALF012","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0470001-00","Blue Protect","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$0","$0","$400","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.alabamablue.com/sb/2018bpi.pdf","https://www.alabamablue.com/bb/2018bpi.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0470001","Blue Protect","46944AL047","7346243505","ALN001","ALS001","ALF012","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0470001-01","Blue Protect","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$0","$0","$400","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.alabamablue.com/sb/2018bpi.pdf","https://www.alabamablue.com/bb/2018bpi.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0650001","Blue Cross Select Gold","46944AL065","7346243505","ALN001","ALS001","ALF201","New","PPO","Gold","Not Applicable","Yes","Both","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0650001-00","Blue Cross Select Gold","Standard Gold Off Exchange Plan","76.79%",,"No","Yes","Yes","95%","5%","$850","$600","$0","$60","$20","$700","$0","$400","$850","$100","$40","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","20.00%","$850","$850 per person","$1700 per group","20.00%","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018csg.pdf","https://www.alabamablue.com/bb/2018csg.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0650001","Blue Cross Select Gold","46944AL065","7346243505","ALN001","ALS001","ALF201","New","PPO","Gold","Not Applicable","Yes","Both","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0650001-01","Blue Cross Select Gold","Standard Gold On Exchange Plan","76.79%",,"No","Yes","Yes","95%","5%","$850","$600","$0","$60","$20","$700","$0","$400","$850","$100","$40","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","20.00%","$850","$850 per person","$1700 per group","20.00%","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018csg.pdf","https://www.alabamablue.com/bb/2018csg.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0660001","Blue Cross Select Silver","46944AL066","7346243505","ALN001","ALS001","ALF202","New","PPO","Silver","Not Applicable","Yes","Both","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0660001-01","Blue Cross Select Silver","Standard Silver On Exchange Plan","70.18%",,"No","Yes","Yes","95%","5%","$2,600","$40","$1,800","$60","$20","$1,100","$0","$400","$1,300","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018css.pdf","https://www.alabamablue.com/bb/2018css.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020004","Catastrophic","73301AL002",,"ALN001","ALS001","ALF006","New","EPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020004-01","Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,393","$350","$0","$163","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020004_01_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALCatastrophicCOC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020005","Silver HSA","73301AL002",,"ALN001","ALS001","ALF007","New","EPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020005-01","Silver HSA","Standard Silver On Exchange Plan","66.30%",,"Yes","Yes","No","100%",,"$4,000","$80","$1,890","$60","$4,000","$620","$976","$55","$1,636","$0","$289","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020005_01_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALSilverHSACOC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020005","Silver HSA","73301AL002",,"ALN001","ALS001","ALF007","New","EPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020005-02","Silver HSA","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020005_02_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALZeroCostShareCOC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020005","Silver HSA","73301AL002",,"ALN001","ALS001","ALF007","New","EPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020005-03","Silver HSA","Limited Cost Sharing Plan Variation","66.30%",,"Yes","Yes","No","100%",,"$4,000","$80","$1,890","$60","$4,000","$620","$976","$55","$1,636","$0","$289","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020005_03_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALSilverHSACOC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020005","Silver HSA","73301AL002",,"ALN001","ALS001","ALF007","New","EPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020005-04","Silver HSA","73% AV Level Silver Plan","72.10%",,"Yes","Yes","No","100%",,"$2,700","$10","$1,890","$60","$2,700","$465","$976","$55","$1,636","$0","$289","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020005_04_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALSilverHSA73COC.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0660001","Blue Cross Select Silver","46944AL066","7346243505","ALN001","ALS001","ALF202","New","PPO","Silver","Not Applicable","Yes","Both","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0660001-02","Blue Cross Select Silver","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","95%","5%","$0","$0","$0","$60","$0","$0","$0","$400","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018css-nocost.pdf","https://www.alabamablue.com/bb/2018css-nocost.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0660001","Blue Cross Select Silver","46944AL066","7346243505","ALN001","ALS001","ALF202","New","PPO","Silver","Not Applicable","Yes","Both","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0660001-03","Blue Cross Select Silver","Limited Cost Sharing Plan Variation","70.18%",,"No","Yes","Yes","95%","5%","$2,600","$40","$1,800","$60","$20","$1,100","$0","$400","$1,300","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018css-limited.pdf","https://www.alabamablue.com/bb/2018css-limited.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0660001","Blue Cross Select Silver","46944AL066","7346243505","ALN001","ALS001","ALF202","New","PPO","Silver","Not Applicable","Yes","Both","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0660001-04","Blue Cross Select Silver","73% AV Level Silver Plan","73.88%",,"No","Yes","Yes","95%","5%","$2,000","$30","$1,800","$60","$20","$700","$0","$400","$1,300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018css-73.pdf","https://www.alabamablue.com/bb/2018css-73.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0660001","Blue Cross Select Silver","46944AL066","7346243505","ALN001","ALS001","ALF202","New","PPO","Silver","Not Applicable","Yes","Both","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0660001-05","Blue Cross Select Silver","87% AV Level Silver Plan","87.59%",,"No","Yes","Yes","95%","5%","$450","$0","$1,200","$60","$20","$500","$0","$400","$450","$100","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018css-87.pdf","https://www.alabamablue.com/bb/2018css-87.pdf"
"2018","AL","46944","HIOS","2017-09-22 02:20:26","Individual","No","63-0103830","46944AL0660001","Blue Cross Select Silver","46944AL066","7346243505","ALN001","ALS001","ALF202","New","PPO","Silver","Not Applicable","Yes","Both","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf","46944AL0660001-06","Blue Cross Select Silver","94% AV Level Silver Plan","94.50%",,"No","Yes","Yes","95%","5%","$100","$0","$500","$60","$20","$400","$0","$400","$100","$70","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","10.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.alabamablue.com/sb/2018css-94.pdf","https://www.alabamablue.com/bb/2018css-94.pdf"
"2018","AL","60075","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","60075AL0030001","TruAssure Dental Small Group Basic Plan","60075AL003",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","60075AL0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AL","60075","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","60075AL0010001","TruAssure Basic Adult or Child Dental Plan","60075AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","60075AL0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","68.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AL","https://www.truassure.com/brochure?state=AL"
"2018","AL","60075","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","60075AL0010001","TruAssure Basic Adult or Child Dental Plan","60075AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","60075AL0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","68.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AL","https://www.truassure.com/brochure?state=AL"
"2018","AL","60075","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","60075AL0040001","TruAssure Dental Small Group Preferred Plan","60075AL004",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","60075AL0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AL","60075","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","60075AL0020001","TruAssure Preferred Adult or Child Dental Plan","60075AL002",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","60075AL0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AL","https://www.truassure.com/brochure?state=AL"
"2018","AL","60075","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","60075AL0020001","TruAssure Preferred Adult or Child Dental Plan","60075AL002",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","60075AL0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AL","https://www.truassure.com/brochure?state=AL"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020001","Gold","73301AL002",,"ALN001","ALS001","ALF001","New","EPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020001-01","Gold","Standard Gold On Exchange Plan","76.10%",,"Yes","Yes","No","100%",,"$3,000","$80","$2,480","$60","$1,489","$1,200","$372","$55","$1,305","$135","$326","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020001_01_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALGoldCOC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020001","Gold","73301AL002",,"ALN001","ALS001","ALF001","New","EPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020001-02","Gold","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020001_02_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALZeroCostShareCOC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020001","Gold","73301AL002",,"ALN001","ALS001","ALF001","New","EPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020001-03","Gold","Limited Cost Sharing Plan Variation","76.10%",,"Yes","Yes","No","100%",,"$3,000","$80","$2,480","$60","$1,489","$1,200","$372","$55","$1,305","$135","$326","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020001_03_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALGoldCOC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020002","Silver","73301AL002",,"ALN001","ALS001","ALF002","New","EPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020002-01","Silver","Standard Silver On Exchange Plan","66.60%",,"Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$1,117","$2,545","$745","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020002_01_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALSilverCOC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020002","Silver","73301AL002",,"ALN001","ALS001","ALF002","New","EPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020002-02","Silver","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020002_02_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALZeroCostShareCOC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020002","Silver","73301AL002",,"ALN001","ALS001","ALF002","New","EPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020002-03","Silver","Limited Cost Sharing Plan Variation","66.60%",,"Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$1,117","$2,545","$745","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020002_03_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALSilverCOC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020002","Silver","73301AL002",,"ALN001","ALS001","ALF002","New","EPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020002-04","Silver","73% AV Level Silver Plan","72.00%",,"Yes","Yes","No","100%",,"$2,064","$0","$3,786","$60","$1,117","$2,025","$745","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020002_04_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALSilver73COC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020002","Silver","73301AL002",,"ALN001","ALS001","ALF002","New","EPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020002-05","Silver","87% AV Level Silver Plan","86.40%",,"Yes","Yes","No","100%",,"$950","$0","$1,240","$60","$950","$1,314","$186","$55","$950","$120","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020002_05_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALSilver87COC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020002","Silver","73301AL002",,"ALN001","ALS001","ALF002","New","EPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020002-06","Silver","94% AV Level Silver Plan","93.50%",,"Yes","Yes","No","100%",,"$0","$30","$1,240","$60","$0","$550","$186","$55","$0","$45","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020002_06_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALSilver94COC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020003","Bronze","73301AL002",,"ALN001","ALS001","ALF005","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020003-00","Bronze","Standard Bronze Off Exchange Plan","61.60%",,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$5,941","$1,055","$0","$163","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020003_00_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALBronzeCOC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020003","Bronze","73301AL002",,"ALN001","ALS001","ALF005","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020003-01","Bronze","Standard Bronze On Exchange Plan","61.60%",,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$5,941","$1,055","$0","$163","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020003_01_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALBronzeCOC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020003","Bronze","73301AL002",,"ALN001","ALS001","ALF005","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020003-02","Bronze","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020003_02_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALZeroCostShareCOC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020003","Bronze","73301AL002",,"ALN001","ALS001","ALF005","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020003-03","Bronze","Limited Cost Sharing Plan Variation","61.60%",,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$5,941","$1,055","$0","$163","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020003_03_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALBronzeCOC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020004","Catastrophic","73301AL002",,"ALN001","ALS001","ALF006","New","EPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020004-00","Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,393","$350","$0","$163","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020004_00_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALCatastrophicCOC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020005","Silver HSA","73301AL002",,"ALN001","ALS001","ALF007","New","EPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020005-05","Silver HSA","87% AV Level Silver Plan","86.40%",,"Yes","Yes","No","100%",,"$750","$60","$1,260","$60","$750","$465","$651","$55","$750","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020005_05_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALSilverHSA87COC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020005","Silver HSA","73301AL002",,"ALN001","ALS001","ALF007","New","EPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020005-06","Silver HSA","94% AV Level Silver Plan","94.00%",,"Yes","Yes","No","100%",,"$0","$0","$1,250","$60","$0","$465","$651","$55","$0","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020005_06_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALSilverHSA94COC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020006","Bronze HSA","73301AL002",,"ALN001","ALS001","ALF006","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020006-00","Bronze HSA","Standard Bronze Off Exchange Plan","61.00%",,"Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020006_00_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALBronzeHSACOC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020006","Bronze HSA","73301AL002",,"ALN001","ALS001","ALF006","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020006-01","Bronze HSA","Standard Bronze On Exchange Plan","61.00%",,"Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020006_01_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALBronzeHSACOC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020006","Bronze HSA","73301AL002",,"ALN001","ALS001","ALF006","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020006-02","Bronze HSA","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020006_02_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALZeroCostShareCOC.pdf"
"2018","AL","73301","HIOS","2017-11-01 02:20:20","Individual","No","32-0509107","73301AL0020006","Bronze HSA","73301AL002",,"ALN001","ALS001","ALF006","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01",,"Yes","Emergency coverage only","Yes","Emergency coverage only","No","https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs","https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf","73301AL0020006-03","Bronze HSA","Limited Cost Sharing Plan Variation","61.00%",,"Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020006_03_20170731.pdf","https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALBronzeHSACOC.pdf"
"2018","AL","82285","HIOS","2017-08-12 02:21:25","SHOP (Small Group)","Yes","94-2761537","82285AL0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","82285AL002",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82285AL0020002-00","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/al/82285al0020002-18"
"2018","AL","82285","HIOS","2017-08-12 02:21:25","Individual","Yes","94-2761537","82285AL0010002","Delta Dental PPO Pediatric Preferred Plan","82285AL001",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82285AL0010002-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/al/82285al0010002-18"
"2018","AL","82285","HIOS","2017-08-12 02:21:25","Individual","Yes","94-2761537","82285AL0010001","Delta Dental PPO Pediatric Basic Plan","82285AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82285AL0010001-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/al/82285al0010001-18"
"2018","AL","82285","HIOS","2017-08-12 02:21:25","SHOP (Small Group)","Yes","94-2761537","82285AL0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","82285AL002",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","82285AL0020001-00","Delta Dental PPO Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/al/82285al0020001-18"
"2018","AL","82285","HIOS","2017-08-12 02:21:25","Individual","Yes","94-2761537","82285AL0010006","Delta Dental PPO Basic Plan for Families","82285AL001",,"ALN001","ALS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","82285AL0010006-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/al/82285al0010006-18"
"2018","AL","82285","HIOS","2017-08-12 02:21:25","Individual","Yes","94-2761537","82285AL0010004","Delta Dental PPO Preferred Plan for Families","82285AL001",,"ALN001","ALS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","82285AL0010004-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/al/82285al0010004-18"
"2018","AZ","12303","HIOS","2017-08-10 02:20:26","Individual","Yes","59-0397210","12303AZ0010001","DentaQuest PPO  Pediatric High","12303AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","12303AZ0010001-00","DentaQuest PPO  Pediatric High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/"
"2018","AZ","12303","HIOS","2017-08-10 02:20:26","Individual","Yes","59-0397210","12303AZ0010001","DentaQuest PPO  Pediatric High","12303AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","12303AZ0010001-01","DentaQuest PPO  Pediatric High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/"
"2018","AZ","12303","HIOS","2017-08-10 02:20:26","Individual","Yes","59-0397210","12303AZ0010003","DentaQuest PPO Family High","12303AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","12303AZ0010003-00","DentaQuest PPO Family High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/"
"2018","AZ","12303","HIOS","2017-08-10 02:20:26","Individual","Yes","59-0397210","12303AZ0010003","DentaQuest PPO Family High","12303AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","12303AZ0010003-01","DentaQuest PPO Family High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/"
"2018","AZ","12303","HIOS","2017-08-10 02:20:26","Individual","Yes","59-0397210","12303AZ0010004","DentaQuest PPO Family Low","12303AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","12303AZ0010004-00","DentaQuest PPO Family Low","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/"
"2018","AZ","12303","HIOS","2017-08-10 02:20:26","Individual","Yes","59-0397210","12303AZ0010004","DentaQuest PPO Family Low","12303AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","12303AZ0010004-01","DentaQuest PPO Family Low","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/"
"2018","AZ","17100","HIOS","2017-06-03 02:07:36","SHOP (Small Group)","Yes","13-5581829","17100AZ0160001","EHB Basic Dental Plan (Low)","17100AZ016",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","17100AZ0160001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AZ","17454","HIOS","2017-05-18 02:20:21","SHOP (Small Group)","Yes","13-5123390","17454AZ0010003","Guardian Pediatric Advantage","17454AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","17454AZ0010003-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AZ","17454","HIOS","2017-05-18 02:20:21","SHOP (Small Group)","Yes","13-5123390","17454AZ0020003","Guardian Pediatric Essentials","17454AZ002",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","17454AZ0020003-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AZ","24106","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","24106AZ0010001","TruAssure Basic Adult or Child Dental Plan","24106AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","24106AZ0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$120","$120 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AZ","https://www.truassure.com/brochure?state=AZ"
"2018","AZ","24106","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","24106AZ0030001","TruAssure Dental Small Group Basic Plan","24106AZ003",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","24106AZ0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AZ","24106","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","24106AZ0040001","TruAssure Dental Small Group Preferred Plan","24106AZ004",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","24106AZ0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AZ","24106","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","24106AZ0010001","TruAssure Basic Adult or Child Dental Plan","24106AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","24106AZ0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$120","$120 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AZ","https://www.truassure.com/brochure?state=AZ"
"2018","AZ","24106","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","24106AZ0020001","TruAssure Preferred Adult or Child Dental Plan","24106AZ002",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","24106AZ0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AZ","https://www.truassure.com/brochure?state=AZ"
"2018","AZ","24106","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","24106AZ0020001","TruAssure Preferred Adult or Child Dental Plan","24106AZ002",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","24106AZ0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AZ","https://www.truassure.com/brochure?state=AZ"
"2018","AZ","30045","HIOS","2017-08-16 02:20:33","Individual","Yes","86-0274899","30045AZ0010021","Delta Dental Essential - Family or Child Only","30045AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"For a full list of exclusions, please see the summary of benefits",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","In a foreign country and need emergency dental treatment?  You are covered with Delta Dental wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0010021-00","Delta Dental Essential - Family or Child Only","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalaz.com/Individual_Essential_2018.pdf","http://www.deltadentalaz.com/Individual_Essential_2018.pdf"
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420006","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420006-03","EverydayHealth HMO 1500 - Neighborhood Network","Limited Cost Sharing Plan Variation","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420011","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420011-01","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver On Exchange Plan","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420020","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420020-03","EverydayHealth HMO 6500 - Neighborhood Network","Limited Cost Sharing Plan Variation","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420021","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420021-00","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze Off Exchange Plan","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420021","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420021-01","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze On Exchange Plan","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500Neighborhood",
"2018","AZ","30045","HIOS","2017-08-16 02:20:33","SHOP (Small Group)","Yes","86-0274899","30045AZ0020021","Delta Dental Essential - Family or Child Only","30045AZ002",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"For a full list of exclusions, please see the summary of benefits",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","In a foreign country and need emergency dental treatment?  You are covered with Delta Dental wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0020021-00","Delta Dental Essential - Family or Child Only","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalaz.com/SHOP","https://www.deltadentalaz.com/SHOP"
"2018","AZ","30045","HIOS","2017-08-16 02:20:33","SHOP (Small Group)","Yes","86-0274899","30045AZ0020021","Delta Dental Essential - Family or Child Only","30045AZ002",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"For a full list of exclusions, please see the summary of benefits",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","In a foreign country and need emergency dental treatment?  You are covered with Delta Dental wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0020021-01","Delta Dental Essential - Family or Child Only","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalaz.com/SHOP","https://www.deltadentalaz.com/SHOP"
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420011","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420011-00","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver Off Exchange Plan","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood",
"2018","AZ","30045","HIOS","2017-08-16 02:20:33","Individual","Yes","86-0274899","30045AZ0010021","Delta Dental Essential - Family or Child Only","30045AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"For a full list of exclusions, please see the summary of benefits",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","In a foreign country and need emergency dental treatment?  You are covered with Delta Dental wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0010021-01","Delta Dental Essential - Family or Child Only","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalaz.com/Individual_Essential_2018.pdf","http://www.deltadentalaz.com/Individual_Essential_2018.pdf"
"2018","AZ","30045","HIOS","2017-08-16 02:20:33","Individual","Yes","86-0274899","30045AZ0010032","Delta Dental Select PPO - Family or Child Only","30045AZ001",,"AZN002","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"For a full list of exclusions, please see the summary of benefits",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","In a foreign country and need emergency dental treatment?  You are covered with Delta Dental wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0010032-00","Delta Dental Select PPO - Family or Child Only","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalaz.com/Individual_Select_PPO_2018.pdf","http://www.deltadentalaz.com/Individual_Select_PPO_2018.pdf"
"2018","AZ","30045","HIOS","2017-08-16 02:20:33","SHOP (Small Group)","Yes","86-0274899","30045AZ0020032","Delta Dental Select PPO - Family or Child Only","30045AZ002",,"AZN002","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"For a full list of exclusions, please see the summary of benefits",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","In a foreign country and need emergency dental treatment?  You are covered with Delta Dental wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0020032-00","Delta Dental Select PPO - Family or Child Only","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalaz.com/SHOP","https://www.deltadentalaz.com/SHOP"
"2018","AZ","30045","HIOS","2017-08-16 02:20:33","SHOP (Small Group)","Yes","86-0274899","30045AZ0020032","Delta Dental Select PPO - Family or Child Only","30045AZ002",,"AZN002","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"For a full list of exclusions, please see the summary of benefits",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","In a foreign country and need emergency dental treatment?  You are covered with Delta Dental wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0020032-01","Delta Dental Select PPO - Family or Child Only","Standard High On Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalaz.com/SHOP","https://www.deltadentalaz.com/SHOP"
"2018","AZ","30045","HIOS","2017-08-16 02:20:33","Individual","Yes","86-0274899","30045AZ0010032","Delta Dental Select PPO - Family or Child Only","30045AZ001",,"AZN002","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"For a full list of exclusions, please see the summary of benefits",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","In a foreign country and need emergency dental treatment?  You are covered with Delta Dental wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0010032-01","Delta Dental Select PPO - Family or Child Only","Standard High On Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalaz.com/Individual_Select_PPO_2018.pdf","http://www.deltadentalaz.com/Individual_Select_PPO_2018.pdf"
"2018","AZ","30045","HIOS","2017-08-16 02:20:33","SHOP (Small Group)","Yes","86-0274899","30045AZ0020030","Delta Dental Child Only PPO Plan","30045AZ002",,"AZN002","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"For a full list of exclusions, please see Summary of Benefits & Coverage.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","In a foreign country and need emergency dental treatment?  You are covered with Delta Dental wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0020030-00","Delta Dental Child Only PPO Plan","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalaz.com/SHOP","https://www.deltadentalaz.com/SHOP"
"2018","AZ","33851","HIOS","2017-05-20 02:20:32","Individual","Yes","91-1857813","33851AZ0110007","Guardian Choice","33851AZ011",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes",,"","33851AZ0110007-00","Guardian Choice","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/arizona/","https://dentalexchange.guardianlife.com/our-plans/arizona/"
"2018","AZ","33851","HIOS","2017-05-20 02:20:32","Individual","Yes","91-1857813","33851AZ0110007","Guardian Choice","33851AZ011",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes",,"","33851AZ0110007-01","Guardian Choice","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/arizona/","https://dentalexchange.guardianlife.com/our-plans/arizona/"
"2018","AZ","53613","HIOS","2017-06-09 02:20:26","Individual","Yes","20-4023720","53613AZ0010001","EMI Health Choice PPO (High)","53613AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9651","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","53613AZ0010001-01","EMI Health Choice PPO (High)","Standard High On Exchange Plan","86.44%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$15","$15 per person","$45 per group",,"$15","$15 per person","$45 per group",,"$15","$15 per person","$45 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/az-federal-marketplace-dental.aspx"
"2018","AZ","53613","HIOS","2017-06-09 02:20:26","Individual","Yes","20-4023720","53613AZ0010002","EMI Health Choice PPO (Low)","53613AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9576","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","53613AZ0010002-01","EMI Health Choice PPO (Low)","Standard Low On Exchange Plan","70.71%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,"$100","$100 per person","$300 per group",,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/az-federal-marketplace-dental.aspx"
"2018","AZ","53613","HIOS","2017-06-09 02:20:26","Individual","Yes","20-4023720","53613AZ0010003","EMI Health Advantage Co-Pay","53613AZ001",,"AZN002","AZS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9572","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","53613AZ0010003-01","EMI Health Advantage Co-Pay","Standard Low On Exchange Plan","68.32%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/az-federal-marketplace-dental.aspx"
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420001","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420001-00","EverydayHealth HMO 1500 - Neighborhood Network","Standard Gold Off Exchange Plan","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420001","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420001-01","EverydayHealth HMO 1500 - Neighborhood Network","Standard Gold On Exchange Plan","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420001","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420001-02","EverydayHealth HMO 1500 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420001","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420001-03","EverydayHealth HMO 1500 - Neighborhood Network","Limited Cost Sharing Plan Variation","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420002","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420002-00","EverydayHealth HMO 1500 - Neighborhood Network","Standard Gold Off Exchange Plan","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420002","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420002-01","EverydayHealth HMO 1500 - Neighborhood Network","Standard Gold On Exchange Plan","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420002","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420002-02","EverydayHealth HMO 1500 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420002","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF001","New","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420002-03","EverydayHealth HMO 1500 - Neighborhood Network","Limited Cost Sharing Plan Variation","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420003","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420003-00","EverydayHealth HMO 1500 - Neighborhood Network","Standard Gold Off Exchange Plan","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420003","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420003-01","EverydayHealth HMO 1500 - Neighborhood Network","Standard Gold On Exchange Plan","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420003","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420003-02","EverydayHealth HMO 1500 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420003","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420003-03","EverydayHealth HMO 1500 - Neighborhood Network","Limited Cost Sharing Plan Variation","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420004","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420004-00","EverydayHealth HMO 1500 - Neighborhood Network","Standard Gold Off Exchange Plan","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420004","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420004-01","EverydayHealth HMO 1500 - Neighborhood Network","Standard Gold On Exchange Plan","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420004","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420004-02","EverydayHealth HMO 1500 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420004","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420004-03","EverydayHealth HMO 1500 - Neighborhood Network","Limited Cost Sharing Plan Variation","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420005","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420005-00","EverydayHealth HMO 1500 - Neighborhood Network","Standard Gold Off Exchange Plan","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420005","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420005-01","EverydayHealth HMO 1500 - Neighborhood Network","Standard Gold On Exchange Plan","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420005","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420005-02","EverydayHealth HMO 1500 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420005","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420005-03","EverydayHealth HMO 1500 - Neighborhood Network","Limited Cost Sharing Plan Variation","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420006","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420006-00","EverydayHealth HMO 1500 - Neighborhood Network","Standard Gold Off Exchange Plan","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420006","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420006-01","EverydayHealth HMO 1500 - Neighborhood Network","Standard Gold On Exchange Plan","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420006","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420006-02","EverydayHealth HMO 1500 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420007","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420007-00","EverydayHealth HMO 1500 - Neighborhood Network","Standard Gold Off Exchange Plan","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420007","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420007-01","EverydayHealth HMO 1500 - Neighborhood Network","Standard Gold On Exchange Plan","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420007","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420007-02","EverydayHealth HMO 1500 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420007","EverydayHealth HMO 1500 - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF001","Existing","HMO","Gold","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420007-03","EverydayHealth HMO 1500 - Neighborhood Network","Limited Cost Sharing Plan Variation","78.41%",,"No","Yes","No","100%",,"$1,500","$90","$1,700","$60","$360","$870","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth1500NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420008","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420008-00","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver Off Exchange Plan","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420008","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420008-01","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver On Exchange Plan","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420008","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420008-02","EverydayHealth HMO 4000 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420008","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420008-03","EverydayHealth HMO 4000 - Neighborhood Network","Limited Cost Sharing Plan Variation","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420008","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420008-04","EverydayHealth HMO 4000 73AV - Neighborhood Network","73% AV Level Silver Plan","73.93%",,"No","Yes","No","100%",,"$3,150","$110","$1,370","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,150","$3150 per person","$6300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood73",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420008","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420008-05","EverydayHealth HMO 4000 87AV - Neighborhood Network","87% AV Level Silver Plan","86.31%",,"No","Yes","No","100%",,"$1,000","$60","$900","$60","$310","$800","$0","$60","$970","$40","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood87",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420008","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420008-06","EverydayHealth HMO 4000 94AV - Neighborhood Network","94% AV Level Silver Plan","93.21%",,"No","Yes","No","100%",,"$50","$40","$1,000","$60","$50","$410","$10","$60","$50","$30","$150","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood94",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420009","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420009-00","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver Off Exchange Plan","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420009","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420009-01","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver On Exchange Plan","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420009","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420009-02","EverydayHealth HMO 4000 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420009","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420009-03","EverydayHealth HMO 4000 - Neighborhood Network","Limited Cost Sharing Plan Variation","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420009","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420009-04","EverydayHealth HMO 4000 73AV - Neighborhood Network","73% AV Level Silver Plan","73.93%",,"No","Yes","No","100%",,"$3,150","$110","$1,370","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,150","$3150 per person","$6300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood73",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420009","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420009-05","EverydayHealth HMO 4000 87AV - Neighborhood Network","87% AV Level Silver Plan","86.31%",,"No","Yes","No","100%",,"$1,000","$60","$900","$60","$310","$800","$0","$60","$970","$40","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood87",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420009","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF002","New","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420009-06","EverydayHealth HMO 4000 94AV - Neighborhood Network","94% AV Level Silver Plan","93.21%",,"No","Yes","No","100%",,"$50","$40","$1,000","$60","$50","$410","$10","$60","$50","$30","$150","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood94",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420010","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420010-00","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver Off Exchange Plan","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420010","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420010-01","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver On Exchange Plan","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420010","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420010-02","EverydayHealth HMO 4000 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420010","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420010-03","EverydayHealth HMO 4000 - Neighborhood Network","Limited Cost Sharing Plan Variation","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420010","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420010-04","EverydayHealth HMO 4000 73AV - Neighborhood Network","73% AV Level Silver Plan","73.93%",,"No","Yes","No","100%",,"$3,150","$110","$1,370","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,150","$3150 per person","$6300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood73",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420010","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420010-05","EverydayHealth HMO 4000 87AV - Neighborhood Network","87% AV Level Silver Plan","86.31%",,"No","Yes","No","100%",,"$1,000","$60","$900","$60","$310","$800","$0","$60","$970","$40","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood87",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420010","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420010-06","EverydayHealth HMO 4000 94AV - Neighborhood Network","94% AV Level Silver Plan","93.21%",,"No","Yes","No","100%",,"$50","$40","$1,000","$60","$50","$410","$10","$60","$50","$30","$150","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood94",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420011","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420011-02","EverydayHealth HMO 4000 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420011","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420011-03","EverydayHealth HMO 4000 - Neighborhood Network","Limited Cost Sharing Plan Variation","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420011","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420011-04","EverydayHealth HMO 4000 73AV - Neighborhood Network","73% AV Level Silver Plan","73.93%",,"No","Yes","No","100%",,"$3,150","$110","$1,370","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,150","$3150 per person","$6300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood73",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420011","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420011-05","EverydayHealth HMO 4000 87AV - Neighborhood Network","87% AV Level Silver Plan","86.31%",,"No","Yes","No","100%",,"$1,000","$60","$900","$60","$310","$800","$0","$60","$970","$40","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood87",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420011","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420011-06","EverydayHealth HMO 4000 94AV - Neighborhood Network","94% AV Level Silver Plan","93.21%",,"No","Yes","No","100%",,"$50","$40","$1,000","$60","$50","$410","$10","$60","$50","$30","$150","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood94",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420012","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420012-00","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver Off Exchange Plan","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood",
"2018","AZ","86830","HIOS","2017-06-21 02:20:35","Individual","Yes","59-1031071","86830AZ0050001","Cigna Dental Pediatric","86830AZ005","7730182962","AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Services","Yes","All Services","Yes",,"","86830AZ0050001-00","Cigna Dental Pediatric","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2018/sob/cigna-dental-pediatric-fedvip"
"2018","AZ","86830","HIOS","2017-06-21 02:20:35","Individual","Yes","59-1031071","86830AZ0050001","Cigna Dental Pediatric","86830AZ005","7730182962","AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Services","Yes","All Services","Yes",,"","86830AZ0050001-01","Cigna Dental Pediatric","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2018/sob/cigna-dental-pediatric-fedvip"
"2018","AZ","86830","HIOS","2017-06-21 02:20:35","Individual","Yes","59-1031071","86830AZ0050002","Cigna Dental Family + Pediatric","86830AZ005","7730182962","AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Services","Yes","All Services","Yes",,"","86830AZ0050002-01","Cigna Dental Family + Pediatric","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2018/sob/cigna-dental-family-pediatric-fedvip"
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420012","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420012-01","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver On Exchange Plan","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420012","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420012-02","EverydayHealth HMO 4000 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420012","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420012-03","EverydayHealth HMO 4000 - Neighborhood Network","Limited Cost Sharing Plan Variation","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420012","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420012-04","EverydayHealth HMO 4000 73AV - Neighborhood Network","73% AV Level Silver Plan","73.93%",,"No","Yes","No","100%",,"$3,150","$110","$1,370","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,150","$3150 per person","$6300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood73",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420012","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420012-05","EverydayHealth HMO 4000 87AV - Neighborhood Network","87% AV Level Silver Plan","86.31%",,"No","Yes","No","100%",,"$1,000","$60","$900","$60","$310","$800","$0","$60","$970","$40","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood87",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420012","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420012-06","EverydayHealth HMO 4000 94AV - Neighborhood Network","94% AV Level Silver Plan","93.21%",,"No","Yes","No","100%",,"$50","$40","$1,000","$60","$50","$410","$10","$60","$50","$30","$150","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood94",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420013","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420013-00","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver Off Exchange Plan","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420013","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420013-01","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver On Exchange Plan","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420013","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420013-02","EverydayHealth HMO 4000 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420013","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420013-03","EverydayHealth HMO 4000 - Neighborhood Network","Limited Cost Sharing Plan Variation","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420013","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420013-04","EverydayHealth HMO 4000 73AV - Neighborhood Network","73% AV Level Silver Plan","73.93%",,"No","Yes","No","100%",,"$3,150","$110","$1,370","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,150","$3150 per person","$6300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood73",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420013","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420013-05","EverydayHealth HMO 4000 87AV - Neighborhood Network","87% AV Level Silver Plan","86.31%",,"No","Yes","No","100%",,"$1,000","$60","$900","$60","$310","$800","$0","$60","$970","$40","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood87",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420013","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420013-06","EverydayHealth HMO 4000 94AV - Neighborhood Network","94% AV Level Silver Plan","93.21%",,"No","Yes","No","100%",,"$50","$40","$1,000","$60","$50","$410","$10","$60","$50","$30","$150","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood94",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420014","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420014-00","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver Off Exchange Plan","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420014","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420014-01","EverydayHealth HMO 4000 - Neighborhood Network","Standard Silver On Exchange Plan","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420014","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420014-02","EverydayHealth HMO 4000 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420014","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420014-03","EverydayHealth HMO 4000 - Neighborhood Network","Limited Cost Sharing Plan Variation","71.46%",,"No","Yes","No","100%",,"$4,000","$110","$1,200","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420014","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420014-04","EverydayHealth HMO 4000 73AV - Neighborhood Network","73% AV Level Silver Plan","73.93%",,"No","Yes","No","100%",,"$3,150","$110","$1,370","$60","$360","$1,170","$0","$60","$970","$80","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,150","$3150 per person","$6300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood73",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420014","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420014-05","EverydayHealth HMO 4000 87AV - Neighborhood Network","87% AV Level Silver Plan","86.31%",,"No","Yes","No","100%",,"$1,000","$60","$900","$60","$310","$800","$0","$60","$970","$40","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood87",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420014","EverydayHealth HMO 4000 - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420014-06","EverydayHealth HMO 4000 94AV - Neighborhood Network","94% AV Level Silver Plan","93.21%",,"No","Yes","No","100%",,"$50","$40","$1,000","$60","$50","$410","$10","$60","$50","$30","$150","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth4000Neighborhood94",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420015","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF003","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420015-00","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze Off Exchange Plan","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420015","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF003","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420015-01","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze On Exchange Plan","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420015","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF003","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420015-02","EverydayHealth HMO 6500 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420015","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF003","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420015-03","EverydayHealth HMO 6500 - Neighborhood Network","Limited Cost Sharing Plan Variation","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420016","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF003","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420016-00","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze Off Exchange Plan","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420016","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF003","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420016-01","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze On Exchange Plan","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420016","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF003","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420016-02","EverydayHealth HMO 6500 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420016","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF003","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420016-03","EverydayHealth HMO 6500 - Neighborhood Network","Limited Cost Sharing Plan Variation","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420017","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420017-00","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze Off Exchange Plan","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420017","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420017-01","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze On Exchange Plan","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420017","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420017-02","EverydayHealth HMO 6500 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420017","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420017-03","EverydayHealth HMO 6500 - Neighborhood Network","Limited Cost Sharing Plan Variation","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420018","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420018-00","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze Off Exchange Plan","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420018","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420018-01","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze On Exchange Plan","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420018","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420018-02","EverydayHealth HMO 6500 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420018","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420018-03","EverydayHealth HMO 6500 - Neighborhood Network","Limited Cost Sharing Plan Variation","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420019","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420019-00","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze Off Exchange Plan","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420019","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420019-01","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze On Exchange Plan","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420019","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420019-02","EverydayHealth HMO 6500 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420019","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420019-03","EverydayHealth HMO 6500 - Neighborhood Network","Limited Cost Sharing Plan Variation","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420020","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420020-00","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze Off Exchange Plan","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420020","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420020-01","EverydayHealth HMO 6500 - Neighborhood Network","Standard Bronze On Exchange Plan","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420020","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420020-02","EverydayHealth HMO 6500 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420021","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420021-02","EverydayHealth HMO 6500 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420021","EverydayHealth HMO 6500 - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1420021-03","EverydayHealth HMO 6500 - Neighborhood Network","Limited Cost Sharing Plan Variation","64.29%",,"No","Yes","No","100%",,"$6,500","$200","$350","$60","$360","$2,140","$0","$60","$970","$170","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2018plans/EverydayHealth6500NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420028","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420028-00","Portfolio HSA HMO 6650 - Neighborhood Network","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2018plans/Portfolio6650Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420028","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420028-01","Portfolio HSA HMO 6650 - Neighborhood Network","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2018plans/Portfolio6650Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420028","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420028-02","Portfolio HMO 6650 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.azblue.com/2018plans/Portfolio6650NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420028","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420028-03","Portfolio HMO 6650 - Neighborhood Network","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/Portfolio6650NeighborhoodLtd",
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","Individual","Yes","95-6042390","77352AZ0020005","BESTOne Plus Silver","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/az/2017/AZ_BESTOne_Dental_Plus-Silver_Plan.pdf","","77352AZ0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","77352AZ0010009","BESTDental Standard - L","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTDental_Standard-L_Plan.pdf"
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","77352AZ0010011","BESTDental Choice - L","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTDental_Choice-L_Plan.pdf"
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","Individual","Yes","95-6042390","77352AZ0020006","BESTOne Basic Silver","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/az/2017/AZ_BESTOne_Dental_Basic-Silver_Plan.pdf","","77352AZ0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","Individual","Yes","95-6042390","77352AZ0020006","BESTOne Basic Silver","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/az/2017/AZ_BESTOne_Dental_Basic-Silver_Plan.pdf","","77352AZ0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","77352AZ0010011","BESTDental Choice - L","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTDental_Choice-L_Plan.pdf"
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420022","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420022-00","Portfolio HSA HMO 6650 - Neighborhood Network","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2018plans/Portfolio6650Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420022","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420022-01","Portfolio HSA HMO 6650 - Neighborhood Network","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2018plans/Portfolio6650Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420022","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420022-02","Portfolio HMO 6650 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.azblue.com/2018plans/Portfolio6650NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420022","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420022-03","Portfolio HMO 6650 - Neighborhood Network","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/Portfolio6650NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420023","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420023-00","Portfolio HSA HMO 6650 - Neighborhood Network","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2018plans/Portfolio6650Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420023","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420023-01","Portfolio HSA HMO 6650 - Neighborhood Network","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2018plans/Portfolio6650Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420023","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420023-02","Portfolio HMO 6650 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.azblue.com/2018plans/Portfolio6650NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420023","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420023-03","Portfolio HMO 6650 - Neighborhood Network","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/Portfolio6650NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420024","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420024-00","Portfolio HSA HMO 6650 - Neighborhood Network","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2018plans/Portfolio6650Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420024","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420024-01","Portfolio HSA HMO 6650 - Neighborhood Network","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2018plans/Portfolio6650Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420024","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420024-02","Portfolio HMO 6650 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.azblue.com/2018plans/Portfolio6650NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420024","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420024-03","Portfolio HMO 6650 - Neighborhood Network","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/Portfolio6650NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420025","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420025-00","Portfolio HSA HMO 6650 - Neighborhood Network","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2018plans/Portfolio6650Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420025","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420025-01","Portfolio HSA HMO 6650 - Neighborhood Network","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2018plans/Portfolio6650Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420025","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420025-02","Portfolio HMO 6650 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.azblue.com/2018plans/Portfolio6650NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420025","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420025-03","Portfolio HMO 6650 - Neighborhood Network","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/Portfolio6650NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420026","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420026-00","Portfolio HSA HMO 6650 - Neighborhood Network","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2018plans/Portfolio6650Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420026","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420026-01","Portfolio HSA HMO 6650 - Neighborhood Network","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2018plans/Portfolio6650Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420026","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420026-02","Portfolio HMO 6650 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.azblue.com/2018plans/Portfolio6650NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420026","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420026-03","Portfolio HMO 6650 - Neighborhood Network","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/Portfolio6650NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420027","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420027-00","Portfolio HSA HMO 6650 - Neighborhood Network","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2018plans/Portfolio6650Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420027","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420027-01","Portfolio HSA HMO 6650 - Neighborhood Network","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2018plans/Portfolio6650Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420027","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420027-02","Portfolio HMO 6650 ZCS - Neighborhood Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.azblue.com/2018plans/Portfolio6650NeighborhoodZero",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420027","Portfolio HSA HMO 6650 - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420027-03","Portfolio HMO 6650 - Neighborhood Network","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/Portfolio6650NeighborhoodLtd",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420029","SimpleHealth HMO - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF004","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420029-00","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,900","$60","$0","$60","$1,740","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/SimpleHealth7350Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420029","SimpleHealth HMO - Neighborhood Network","53901AZ142",,"AZN002","AZS001","AZF004","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420029-01","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,900","$60","$0","$60","$1,740","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/SimpleHealth7350Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420030","SimpleHealth HMO - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF004","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420030-00","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,900","$60","$0","$60","$1,740","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/SimpleHealth7350Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420030","SimpleHealth HMO - Neighborhood Network","53901AZ142",,"AZN002","AZS002","AZF004","New","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420030-01","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,900","$60","$0","$60","$1,740","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/SimpleHealth7350Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420031","SimpleHealth HMO - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF004","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420031-00","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,900","$60","$0","$60","$1,740","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/SimpleHealth7350Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420031","SimpleHealth HMO - Neighborhood Network","53901AZ142",,"AZN002","AZS003","AZF004","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420031-01","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,900","$60","$0","$60","$1,740","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/SimpleHealth7350Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420032","SimpleHealth HMO - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF004","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420032-00","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,900","$60","$0","$60","$1,740","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/SimpleHealth7350Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420032","SimpleHealth HMO - Neighborhood Network","53901AZ142",,"AZN002","AZS004","AZF004","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420032-01","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,900","$60","$0","$60","$1,740","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/SimpleHealth7350Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420033","SimpleHealth HMO - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF004","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420033-00","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,900","$60","$0","$60","$1,740","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/SimpleHealth7350Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420033","SimpleHealth HMO - Neighborhood Network","53901AZ142",,"AZN002","AZS005","AZF004","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420033-01","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,900","$60","$0","$60","$1,740","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/SimpleHealth7350Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420034","SimpleHealth HMO - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF004","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420034-00","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,900","$60","$0","$60","$1,740","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/SimpleHealth7350Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420034","SimpleHealth HMO - Neighborhood Network","53901AZ142",,"AZN002","AZS006","AZF004","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420034-01","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,900","$60","$0","$60","$1,740","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/SimpleHealth7350Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420035","SimpleHealth HMO - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF004","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420035-00","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,900","$60","$0","$60","$1,740","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/SimpleHealth7350Neighborhood",
"2018","AZ","53901","HIOS","2017-09-06 02:20:26","Individual","No","86-0004538","53901AZ1420035","SimpleHealth HMO - Neighborhood Network","53901AZ142",,"AZN002","AZS007","AZF004","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.","Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1420035-01","SimpleHealth HMO - Neighborhood Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,900","$60","$0","$60","$1,740","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2018plans/SimpleHealth7350Neighborhood",
"2018","AZ","58292","HIOS","2017-08-12 02:21:25","Individual","Yes","75-1233841","58292AZ0010001","Dentegra Dental PPO Pediatric Basic Plan","58292AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","58292AZ0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/az/58292az0010001-18"
"2018","AZ","58292","HIOS","2017-08-12 02:21:25","Individual","Yes","75-1233841","58292AZ0010008","Dentegra Dental PPO Family Preferred Plan","58292AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","58292AZ0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","$45 per person","per group not applicable",,,,,,"$45","$45 per person","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/az/58292az0010008-18"
"2018","AZ","58292","HIOS","2017-08-12 02:21:25","Individual","Yes","75-1233841","58292AZ0010007","Dentegra Dental PPO Family Basic Plan","58292AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","58292AZ0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/az/58292az0010007-18"
"2018","AZ","59748","HIOS","2017-05-17 02:20:17","SHOP (Small Group)","Yes","44-0308260","59748AZ0010001","KCL EHB Low PPO","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010001-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AZ","59748","HIOS","2017-05-17 02:20:17","SHOP (Small Group)","Yes","44-0308260","59748AZ0010003","KCL EHB Low MAC","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010003-00","KCL EHB Low MAC","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AZ","59748","HIOS","2017-05-17 02:20:17","SHOP (Small Group)","Yes","44-0308260","59748AZ0010005","KCL Fam Low PPO","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010005-00","KCL Fam Low PPO","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AZ","59748","HIOS","2017-05-17 02:20:17","SHOP (Small Group)","Yes","44-0308260","59748AZ0010007","KCL Fam Low MAC","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010007-00","KCL Fam Low MAC","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AZ","59748","HIOS","2017-05-17 02:20:17","SHOP (Small Group)","Yes","44-0308260","59748AZ0010002","KCL EHB High PPO","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010002-00","KCL EHB High PPO","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AZ","59748","HIOS","2017-05-17 02:20:17","SHOP (Small Group)","Yes","44-0308260","59748AZ0010004","KCL EHB High MAC","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010004-00","KCL EHB High MAC","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AZ","59748","HIOS","2017-05-17 02:20:17","SHOP (Small Group)","Yes","44-0308260","59748AZ0010006","KCL Fam High PPO","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010006-00","KCL Fam High PPO","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AZ","59748","HIOS","2017-05-17 02:20:17","SHOP (Small Group)","Yes","44-0308260","59748AZ0010008","KCL Fam High MAC","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010008-00","KCL Fam High MAC","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AZ","66105","HIOS","2017-08-08 02:20:26","Individual","Yes","39-1263473","66105AZ0620002","Humana Dental Smart Choice","66105AZ062",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9873","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","66105AZ0620002-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","68.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110250"
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","Individual","Yes","95-6042390","77352AZ0020003","BESTOne Advantage Gold","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","77352AZ0010007","BESTDental Premium","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010007-00","BESTDental Premium","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTDental_Premium_Plan.pdf"
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","77352AZ0010007","BESTDental Premium","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010007-01","BESTDental Premium","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTDental_Premium_Plan.pdf"
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","Individual","Yes","95-6042390","77352AZ0020003","BESTOne Advantage Gold","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","Individual","Yes","95-6042390","77352AZ0020004","BESTOne Plus Gold","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","77352AZ0010008","BESTDental Standard - H","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTDental_Standard-H_Plan.pdf"
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","77352AZ0010008","BESTDental Standard - H","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTDental_Standard-H_Plan.pdf"
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","Individual","Yes","95-6042390","77352AZ0020004","BESTOne Plus Gold","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","77352AZ0010010","BESTDental Choice - H","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTDental_Choice-H_Plan.pdf"
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","77352AZ0010010","BESTDental Choice - H","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTDental_Choice-H_Plan.pdf"
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","77352AZ0010009","BESTDental Standard - L","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTDental_Standard-L_Plan.pdf"
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","Individual","Yes","95-6042390","77352AZ0020005","BESTOne Plus Silver","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/az/2017/AZ_BESTOne_Dental_Plus-Silver_Plan.pdf","","77352AZ0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","77352AZ0010012","BESTDental Value","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTDental_Value_Plan.pdf"
"2018","AZ","77352","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","77352AZ0010012","BESTDental Value","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/current/AZ_BESTDental_Value_Plan.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080029","Ambetter Secure Care 4 (2018)","91450AZ008",,"AZN004","AZS004","AZF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080029-00","Ambetter Secure Care 4 (2018)","Standard Gold Off Exchange Plan",,"0.795838481708338","Yes","Yes","No","100%",,"$1,400","$700","$0","$60","$1,400","$1,300","$200","$60","$1,300","$400","$100","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080029-00.pdf","https://api.centene.com/Brochures/2018/91450AZ0080029-00.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080029","Ambetter Secure Care 4 (2018)","91450AZ008",,"AZN004","AZS004","AZF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080029-01","Ambetter Secure Care 4 (2018)","Standard Gold On Exchange Plan",,"0.795838481708338","Yes","Yes","No","100%",,"$1,400","$700","$0","$60","$1,400","$1,300","$200","$60","$1,300","$400","$100","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080029-01.pdf","https://api.centene.com/Brochures/2018/91450AZ0080029-01.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080029","Ambetter Secure Care 4 (2018)","91450AZ008",,"AZN004","AZS004","AZF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080029-02","Ambetter Secure Care 4 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080029-02.pdf","https://api.centene.com/Brochures/2018/91450AZ0080029-02.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080029","Ambetter Secure Care 4 (2018)","91450AZ008",,"AZN004","AZS004","AZF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080029-03","Ambetter Secure Care 4 (2018)","Limited Cost Sharing Plan Variation",,"0.795838481708338","Yes","Yes","No","100%",,"$1,400","$700","$0","$60","$1,400","$1,300","$200","$60","$1,300","$400","$100","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080029-03.pdf","https://api.centene.com/Brochures/2018/91450AZ0080029-03.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080033","Ambetter Secure Care 4 (2018)","91450AZ008",,"AZN004","AZS001","AZF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080033-00","Ambetter Secure Care 4 (2018)","Standard Gold Off Exchange Plan",,"0.795838481708338","Yes","Yes","No","100%",,"$1,400","$700","$0","$60","$1,400","$1,300","$200","$60","$1,300","$400","$100","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080033-00.pdf","https://api.centene.com/Brochures/2018/91450AZ0080033-00.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080033","Ambetter Secure Care 4 (2018)","91450AZ008",,"AZN004","AZS001","AZF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080033-01","Ambetter Secure Care 4 (2018)","Standard Gold On Exchange Plan",,"0.795838481708338","Yes","Yes","No","100%",,"$1,400","$700","$0","$60","$1,400","$1,300","$200","$60","$1,300","$400","$100","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080033-01.pdf","https://api.centene.com/Brochures/2018/91450AZ0080033-01.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080033","Ambetter Secure Care 4 (2018)","91450AZ008",,"AZN004","AZS001","AZF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080033-02","Ambetter Secure Care 4 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080033-02.pdf","https://api.centene.com/Brochures/2018/91450AZ0080033-02.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080033","Ambetter Secure Care 4 (2018)","91450AZ008",,"AZN004","AZS001","AZF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080033-03","Ambetter Secure Care 4 (2018)","Limited Cost Sharing Plan Variation",,"0.795838481708338","Yes","Yes","No","100%",,"$1,400","$700","$0","$60","$1,400","$1,300","$200","$60","$1,300","$400","$100","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080033-03.pdf","https://api.centene.com/Brochures/2018/91450AZ0080033-03.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080036","Ambetter Essential Care 1 (2018)","91450AZ008",,"AZN004","AZS001","AZF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080036-00","Ambetter Essential Care 1 (2018)","Standard Bronze Off Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080036-00.pdf","https://api.centene.com/Brochures/2018/91450AZ0080036-00.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080036","Ambetter Essential Care 1 (2018)","91450AZ008",,"AZN004","AZS001","AZF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080036-01","Ambetter Essential Care 1 (2018)","Standard Bronze On Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080036-01.pdf","https://api.centene.com/Brochures/2018/91450AZ0080036-01.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080036","Ambetter Essential Care 1 (2018)","91450AZ008",,"AZN004","AZS001","AZF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080036-02","Ambetter Essential Care 1 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080036-02.pdf","https://api.centene.com/Brochures/2018/91450AZ0080036-02.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080036","Ambetter Essential Care 1 (2018)","91450AZ008",,"AZN004","AZS001","AZF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080036-03","Ambetter Essential Care 1 (2018)","Limited Cost Sharing Plan Variation",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080036-03.pdf","https://api.centene.com/Brochures/2018/91450AZ0080036-03.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080037","Ambetter Essential Care 2 HSA (2018)","91450AZ008",,"AZN004","AZS001","AZF006","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080037-00","Ambetter Essential Care 2 HSA (2018)","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://api.centene.com/SBC/2018/91450AZ0080037-00.pdf","https://api.centene.com/Brochures/2018/91450AZ0080037-00.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080037","Ambetter Essential Care 2 HSA (2018)","91450AZ008",,"AZN004","AZS001","AZF006","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080037-01","Ambetter Essential Care 2 HSA (2018)","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://api.centene.com/SBC/2018/91450AZ0080037-01.pdf","https://api.centene.com/Brochures/2018/91450AZ0080037-01.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080037","Ambetter Essential Care 2 HSA (2018)","91450AZ008",,"AZN004","AZS001","AZF006","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080037-02","Ambetter Essential Care 2 HSA (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080037-02.pdf","https://api.centene.com/Brochures/2018/91450AZ0080037-02.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080037","Ambetter Essential Care 2 HSA (2018)","91450AZ008",,"AZN004","AZS001","AZF006","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080037-03","Ambetter Essential Care 2 HSA (2018)","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://api.centene.com/SBC/2018/91450AZ0080037-03.pdf","https://api.centene.com/Brochures/2018/91450AZ0080037-03.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080040","Ambetter Essential Care 2 HSA (2018)","91450AZ008",,"AZN004","AZS004","AZF006","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080040-00","Ambetter Essential Care 2 HSA (2018)","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://api.centene.com/SBC/2018/91450AZ0080040-00.pdf","https://api.centene.com/Brochures/2018/91450AZ0080040-00.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080040","Ambetter Essential Care 2 HSA (2018)","91450AZ008",,"AZN004","AZS004","AZF006","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080040-01","Ambetter Essential Care 2 HSA (2018)","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://api.centene.com/SBC/2018/91450AZ0080040-01.pdf","https://api.centene.com/Brochures/2018/91450AZ0080040-01.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080040","Ambetter Essential Care 2 HSA (2018)","91450AZ008",,"AZN004","AZS004","AZF006","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080040-02","Ambetter Essential Care 2 HSA (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080040-02.pdf","https://api.centene.com/Brochures/2018/91450AZ0080040-02.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080040","Ambetter Essential Care 2 HSA (2018)","91450AZ008",,"AZN004","AZS004","AZF006","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080040-03","Ambetter Essential Care 2 HSA (2018)","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://api.centene.com/SBC/2018/91450AZ0080040-03.pdf","https://api.centene.com/Brochures/2018/91450AZ0080040-03.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080030","Ambetter Balanced Care 9 (2018)","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080030-00","Ambetter Balanced Care 9 (2018)","Standard Silver Off Exchange Plan",,"0.70322669552678","Yes","Yes","No","100%",,"$4,200","$1,000","$1,800","$60","$4,200","$1,800","$300","$60","$1,100","$400","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080030-00.pdf","https://api.centene.com/Brochures/2018/91450AZ0080030-00.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080030","Ambetter Balanced Care 9 (2018)","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080030-01","Ambetter Balanced Care 9 (2018)","Standard Silver On Exchange Plan",,"0.70322669552678","Yes","Yes","No","100%",,"$4,200","$1,000","$1,800","$60","$4,200","$1,800","$300","$60","$1,100","$400","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080030-01.pdf","https://api.centene.com/Brochures/2018/91450AZ0080030-01.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080030","Ambetter Balanced Care 9 (2018)","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080030-02","Ambetter Balanced Care 9 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080030-02.pdf","https://api.centene.com/Brochures/2018/91450AZ0080030-02.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080030","Ambetter Balanced Care 9 (2018)","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080030-03","Ambetter Balanced Care 9 (2018)","Limited Cost Sharing Plan Variation",,"0.70322669552678","Yes","Yes","No","100%",,"$4,200","$1,000","$1,800","$60","$4,200","$1,800","$300","$60","$1,100","$400","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080030-03.pdf","https://api.centene.com/Brochures/2018/91450AZ0080030-03.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080030","Ambetter Balanced Care 9 (2018)","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080030-04","Ambetter Balanced Care 9 (2018)","73% AV Level Silver Plan",,"0.739694241067211","Yes","Yes","No","100%",,"$2,850","$1,000","$1,800","$60","$2,850","$1,800","$300","$60","$1,100","$400","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080030-04.pdf","https://api.centene.com/Brochures/2018/91450AZ0080030-04.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080030","Ambetter Balanced Care 9 (2018)","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080030-05","Ambetter Balanced Care 9 (2018)","87% AV Level Silver Plan",,"0.879769943295724","Yes","Yes","No","100%",,"$600","$500","$1,300","$60","$800","$700","$300","$60","$800","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080030-05.pdf","https://api.centene.com/Brochures/2018/91450AZ0080030-05.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080030","Ambetter Balanced Care 9 (2018)","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080030-06","Ambetter Balanced Care 9 (2018)","94% AV Level Silver Plan",,"0.949895522718681","Yes","Yes","No","100%",,"$50","$100","$900","$60","$50","$400","$200","$60","$50","$30","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080030-06.pdf","https://api.centene.com/Brochures/2018/91450AZ0080030-06.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080034","Ambetter Balanced Care 9 (2018)","91450AZ008",,"AZN004","AZS001","AZF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080034-00","Ambetter Balanced Care 9 (2018)","Standard Silver Off Exchange Plan",,"0.70322669552678","Yes","Yes","No","100%",,"$4,200","$1,000","$1,800","$60","$4,200","$1,800","$300","$60","$1,100","$400","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080034-00.pdf","https://api.centene.com/Brochures/2018/91450AZ0080034-00.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080034","Ambetter Balanced Care 9 (2018)","91450AZ008",,"AZN004","AZS001","AZF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080034-01","Ambetter Balanced Care 9 (2018)","Standard Silver On Exchange Plan",,"0.70322669552678","Yes","Yes","No","100%",,"$4,200","$1,000","$1,800","$60","$4,200","$1,800","$300","$60","$1,100","$400","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080034-01.pdf","https://api.centene.com/Brochures/2018/91450AZ0080034-01.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080034","Ambetter Balanced Care 9 (2018)","91450AZ008",,"AZN004","AZS001","AZF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080034-02","Ambetter Balanced Care 9 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080034-02.pdf","https://api.centene.com/Brochures/2018/91450AZ0080034-02.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080034","Ambetter Balanced Care 9 (2018)","91450AZ008",,"AZN004","AZS001","AZF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080034-03","Ambetter Balanced Care 9 (2018)","Limited Cost Sharing Plan Variation",,"0.70322669552678","Yes","Yes","No","100%",,"$4,200","$1,000","$1,800","$60","$4,200","$1,800","$300","$60","$1,100","$400","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080034-03.pdf","https://api.centene.com/Brochures/2018/91450AZ0080034-03.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080034","Ambetter Balanced Care 9 (2018)","91450AZ008",,"AZN004","AZS001","AZF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080034-04","Ambetter Balanced Care 9 (2018)","73% AV Level Silver Plan",,"0.739694241067211","Yes","Yes","No","100%",,"$2,850","$1,000","$1,800","$60","$2,850","$1,800","$300","$60","$1,100","$400","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080034-04.pdf","https://api.centene.com/Brochures/2018/91450AZ0080034-04.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080034","Ambetter Balanced Care 9 (2018)","91450AZ008",,"AZN004","AZS001","AZF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080034-05","Ambetter Balanced Care 9 (2018)","87% AV Level Silver Plan",,"0.879769943295724","Yes","Yes","No","100%",,"$600","$500","$1,300","$60","$800","$700","$300","$60","$800","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080034-05.pdf","https://api.centene.com/Brochures/2018/91450AZ0080034-05.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080034","Ambetter Balanced Care 9 (2018)","91450AZ008",,"AZN004","AZS001","AZF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080034-06","Ambetter Balanced Care 9 (2018)","94% AV Level Silver Plan",,"0.949895522718681","Yes","Yes","No","100%",,"$50","$100","$900","$60","$50","$400","$200","$60","$50","$30","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080034-06.pdf","https://api.centene.com/Brochures/2018/91450AZ0080034-06.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080043","Ambetter Balanced Care 4 (2018)","91450AZ008",,"AZN004","AZS004","AZF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080043-00","Ambetter Balanced Care 4 (2018)","Standard Silver Off Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080043-00.pdf","https://api.centene.com/Brochures/2018/91450AZ0080043-00.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080043","Ambetter Balanced Care 4 (2018)","91450AZ008",,"AZN004","AZS004","AZF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080043-01","Ambetter Balanced Care 4 (2018)","Standard Silver On Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080043-01.pdf","https://api.centene.com/Brochures/2018/91450AZ0080043-01.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080043","Ambetter Balanced Care 4 (2018)","91450AZ008",,"AZN004","AZS004","AZF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080043-02","Ambetter Balanced Care 4 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080043-02.pdf","https://api.centene.com/Brochures/2018/91450AZ0080043-02.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080043","Ambetter Balanced Care 4 (2018)","91450AZ008",,"AZN004","AZS004","AZF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080043-03","Ambetter Balanced Care 4 (2018)","Limited Cost Sharing Plan Variation",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080043-03.pdf","https://api.centene.com/Brochures/2018/91450AZ0080043-03.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080043","Ambetter Balanced Care 4 (2018)","91450AZ008",,"AZN004","AZS004","AZF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080043-04","Ambetter Balanced Care 4 (2018)","73% AV Level Silver Plan",,"0.727430168333116","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$1,800","$1,300","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080043-04.pdf","https://api.centene.com/Brochures/2018/91450AZ0080043-04.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080043","Ambetter Balanced Care 4 (2018)","91450AZ008",,"AZN004","AZS004","AZF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080043-05","Ambetter Balanced Care 4 (2018)","87% AV Level Silver Plan",,"0.863154651499334","Yes","Yes","No","100%",,"$1,850","$0","$0","$60","$1,850","$0","$0","$60","$1,630","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080043-05.pdf","https://api.centene.com/Brochures/2018/91450AZ0080043-05.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080043","Ambetter Balanced Care 4 (2018)","91450AZ008",,"AZN004","AZS004","AZF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080043-06","Ambetter Balanced Care 4 (2018)","94% AV Level Silver Plan",,"0.940719200046497","Yes","Yes","No","100%",,"$600","$0","$0","$60","$600","$0","$0","$60","$600","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080043-06.pdf","https://api.centene.com/Brochures/2018/91450AZ0080043-06.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080035","Ambetter Balanced Care 4 (2018)","91450AZ008",,"AZN004","AZS001","AZF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080035-00","Ambetter Balanced Care 4 (2018)","Standard Silver Off Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080035-00.pdf","https://api.centene.com/Brochures/2018/91450AZ0080035-00.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080035","Ambetter Balanced Care 4 (2018)","91450AZ008",,"AZN004","AZS001","AZF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080035-01","Ambetter Balanced Care 4 (2018)","Standard Silver On Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080035-01.pdf","https://api.centene.com/Brochures/2018/91450AZ0080035-01.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080035","Ambetter Balanced Care 4 (2018)","91450AZ008",,"AZN004","AZS001","AZF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080035-02","Ambetter Balanced Care 4 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080035-02.pdf","https://api.centene.com/Brochures/2018/91450AZ0080035-02.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080035","Ambetter Balanced Care 4 (2018)","91450AZ008",,"AZN004","AZS001","AZF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080035-03","Ambetter Balanced Care 4 (2018)","Limited Cost Sharing Plan Variation",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080035-03.pdf","https://api.centene.com/Brochures/2018/91450AZ0080035-03.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080035","Ambetter Balanced Care 4 (2018)","91450AZ008",,"AZN004","AZS001","AZF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080035-04","Ambetter Balanced Care 4 (2018)","73% AV Level Silver Plan",,"0.727430168333116","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$1,800","$1,300","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080035-04.pdf","https://api.centene.com/Brochures/2018/91450AZ0080035-04.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080035","Ambetter Balanced Care 4 (2018)","91450AZ008",,"AZN004","AZS001","AZF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080035-05","Ambetter Balanced Care 4 (2018)","87% AV Level Silver Plan",,"0.863154651499334","Yes","Yes","No","100%",,"$1,850","$0","$0","$60","$1,850","$0","$0","$60","$1,630","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080035-05.pdf","https://api.centene.com/Brochures/2018/91450AZ0080035-05.pdf"
"2018","AZ","91450","HIOS","2017-09-22 02:20:26","Individual","No","36-3097810","91450AZ0080035","Ambetter Balanced Care 4 (2018)","91450AZ008",,"AZN004","AZS001","AZF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.996",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.ambetterhealthnet.com/payments","https://www.ambetterhealthnet.com/resources/pharmacy-resources.html","91450AZ0080035-06","Ambetter Balanced Care 4 (2018)","94% AV Level Silver Plan",,"0.940719200046497","Yes","Yes","No","100%",,"$600","$0","$0","$60","$600","$0","$0","$60","$600","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/91450AZ0080035-06.pdf","https://api.centene.com/Brochures/2018/91450AZ0080035-06.pdf"
"2018","FL","15833","HIOS","2017-08-17 02:20:39","Individual","Yes","13-5123390","15833FL0120002","Managed DentalGuard FL Essentials 1","15833FL012",,"FLN004","FLS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.941","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","15833FL0120002-00","Managed DentalGuard FL Essentials 1","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/florida/","https://dentalexchange.guardianlife.com/our-plans/florida/"
"2018","FL","15833","HIOS","2017-08-17 02:20:39","Individual","Yes","13-5123390","15833FL0120002","Managed DentalGuard FL Essentials 1","15833FL012",,"FLN004","FLS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.941","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","15833FL0120002-01","Managed DentalGuard FL Essentials 1","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/florida/","https://dentalexchange.guardianlife.com/our-plans/florida/"
"2018","FL","15833","HIOS","2017-08-17 02:20:39","Individual","Yes","13-5123390","15833FL0130001","Guardian Essentials for Families and Individuals","15833FL013",,"FLN003","FLS002",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","15833FL0130001-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/florida/","https://dentalexchange.guardianlife.com/our-plans/florida/"
"2018","FL","15833","HIOS","2017-08-17 02:20:39","Individual","Yes","13-5123390","15833FL0130001","Guardian Essentials for Families and Individuals","15833FL013",,"FLN003","FLS002",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","15833FL0130001-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/florida/","https://dentalexchange.guardianlife.com/our-plans/florida/"
"2018","FL","15833","HIOS","2017-08-17 02:20:39","Individual","Yes","13-5123390","15833FL0140001","Guardian Select for Families and Individuals","15833FL014",,"FLN003","FLS002",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","15833FL0140001-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/florida/","https://dentalexchange.guardianlife.com/our-plans/florida/"
"2018","FL","15833","HIOS","2017-08-17 02:20:39","Individual","Yes","13-5123390","15833FL0140001","Guardian Select for Families and Individuals","15833FL014",,"FLN003","FLS002",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","15833FL0140001-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/florida/","https://dentalexchange.guardianlife.com/our-plans/florida/"
"2018","FL","15980","HIOS","2017-08-08 02:20:26","Individual","Yes","39-1263473","15980FL0160002","Humana Dental Smart Choice","15980FL016",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9879","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","15980FL0160002-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110263"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070073","BlueOptions Silver 1423","16842FL007","7700889661","FLN001","FLS001","FLF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070073-00","BlueOptions Silver 1423","Standard Silver Off Exchange Plan",,"0.681109567456173","No","Yes","No","100%",,"$6,000","$700","$0","$60","$3,000","$2,100","$0","$60","$200","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"$11,900","$11900 per person","$23800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1423.pdf","https://www.flblue.com/plan-brochure/bo?id=1423"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070073","BlueOptions Silver 1423","16842FL007","7700889661","FLN001","FLS001","FLF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070073-01","BlueOptions Silver 1423","Standard Silver On Exchange Plan",,"0.681109567456173","No","Yes","No","100%",,"$6,000","$700","$0","$60","$3,000","$2,100","$0","$60","$200","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"$11,900","$11900 per person","$23800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1423.pdf","https://www.flblue.com/plan-brochure/bo?id=1423"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070073","BlueOptions Silver 1423","16842FL007","7700889661","FLN001","FLS001","FLF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070073-02","BlueOptions Silver 1423","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1423U.pdf","https://www.flblue.com/plan-brochure/bo?id=1423U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070073","BlueOptions Silver 1423","16842FL007","7700889661","FLN001","FLS001","FLF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070073-03","BlueOptions Silver 1423","Limited Cost Sharing Plan Variation",,"0.681109567456173","No","Yes","No","100%",,"$6,000","$700","$0","$60","$3,000","$2,100","$0","$60","$200","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"$11,900","$11900 per person","$23800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1423O.pdf","https://www.flblue.com/plan-brochure/bo?id=1423O"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070073","BlueOptions Silver 1423","16842FL007","7700889661","FLN001","FLS001","FLF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070073-04","BlueOptions Silver 1423","73% AV Level Silver Plan",,"0.737386190993512","No","Yes","No","100%",,"$3,000","$700","$0","$60","$3,000","$1,600","$0","$60","$200","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","40.00%",,,,,"$11,900","$11900 per person","$23800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1423A.pdf","https://www.flblue.com/plan-brochure/bo?id=1423A"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070073","BlueOptions Silver 1423","16842FL007","7700889661","FLN001","FLS001","FLF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070073-05","BlueOptions Silver 1423","87% AV Level Silver Plan",,"0.873151773834928","No","Yes","No","100%",,"$600","$600","$0","$60","$0","$2,200","$0","$60","$200","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%",,,,,"$11,900","$11900 per person","$23800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1423B.pdf","https://www.flblue.com/plan-brochure/bo?id=1423B"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070073","BlueOptions Silver 1423","16842FL007","7700889661","FLN001","FLS001","FLF005","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070073-06","BlueOptions Silver 1423","94% AV Level Silver Plan",,"0.939893168760571","No","Yes","No","100%",,"$0","$400","$0","$60","$0","$800","$0","$60","$0","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","$1050 per person","$2100 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$11,900","$11900 per person","$23800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1423C.pdf","https://www.flblue.com/plan-brochure/bo?id=1423C"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070084","BlueOptions Bronze 1419","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070084-00","BlueOptions Bronze 1419","Standard Bronze Off Exchange Plan",,"0.599723362353384","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$5,600","$800","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1419.pdf","https://www.flblue.com/plan-brochure/bo?id=1419"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070084","BlueOptions Bronze 1419","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070084-01","BlueOptions Bronze 1419","Standard Bronze On Exchange Plan",,"0.599723362353384","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$5,600","$800","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1419.pdf","https://www.flblue.com/plan-brochure/bo?id=1419"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070084","BlueOptions Bronze 1419","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070084-02","BlueOptions Bronze 1419","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1419U.pdf","https://www.flblue.com/plan-brochure/bo?id=1419U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070084","BlueOptions Bronze 1419","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070084-03","BlueOptions Bronze 1419","Limited Cost Sharing Plan Variation",,"0.599723362353384","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$5,600","$800","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1419O.pdf","https://www.flblue.com/plan-brochure/bo?id=1419O"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070100","BlueOptions Silver 1431","16842FL007","7700889661","FLN001","FLS001","FLF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070100-00","BlueOptions Silver 1431","Standard Silver Off Exchange Plan",,"0.718066851628673","No","Yes","No","100%",,"$5,500","$100","$600","$60","$0","$3,100","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","10.00%",,,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1431.pdf","https://www.flblue.com/plan-brochure/bo?id=1431"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070100","BlueOptions Silver 1431","16842FL007","7700889661","FLN001","FLS001","FLF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070100-01","BlueOptions Silver 1431","Standard Silver On Exchange Plan",,"0.718066851628673","No","Yes","No","100%",,"$5,500","$100","$600","$60","$0","$3,100","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","10.00%",,,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1431.pdf","https://www.flblue.com/plan-brochure/bo?id=1431"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070100","BlueOptions Silver 1431","16842FL007","7700889661","FLN001","FLS001","FLF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070100-02","BlueOptions Silver 1431","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1431U.pdf","https://www.flblue.com/plan-brochure/bo?id=1431U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070100","BlueOptions Silver 1431","16842FL007","7700889661","FLN001","FLS001","FLF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070100-03","BlueOptions Silver 1431","Limited Cost Sharing Plan Variation",,"0.718066851628673","No","Yes","No","100%",,"$5,500","$100","$600","$60","$0","$3,100","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","10.00%",,,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1431O.pdf","https://www.flblue.com/plan-brochure/bo?id=1431O"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070100","BlueOptions Silver 1431","16842FL007","7700889661","FLN001","FLS001","FLF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070100-04","BlueOptions Silver 1431","73% AV Level Silver Plan",,"0.738565054351971","No","Yes","No","100%",,"$5,000","$100","$700","$60","$0","$3,000","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$4,950","$4950 per person","$9900 per group","10.00%",,,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1431A.pdf","https://www.flblue.com/plan-brochure/bo?id=1431A"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070100","BlueOptions Silver 1431","16842FL007","7700889661","FLN001","FLS001","FLF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070100-05","BlueOptions Silver 1431","87% AV Level Silver Plan",,"0.874952450630743","No","Yes","No","100%",,"$1,500","$0","$800","$60","$0","$900","$0","$60","$600","$400","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1431B.pdf","https://www.flblue.com/plan-brochure/bo?id=1431B"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070100","BlueOptions Silver 1431","16842FL007","7700889661","FLN001","FLS001","FLF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070100-06","BlueOptions Silver 1431","94% AV Level Silver Plan",,"0.939738336098804","No","Yes","No","100%",,"$400","$20","$600","$60","$0","$500","$0","$60","$400","$200","$10","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","5.00%",,,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1431C.pdf","https://www.flblue.com/plan-brochure/bo?id=1431C"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070102","BlueOptions Platinum 1418","16842FL007","7700889661","FLN001","FLS001","FLF003","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070102-00","BlueOptions Platinum 1418","Standard Platinum Off Exchange Plan",,"0.907557078777632","No","Yes","No","100%",,"$800","$30","$800","$60","$0","$1,500","$0","$60","$800","$100","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1418.pdf","https://www.flblue.com/plan-brochure/bo?id=1418"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070102","BlueOptions Platinum 1418","16842FL007","7700889661","FLN001","FLS001","FLF003","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070102-01","BlueOptions Platinum 1418","Standard Platinum On Exchange Plan",,"0.907557078777632","No","Yes","No","100%",,"$800","$30","$800","$60","$0","$1,500","$0","$60","$800","$100","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1418.pdf","https://www.flblue.com/plan-brochure/bo?id=1418"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070102","BlueOptions Platinum 1418","16842FL007","7700889661","FLN001","FLS001","FLF003","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070102-02","BlueOptions Platinum 1418","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1418U.pdf","https://www.flblue.com/plan-brochure/bo?id=1418U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070102","BlueOptions Platinum 1418","16842FL007","7700889661","FLN001","FLS001","FLF003","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070102-03","BlueOptions Platinum 1418","Limited Cost Sharing Plan Variation",,"0.907557078777632","No","Yes","No","100%",,"$800","$30","$800","$60","$0","$1,500","$0","$60","$800","$100","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1418O.pdf","https://www.flblue.com/plan-brochure/bo?id=1418O"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070108","BlueOptions Bronze 1416","16842FL007","7700889661","FLN001","FLS001","FLF002","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070108-00","BlueOptions Bronze 1416","Standard Bronze Off Exchange Plan",,"0.64851616055622","Yes","Yes","No","100%",,"$6,400","$200","$0","$60","$4,600","$1,200","$0","$60","$1,300","$300","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group",,,,"$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"$12,800","$12800 per person","$25600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1416.pdf","https://www.flblue.com/plan-brochure/bo?id=1416"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070108","BlueOptions Bronze 1416","16842FL007","7700889661","FLN001","FLS001","FLF002","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070108-01","BlueOptions Bronze 1416","Standard Bronze On Exchange Plan",,"0.64851616055622","Yes","Yes","No","100%",,"$6,400","$200","$0","$60","$4,600","$1,200","$0","$60","$1,300","$300","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group",,,,"$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"$12,800","$12800 per person","$25600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1416.pdf","https://www.flblue.com/plan-brochure/bo?id=1416"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070108","BlueOptions Bronze 1416","16842FL007","7700889661","FLN001","FLS001","FLF002","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070108-02","BlueOptions Bronze 1416","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1416U.pdf","https://www.flblue.com/plan-brochure/bo?id=1416U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070108","BlueOptions Bronze 1416","16842FL007","7700889661","FLN001","FLS001","FLF002","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070108-03","BlueOptions Bronze 1416","Limited Cost Sharing Plan Variation",,"0.64851616055622","Yes","Yes","No","100%",,"$6,400","$200","$0","$60","$4,600","$1,200","$0","$60","$1,300","$300","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group",,,,"$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"$12,800","$12800 per person","$25600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1416O.pdf","https://www.flblue.com/plan-brochure/bo?id=1416O"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070110","BlueOptions Platinum 1424","16842FL007","7700889661","FLN001","FLS001","FLF003","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070110-00","BlueOptions Platinum 1424","Standard Platinum Off Exchange Plan",,"0.898778496100588","Yes","Yes","No","100%",,"$0","$400","$0","$60","$0","$1,500","$0","$60","$0","$500","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1424.pdf","https://www.flblue.com/plan-brochure/bo?id=1424"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070110","BlueOptions Platinum 1424","16842FL007","7700889661","FLN001","FLS001","FLF003","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070110-01","BlueOptions Platinum 1424","Standard Platinum On Exchange Plan",,"0.898778496100588","Yes","Yes","No","100%",,"$0","$400","$0","$60","$0","$1,500","$0","$60","$0","$500","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1424.pdf","https://www.flblue.com/plan-brochure/bo?id=1424"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070110","BlueOptions Platinum 1424","16842FL007","7700889661","FLN001","FLS001","FLF003","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070110-02","BlueOptions Platinum 1424","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1424U.pdf","https://www.flblue.com/plan-brochure/bo?id=1424U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070110","BlueOptions Platinum 1424","16842FL007","7700889661","FLN001","FLS001","FLF003","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070110-03","BlueOptions Platinum 1424","Limited Cost Sharing Plan Variation",,"0.898778496100588","Yes","Yes","No","100%",,"$0","$400","$0","$60","$0","$1,500","$0","$60","$0","$500","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1424O.pdf","https://www.flblue.com/plan-brochure/bo?id=1424O"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070114","BlueOptions Silver 1410","16842FL007","7700889661","FLN001","FLS001","FLF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070114-00","BlueOptions Silver 1410","Standard Silver Off Exchange Plan",,"0.660137929082671","Yes","Yes","No","100%",,"$6,100","$0","$1,300","$60","$1,100","$2,000","$0","$60","$1,400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group","50.00%",,,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1410.pdf","https://www.flblue.com/plan-brochure/bo?id=1410"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070114","BlueOptions Silver 1410","16842FL007","7700889661","FLN001","FLS001","FLF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070114-01","BlueOptions Silver 1410","Standard Silver On Exchange Plan",,"0.660137929082671","Yes","Yes","No","100%",,"$6,100","$0","$1,300","$60","$1,100","$2,000","$0","$60","$1,400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group","50.00%",,,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1410.pdf","https://www.flblue.com/plan-brochure/bo?id=1410"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070114","BlueOptions Silver 1410","16842FL007","7700889661","FLN001","FLS001","FLF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070114-02","BlueOptions Silver 1410","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1410U.pdf","https://www.flblue.com/plan-brochure/bo?id=1410U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070114","BlueOptions Silver 1410","16842FL007","7700889661","FLN001","FLS001","FLF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070114-03","BlueOptions Silver 1410","Limited Cost Sharing Plan Variation",,"0.660137929082671","Yes","Yes","No","100%",,"$6,100","$0","$1,300","$60","$1,100","$2,000","$0","$60","$1,400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group","50.00%",,,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1410O.pdf","https://www.flblue.com/plan-brochure/bo?id=1410O"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070114","BlueOptions Silver 1410","16842FL007","7700889661","FLN001","FLS001","FLF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070114-04","BlueOptions Silver 1410","73% AV Level Silver Plan",,"0.738962761332475","Yes","Yes","No","100%",,"$5,000","$0","$600","$60","$0","$2,400","$0","$60","$600","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$5550 per person","$11100 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1410A.pdf","https://www.flblue.com/plan-brochure/bo?id=1410A"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070114","BlueOptions Silver 1410","16842FL007","7700889661","FLN001","FLS001","FLF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070114-05","BlueOptions Silver 1410","87% AV Level Silver Plan",,"0.878972613666946","Yes","Yes","No","100%",,"$0","$0","$2,500","$60","$0","$1,800","$0","$60","$0","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1410B.pdf","https://www.flblue.com/plan-brochure/bo?id=1410B"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070114","BlueOptions Silver 1410","16842FL007","7700889661","FLN001","FLS001","FLF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070114-06","BlueOptions Silver 1410","94% AV Level Silver Plan",,"0.949963752401131","Yes","Yes","No","100%",,"$0","$0","$1,300","$60","$0","$800","$0","$60","$0","$200","$100","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25.00%",,,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1410C.pdf","https://www.flblue.com/plan-brochure/bo?id=1410C"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070120","BlueOptions Gold 1505","16842FL007","7700889661","FLN001","FLS001","FLF007","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070120-00","BlueOptions Gold 1505","Standard Gold Off Exchange Plan",,"0.793559831541356","Yes","Yes","No","100%",,"$0","$700","$0","$60","$0","$2,200","$0","$60","$0","$800","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1505.pdf","https://www.flblue.com/plan-brochure/bo?id=1505"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070120","BlueOptions Gold 1505","16842FL007","7700889661","FLN001","FLS001","FLF007","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070120-01","BlueOptions Gold 1505","Standard Gold On Exchange Plan",,"0.793559831541356","Yes","Yes","No","100%",,"$0","$700","$0","$60","$0","$2,200","$0","$60","$0","$800","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1505.pdf","https://www.flblue.com/plan-brochure/bo?id=1505"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070120","BlueOptions Gold 1505","16842FL007","7700889661","FLN001","FLS001","FLF007","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070120-02","BlueOptions Gold 1505","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1505U.pdf","https://www.flblue.com/plan-brochure/bo?id=1505U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070120","BlueOptions Gold 1505","16842FL007","7700889661","FLN001","FLS001","FLF007","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070120-03","BlueOptions Gold 1505","Limited Cost Sharing Plan Variation",,"0.793559831541356","Yes","Yes","No","100%",,"$0","$700","$0","$60","$0","$2,200","$0","$60","$0","$800","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1505O.pdf","https://www.flblue.com/plan-brochure/bo?id=1505O"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070122","BlueOptions Bronze (HSA) 1705","16842FL007","7700889661","FLN001","FLS001","FLF008","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices_HSA.pdf","16842FL0070122-00","BlueOptions Bronze (HSA) 1705","Standard Bronze Off Exchange Plan",,"0.61972055561931","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$5,400","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1705.pdf","https://www.flblue.com/plan-brochure/bo?id=1705"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070122","BlueOptions Bronze (HSA) 1705","16842FL007","7700889661","FLN001","FLS001","FLF008","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices_HSA.pdf","16842FL0070122-01","BlueOptions Bronze (HSA) 1705","Standard Bronze On Exchange Plan",,"0.61972055561931","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$5,400","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1705.pdf","https://www.flblue.com/plan-brochure/bo?id=1705"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070122","BlueOptions Bronze (HSA) 1705","16842FL007","7700889661","FLN001","FLS001","FLF008","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices_HSA.pdf","16842FL0070122-02","BlueOptions Bronze (HSA) 1705","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1705U.pdf","https://www.flblue.com/plan-brochure/bo?id=1705U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070122","BlueOptions Bronze (HSA) 1705","16842FL007","7700889661","FLN001","FLS001","FLF008","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices_HSA.pdf","16842FL0070122-03","BlueOptions Bronze (HSA) 1705","Limited Cost Sharing Plan Variation",,"0.61972055561931","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$5,400","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1705O.pdf","https://www.flblue.com/plan-brochure/bo?id=1705O"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070124","BlueOptions Silver 1706S","16842FL007","7700889661","FLN001","FLS001","FLF009","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070124-00","BlueOptions Silver 1706S","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$40","$1,800","$60","$100","$2,400","$0","$60","$800","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1706S.pdf","https://www.flblue.com/plan-brochure/bo?id=1706S"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070124","BlueOptions Silver 1706S","16842FL007","7700889661","FLN001","FLS001","FLF009","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070124-01","BlueOptions Silver 1706S","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$40","$1,800","$60","$100","$2,400","$0","$60","$800","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1706S.pdf","https://www.flblue.com/plan-brochure/bo?id=1706S"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120044","BlueSelect Bronze 1452","16842FL012","7700889661","FLN002","FLS002","FLF015","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120044-02","BlueSelect Bronze 1452","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1452U.pdf","https://www.flblue.com/plan-brochure/bs?id=1452U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070124","BlueOptions Silver 1706S","16842FL007","7700889661","FLN001","FLS001","FLF009","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070124-02","BlueOptions Silver 1706S","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1706US.pdf","https://www.flblue.com/plan-brochure/bo?id=1706US"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070124","BlueOptions Silver 1706S","16842FL007","7700889661","FLN001","FLS001","FLF009","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070124-03","BlueOptions Silver 1706S","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$40","$1,800","$60","$100","$2,400","$0","$60","$800","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1706OS.pdf","https://www.flblue.com/plan-brochure/bo?id=1706OS"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070124","BlueOptions Silver 1706S","16842FL007","7700889661","FLN001","FLS001","FLF009","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070124-04","BlueOptions Silver 1706S","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$40","$1,900","$60","$100","$2,400","$0","$60","$800","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1706AS.pdf","https://www.flblue.com/plan-brochure/bo?id=1706AS"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070124","BlueOptions Silver 1706S","16842FL007","7700889661","FLN001","FLS001","FLF009","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070124-05","BlueOptions Silver 1706S","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,800","$60","$100","$1,300","$0","$60","$700","$100","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1706BS.pdf","https://www.flblue.com/plan-brochure/bo?id=1706BS"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070124","BlueOptions Silver 1706S","16842FL007","7700889661","FLN001","FLS001","FLF009","New","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070124-06","BlueOptions Silver 1706S","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$300","$10","$600","$60","$100","$400","$0","$60","$300","$50","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1706CS.pdf","https://www.flblue.com/plan-brochure/bo?id=1706CS"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070126","BlueOptions Bronze 1707S","16842FL007","7700889661","FLN001","FLS001","FLF010","New","EPO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070126-00","BlueOptions Bronze 1707S","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,700","$0","$700","$60","$5,700","$700","$0","$60","$1,300","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1707S.pdf","https://www.flblue.com/plan-brochure/bo?id=1707S"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120044","BlueSelect Bronze 1452","16842FL012","7700889661","FLN002","FLS002","FLF015","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120044-00","BlueSelect Bronze 1452","Standard Bronze Off Exchange Plan",,"0.599723362353384","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$5,600","$800","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1452.pdf","https://www.flblue.com/plan-brochure/bs?id=1452"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120044","BlueSelect Bronze 1452","16842FL012","7700889661","FLN002","FLS002","FLF015","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120044-01","BlueSelect Bronze 1452","Standard Bronze On Exchange Plan",,"0.599723362353384","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$5,600","$800","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1452.pdf","https://www.flblue.com/plan-brochure/bs?id=1452"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070126","BlueOptions Bronze 1707S","16842FL007","7700889661","FLN001","FLS001","FLF010","New","EPO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070126-01","BlueOptions Bronze 1707S","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,700","$0","$700","$60","$5,700","$700","$0","$60","$1,300","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1707S.pdf","https://www.flblue.com/plan-brochure/bo?id=1707S"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070126","BlueOptions Bronze 1707S","16842FL007","7700889661","FLN001","FLS001","FLF010","New","EPO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070126-02","BlueOptions Bronze 1707S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1707US.pdf","https://www.flblue.com/plan-brochure/bo?id=1707US"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070126","BlueOptions Bronze 1707S","16842FL007","7700889661","FLN001","FLS001","FLF010","New","EPO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070126-03","BlueOptions Bronze 1707S","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,700","$0","$700","$60","$5,700","$700","$0","$60","$1,300","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1707OS.pdf","https://www.flblue.com/plan-brochure/bo?id=1707OS"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070130","BlueOptions Gold 1805","16842FL007","7700889661","FLN001","FLS001","FLF011","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070130-00","BlueOptions Gold 1805","Standard Gold Off Exchange Plan",,"0.782585041781306","No","Yes","No","100%",,"$2,000","$100","$1,400","$60","$0","$2,800","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1805.pdf","https://www.flblue.com/plan-brochure/bo?id=1805"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070130","BlueOptions Gold 1805","16842FL007","7700889661","FLN001","FLS001","FLF011","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070130-01","BlueOptions Gold 1805","Standard Gold On Exchange Plan",,"0.782585041781306","No","Yes","No","100%",,"$2,000","$100","$1,400","$60","$0","$2,800","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1805.pdf","https://www.flblue.com/plan-brochure/bo?id=1805"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070130","BlueOptions Gold 1805","16842FL007","7700889661","FLN001","FLS001","FLF011","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070130-02","BlueOptions Gold 1805","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1805U.pdf","https://www.flblue.com/plan-brochure/bo?id=1805U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0070130","BlueOptions Gold 1805","16842FL007","7700889661","FLN001","FLS001","FLF011","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0070130-03","BlueOptions Gold 1805","Limited Cost Sharing Plan Variation",,"0.782585041781306","No","Yes","No","100%",,"$2,000","$100","$1,400","$60","$0","$2,800","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1805O.pdf","https://www.flblue.com/plan-brochure/bo?id=1805O"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120033","BlueSelect Silver 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120033-00","BlueSelect Silver 1456","Standard Silver Off Exchange Plan",,"0.681109567456173","No","Yes","No","100%",,"$6,000","$700","$0","$60","$3,000","$2,100","$0","$60","$200","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"$11,900","$11900 per person","$23800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1456.pdf","https://www.flblue.com/plan-brochure/bs?id=1456"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120033","BlueSelect Silver 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120033-01","BlueSelect Silver 1456","Standard Silver On Exchange Plan",,"0.681109567456173","No","Yes","No","100%",,"$6,000","$700","$0","$60","$3,000","$2,100","$0","$60","$200","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"$11,900","$11900 per person","$23800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1456.pdf","https://www.flblue.com/plan-brochure/bs?id=1456"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120033","BlueSelect Silver 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120033-02","BlueSelect Silver 1456","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1456U.pdf","https://www.flblue.com/plan-brochure/bs?id=1456U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120033","BlueSelect Silver 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120033-03","BlueSelect Silver 1456","Limited Cost Sharing Plan Variation",,"0.681109567456173","No","Yes","No","100%",,"$6,000","$700","$0","$60","$3,000","$2,100","$0","$60","$200","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"$11,900","$11900 per person","$23800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1456O.pdf","https://www.flblue.com/plan-brochure/bs?id=1456O"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120033","BlueSelect Silver 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120033-04","BlueSelect Silver 1456","73% AV Level Silver Plan",,"0.737386190993512","No","Yes","No","100%",,"$3,000","$700","$0","$60","$3,000","$1,600","$0","$60","$200","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","40.00%",,,,,"$11,900","$11900 per person","$23800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1456A.pdf","https://www.flblue.com/plan-brochure/bs?id=1456A"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120033","BlueSelect Silver 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120033-05","BlueSelect Silver 1456","87% AV Level Silver Plan",,"0.873151773834928","No","Yes","No","100%",,"$600","$600","$0","$60","$0","$2,200","$0","$60","$200","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%",,,,,"$11,900","$11900 per person","$23800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1456B.pdf","https://www.flblue.com/plan-brochure/bs?id=1456B"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120033","BlueSelect Silver 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120033-06","BlueSelect Silver 1456","94% AV Level Silver Plan",,"0.939893168760571","No","Yes","No","100%",,"$0","$400","$0","$60","$0","$800","$0","$60","$0","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","$1050 per person","$2100 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$11,900","$11900 per person","$23800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1456C.pdf","https://www.flblue.com/plan-brochure/bs?id=1456C"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120044","BlueSelect Bronze 1452","16842FL012","7700889661","FLN002","FLS002","FLF015","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120044-03","BlueSelect Bronze 1452","Limited Cost Sharing Plan Variation",,"0.599723362353384","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$5,600","$800","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1452O.pdf","https://www.flblue.com/plan-brochure/bs?id=1452O"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120060","BlueSelect Silver 1464","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120060-00","BlueSelect Silver 1464","Standard Silver Off Exchange Plan",,"0.718066851628673","No","Yes","No","100%",,"$5,500","$100","$600","$60","$0","$3,100","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","10.00%",,,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1464.pdf","https://www.flblue.com/plan-brochure/bs?id=1464"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120060","BlueSelect Silver 1464","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120060-01","BlueSelect Silver 1464","Standard Silver On Exchange Plan",,"0.718066851628673","No","Yes","No","100%",,"$5,500","$100","$600","$60","$0","$3,100","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","10.00%",,,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1464.pdf","https://www.flblue.com/plan-brochure/bs?id=1464"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120060","BlueSelect Silver 1464","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120060-02","BlueSelect Silver 1464","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1464U.pdf","https://www.flblue.com/plan-brochure/bs?id=1464U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120060","BlueSelect Silver 1464","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120060-03","BlueSelect Silver 1464","Limited Cost Sharing Plan Variation",,"0.718066851628673","No","Yes","No","100%",,"$5,500","$100","$600","$60","$0","$3,100","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","10.00%",,,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1464O.pdf","https://www.flblue.com/plan-brochure/bs?id=1464O"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120060","BlueSelect Silver 1464","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120060-04","BlueSelect Silver 1464","73% AV Level Silver Plan",,"0.738565054351971","No","Yes","No","100%",,"$5,000","$100","$700","$60","$0","$3,000","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$4,950","$4950 per person","$9900 per group","10.00%",,,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1464A.pdf","https://www.flblue.com/plan-brochure/bs?id=1464A"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120060","BlueSelect Silver 1464","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120060-05","BlueSelect Silver 1464","87% AV Level Silver Plan",,"0.874952450630743","No","Yes","No","100%",,"$1,500","$0","$800","$60","$0","$900","$0","$60","$600","$400","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1464B.pdf","https://www.flblue.com/plan-brochure/bs?id=1464B"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120060","BlueSelect Silver 1464","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120060-06","BlueSelect Silver 1464","94% AV Level Silver Plan",,"0.939738336098804","No","Yes","No","100%",,"$400","$20","$600","$60","$0","$500","$0","$60","$400","$200","$10","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","5.00%",,,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1464C.pdf","https://www.flblue.com/plan-brochure/bs?id=1464C"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120062","BlueSelect Platinum 1451","16842FL012","7700889661","FLN002","FLS002","FLF014","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120062-00","BlueSelect Platinum 1451","Standard Platinum Off Exchange Plan",,"0.907557078777632","No","Yes","No","100%",,"$800","$30","$800","$60","$0","$1,500","$0","$60","$800","$100","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1451.pdf","https://www.flblue.com/plan-brochure/bs?id=1451"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120062","BlueSelect Platinum 1451","16842FL012","7700889661","FLN002","FLS002","FLF014","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120062-01","BlueSelect Platinum 1451","Standard Platinum On Exchange Plan",,"0.907557078777632","No","Yes","No","100%",,"$800","$30","$800","$60","$0","$1,500","$0","$60","$800","$100","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1451.pdf","https://www.flblue.com/plan-brochure/bs?id=1451"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120062","BlueSelect Platinum 1451","16842FL012","7700889661","FLN002","FLS002","FLF014","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120062-02","BlueSelect Platinum 1451","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1451U.pdf","https://www.flblue.com/plan-brochure/bs?id=1451U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120062","BlueSelect Platinum 1451","16842FL012","7700889661","FLN002","FLS002","FLF014","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120062-03","BlueSelect Platinum 1451","Limited Cost Sharing Plan Variation",,"0.907557078777632","No","Yes","No","100%",,"$800","$30","$800","$60","$0","$1,500","$0","$60","$800","$100","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1451O.pdf","https://www.flblue.com/plan-brochure/bs?id=1451O"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120068","BlueSelect Bronze 1449","16842FL012","7700889661","FLN002","FLS002","FLF013","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120068-00","BlueSelect Bronze 1449","Standard Bronze Off Exchange Plan",,"0.64851616055622","Yes","Yes","No","100%",,"$6,400","$200","$0","$60","$4,600","$1,200","$0","$60","$1,300","$300","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group",,,,"$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"$12,800","$12800 per person","$25600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1449.pdf","https://www.flblue.com/plan-brochure/bs?id=1449"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120068","BlueSelect Bronze 1449","16842FL012","7700889661","FLN002","FLS002","FLF013","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120068-01","BlueSelect Bronze 1449","Standard Bronze On Exchange Plan",,"0.64851616055622","Yes","Yes","No","100%",,"$6,400","$200","$0","$60","$4,600","$1,200","$0","$60","$1,300","$300","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group",,,,"$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"$12,800","$12800 per person","$25600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1449.pdf","https://www.flblue.com/plan-brochure/bs?id=1449"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120076","BlueSelect Gold 1535","16842FL012","7700889661","FLN002","FLS002","FLF018","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120076-01","BlueSelect Gold 1535","Standard Gold On Exchange Plan",,"0.793559831541356","Yes","Yes","No","100%",,"$0","$700","$0","$60","$0","$2,200","$0","$60","$0","$800","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1535.pdf","https://www.flblue.com/plan-brochure/bs?id=1535"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120076","BlueSelect Gold 1535","16842FL012","7700889661","FLN002","FLS002","FLF018","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120076-02","BlueSelect Gold 1535","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1535U.pdf","https://www.flblue.com/plan-brochure/bs?id=1535U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120068","BlueSelect Bronze 1449","16842FL012","7700889661","FLN002","FLS002","FLF013","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120068-02","BlueSelect Bronze 1449","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1449U.pdf","https://www.flblue.com/plan-brochure/bs?id=1449U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120068","BlueSelect Bronze 1449","16842FL012","7700889661","FLN002","FLS002","FLF013","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120068-03","BlueSelect Bronze 1449","Limited Cost Sharing Plan Variation",,"0.64851616055622","Yes","Yes","No","100%",,"$6,400","$200","$0","$60","$4,600","$1,200","$0","$60","$1,300","$300","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group",,,,"$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"$12,800","$12800 per person","$25600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1449O.pdf","https://www.flblue.com/plan-brochure/bs?id=1449O"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120070","BlueSelect Platinum 1457","16842FL012","7700889661","FLN002","FLS002","FLF014","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120070-00","BlueSelect Platinum 1457","Standard Platinum Off Exchange Plan",,"0.898778496100588","Yes","Yes","No","100%",,"$0","$400","$0","$60","$0","$1,500","$0","$60","$0","$500","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1457.pdf","https://www.flblue.com/plan-brochure/bs?id=1457"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120070","BlueSelect Platinum 1457","16842FL012","7700889661","FLN002","FLS002","FLF014","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120070-01","BlueSelect Platinum 1457","Standard Platinum On Exchange Plan",,"0.898778496100588","Yes","Yes","No","100%",,"$0","$400","$0","$60","$0","$1,500","$0","$60","$0","$500","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1457.pdf","https://www.flblue.com/plan-brochure/bs?id=1457"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120070","BlueSelect Platinum 1457","16842FL012","7700889661","FLN002","FLS002","FLF014","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120070-02","BlueSelect Platinum 1457","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1457U.pdf","https://www.flblue.com/plan-brochure/bs?id=1457U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120072","BlueSelect Silver 1443","16842FL012","7700889661","FLN002","FLS002","FLF012","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120072-05","BlueSelect Silver 1443","87% AV Level Silver Plan",,"0.878972613666946","Yes","Yes","No","100%",,"$0","$0","$2,500","$60","$0","$1,800","$0","$60","$0","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1443B.pdf","https://www.flblue.com/plan-brochure/bs?id=1443B"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120072","BlueSelect Silver 1443","16842FL012","7700889661","FLN002","FLS002","FLF012","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120072-06","BlueSelect Silver 1443","94% AV Level Silver Plan",,"0.949963752401131","Yes","Yes","No","100%",,"$0","$0","$1,300","$60","$0","$800","$0","$60","$0","$200","$100","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25.00%",,,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1443C.pdf","https://www.flblue.com/plan-brochure/bs?id=1443C"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120076","BlueSelect Gold 1535","16842FL012","7700889661","FLN002","FLS002","FLF018","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120076-00","BlueSelect Gold 1535","Standard Gold Off Exchange Plan",,"0.793559831541356","Yes","Yes","No","100%",,"$0","$700","$0","$60","$0","$2,200","$0","$60","$0","$800","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1535.pdf","https://www.flblue.com/plan-brochure/bs?id=1535"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120076","BlueSelect Gold 1535","16842FL012","7700889661","FLN002","FLS002","FLF018","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120076-03","BlueSelect Gold 1535","Limited Cost Sharing Plan Variation",,"0.793559831541356","Yes","Yes","No","100%",,"$0","$700","$0","$60","$0","$2,200","$0","$60","$0","$800","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1535O.pdf","https://www.flblue.com/plan-brochure/bs?id=1535O"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120070","BlueSelect Platinum 1457","16842FL012","7700889661","FLN002","FLS002","FLF014","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120070-03","BlueSelect Platinum 1457","Limited Cost Sharing Plan Variation",,"0.898778496100588","Yes","Yes","No","100%",,"$0","$400","$0","$60","$0","$1,500","$0","$60","$0","$500","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1457O.pdf","https://www.flblue.com/plan-brochure/bs?id=1457O"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120072","BlueSelect Silver 1443","16842FL012","7700889661","FLN002","FLS002","FLF012","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120072-00","BlueSelect Silver 1443","Standard Silver Off Exchange Plan",,"0.660137929082671","Yes","Yes","No","100%",,"$6,100","$0","$1,300","$60","$1,100","$2,000","$0","$60","$1,400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group","50.00%",,,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1443.pdf","https://www.flblue.com/plan-brochure/bs?id=1443"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120072","BlueSelect Silver 1443","16842FL012","7700889661","FLN002","FLS002","FLF012","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120072-01","BlueSelect Silver 1443","Standard Silver On Exchange Plan",,"0.660137929082671","Yes","Yes","No","100%",,"$6,100","$0","$1,300","$60","$1,100","$2,000","$0","$60","$1,400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group","50.00%",,,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1443.pdf","https://www.flblue.com/plan-brochure/bs?id=1443"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120072","BlueSelect Silver 1443","16842FL012","7700889661","FLN002","FLS002","FLF012","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120072-02","BlueSelect Silver 1443","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1443U.pdf","https://www.flblue.com/plan-brochure/bs?id=1443U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120072","BlueSelect Silver 1443","16842FL012","7700889661","FLN002","FLS002","FLF012","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120072-03","BlueSelect Silver 1443","Limited Cost Sharing Plan Variation",,"0.660137929082671","Yes","Yes","No","100%",,"$6,100","$0","$1,300","$60","$1,100","$2,000","$0","$60","$1,400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group","50.00%",,,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1443O.pdf","https://www.flblue.com/plan-brochure/bs?id=1443O"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120072","BlueSelect Silver 1443","16842FL012","7700889661","FLN002","FLS002","FLF012","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120072-04","BlueSelect Silver 1443","73% AV Level Silver Plan",,"0.738962761332475","Yes","Yes","No","100%",,"$5,000","$0","$600","$60","$0","$2,400","$0","$60","$600","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$5550 per person","$11100 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1443A.pdf","https://www.flblue.com/plan-brochure/bs?id=1443A"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120078","BlueSelect Bronze (HSA) 1735","16842FL012","7700889661","FLN002","FLS002","FLF019","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices_HSA.pdf","16842FL0120078-00","BlueSelect Bronze (HSA) 1735","Standard Bronze Off Exchange Plan",,"0.61972055561931","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$5,400","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1735.pdf","https://www.flblue.com/plan-brochure/bs?id=1735"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120078","BlueSelect Bronze (HSA) 1735","16842FL012","7700889661","FLN002","FLS002","FLF019","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices_HSA.pdf","16842FL0120078-01","BlueSelect Bronze (HSA) 1735","Standard Bronze On Exchange Plan",,"0.61972055561931","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$5,400","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1735.pdf","https://www.flblue.com/plan-brochure/bs?id=1735"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120078","BlueSelect Bronze (HSA) 1735","16842FL012","7700889661","FLN002","FLS002","FLF019","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices_HSA.pdf","16842FL0120078-02","BlueSelect Bronze (HSA) 1735","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1735U.pdf","https://www.flblue.com/plan-brochure/bs?id=1735U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120078","BlueSelect Bronze (HSA) 1735","16842FL012","7700889661","FLN002","FLS002","FLF019","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices_HSA.pdf","16842FL0120078-03","BlueSelect Bronze (HSA) 1735","Limited Cost Sharing Plan Variation",,"0.61972055561931","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$5,400","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1735O.pdf","https://www.flblue.com/plan-brochure/bs?id=1735O"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120080","BlueSelect Silver 1736S","16842FL012","7700889661","FLN002","FLS002","FLF020","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120080-00","BlueSelect Silver 1736S","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$40","$1,800","$60","$100","$2,400","$0","$60","$800","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1736S.pdf","https://www.flblue.com/plan-brochure/bs?id=1736S"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120080","BlueSelect Silver 1736S","16842FL012","7700889661","FLN002","FLS002","FLF020","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120080-01","BlueSelect Silver 1736S","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$40","$1,800","$60","$100","$2,400","$0","$60","$800","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1736S.pdf","https://www.flblue.com/plan-brochure/bs?id=1736S"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120080","BlueSelect Silver 1736S","16842FL012","7700889661","FLN002","FLS002","FLF020","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120080-02","BlueSelect Silver 1736S","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1736US.pdf","https://www.flblue.com/plan-brochure/bs?id=1736US"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120080","BlueSelect Silver 1736S","16842FL012","7700889661","FLN002","FLS002","FLF020","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120080-03","BlueSelect Silver 1736S","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$40","$1,800","$60","$100","$2,400","$0","$60","$800","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1736OS.pdf","https://www.flblue.com/plan-brochure/bs?id=1736OS"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120080","BlueSelect Silver 1736S","16842FL012","7700889661","FLN002","FLS002","FLF020","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120080-04","BlueSelect Silver 1736S","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$40","$1,900","$60","$100","$2,400","$0","$60","$800","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1736AS.pdf","https://www.flblue.com/plan-brochure/bs?id=1736AS"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120080","BlueSelect Silver 1736S","16842FL012","7700889661","FLN002","FLS002","FLF020","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120080-05","BlueSelect Silver 1736S","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,800","$60","$100","$1,300","$0","$60","$700","$100","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1736BS.pdf","https://www.flblue.com/plan-brochure/bs?id=1736BS"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120080","BlueSelect Silver 1736S","16842FL012","7700889661","FLN002","FLS002","FLF020","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120080-06","BlueSelect Silver 1736S","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$300","$10","$600","$60","$100","$400","$0","$60","$300","$50","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1736CS.pdf","https://www.flblue.com/plan-brochure/bs?id=1736CS"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120082","BlueSelect Bronze 1737S","16842FL012","7700889661","FLN002","FLS002","FLF021","Existing","EPO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120082-00","BlueSelect Bronze 1737S","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,700","$0","$700","$60","$5,700","$700","$0","$60","$1,300","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1737S.pdf","https://www.flblue.com/plan-brochure/bs?id=1737S"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120082","BlueSelect Bronze 1737S","16842FL012","7700889661","FLN002","FLS002","FLF021","Existing","EPO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120082-01","BlueSelect Bronze 1737S","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,700","$0","$700","$60","$5,700","$700","$0","$60","$1,300","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1737S.pdf","https://www.flblue.com/plan-brochure/bs?id=1737S"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120082","BlueSelect Bronze 1737S","16842FL012","7700889661","FLN002","FLS002","FLF021","Existing","EPO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120082-02","BlueSelect Bronze 1737S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1737US.pdf","https://www.flblue.com/plan-brochure/bs?id=1737US"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120082","BlueSelect Bronze 1737S","16842FL012","7700889661","FLN002","FLS002","FLF021","Existing","EPO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120082-03","BlueSelect Bronze 1737S","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,700","$0","$700","$60","$5,700","$700","$0","$60","$1,300","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1737OS.pdf","https://www.flblue.com/plan-brochure/bs?id=1737OS"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120086","BlueSelect Gold 1835","16842FL012","7700889661","FLN002","FLS002","FLF022","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120086-00","BlueSelect Gold 1835","Standard Gold Off Exchange Plan",,"0.782585041781306","No","Yes","No","100%",,"$2,000","$100","$1,400","$60","$0","$2,800","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1835.pdf","https://www.flblue.com/plan-brochure/bs?id=1835"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120086","BlueSelect Gold 1835","16842FL012","7700889661","FLN002","FLS002","FLF022","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120086-01","BlueSelect Gold 1835","Standard Gold On Exchange Plan",,"0.782585041781306","No","Yes","No","100%",,"$2,000","$100","$1,400","$60","$0","$2,800","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1835.pdf","https://www.flblue.com/plan-brochure/bs?id=1835"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120086","BlueSelect Gold 1835","16842FL012","7700889661","FLN002","FLS002","FLF022","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120086-02","BlueSelect Gold 1835","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1835U.pdf","https://www.flblue.com/plan-brochure/bs?id=1835U"
"2018","FL","16842","HIOS","2017-09-06 02:20:26","Individual","No","59-2015694","16842FL0120086","BlueSelect Gold 1835","16842FL012","7700889661","FLN002","FLS002","FLF022","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","16842FL0120086-03","BlueSelect Gold 1835","Limited Cost Sharing Plan Variation",,"0.782585041781306","No","Yes","No","100%",,"$2,000","$100","$1,400","$60","$0","$2,800","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1835O.pdf","https://www.flblue.com/plan-brochure/bs?id=1835O"
"2018","FL","17121","HIOS","2017-08-17 02:20:39","Individual","Yes","95-6042390","17121FL0020003","BEST Dental Advantage - Gold","17121FL002",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","17121FL0020003-00","BEST Dental Advantage - Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","FL","17121","HIOS","2017-08-17 02:20:39","Individual","Yes","95-6042390","17121FL0020003","BEST Dental Advantage - Gold","17121FL002",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","17121FL0020003-01","BEST Dental Advantage - Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","FL","17121","HIOS","2017-08-17 02:20:39","Individual","Yes","95-6042390","17121FL0020004","BEST Dental Plus - Gold","17121FL002",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","17121FL0020004-00","BEST Dental Plus - Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","FL","17121","HIOS","2017-08-17 02:20:39","Individual","Yes","95-6042390","17121FL0020004","BEST Dental Plus - Gold","17121FL002",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","17121FL0020004-01","BEST Dental Plus - Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","FL","17121","HIOS","2017-08-17 02:20:39","Individual","Yes","95-6042390","17121FL0020005","BEST Dental Plus - Silver","17121FL002",,"FLN001","FLS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","17121FL0020005-00","BEST Dental Plus - Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","FL","17121","HIOS","2017-08-17 02:20:39","Individual","Yes","95-6042390","17121FL0020005","BEST Dental Plus - Silver","17121FL002",,"FLN001","FLS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","17121FL0020005-01","BEST Dental Plus - Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","FL","17121","HIOS","2017-08-17 02:20:39","Individual","Yes","95-6042390","17121FL0020006","BEST Dental Basic - Silver","17121FL002",,"FLN001","FLS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","17121FL0020006-00","BEST Dental Basic - Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","FL","17121","HIOS","2017-08-17 02:20:39","Individual","Yes","95-6042390","17121FL0020006","BEST Dental Basic - Silver","17121FL002",,"FLN001","FLS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","17121FL0020006-01","BEST Dental Basic - Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130001","Ambetter Secure Care 3 (2018) with 3 Free PCP Visits","21663FL013",,"FLN001","FLS001","FLF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130001-00","Ambetter Secure Care 3 (2018) with 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.795003190493173","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/21663FL0130001-00.pdf","https://api.centene.com/Brochures/2018/21663FL0130001-00.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130001","Ambetter Secure Care 3 (2018) with 3 Free PCP Visits","21663FL013",,"FLN001","FLS001","FLF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130001-01","Ambetter Secure Care 3 (2018) with 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.795003190493173","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/21663FL0130001-01.pdf","https://api.centene.com/Brochures/2017/21663FL0130001-01.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130001","Ambetter Secure Care 3 (2018) with 3 Free PCP Visits","21663FL013",,"FLN001","FLS001","FLF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130001-02","Ambetter Secure Care 3 (2018) with 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/21663FL0130001-02.pdf","https://api.centene.com/Brochures/2017/21663FL0130001-02.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130001","Ambetter Secure Care 3 (2018) with 3 Free PCP Visits","21663FL013",,"FLN001","FLS001","FLF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130001-03","Ambetter Secure Care 3 (2018) with 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.795003190493173","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2017/21663FL0130001-03.pdf","https://api.centene.com/Brochures/2017/21663FL0130001-03.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2018)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130002-00","Ambetter Balanced Care 1 (2018)","Standard Silver Off Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130002-00.pdf","https://api.centene.com/Brochures/2018/21663FL0130002-00.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2018)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130002-01","Ambetter Balanced Care 1 (2018)","Standard Silver On Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130002-01.pdf","https://api.centene.com/Brochures/2018/21663FL0130002-01.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2018)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130002-02","Ambetter Balanced Care 1 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130002-02.pdf","https://api.centene.com/Brochures/2018/21663FL0130002-02.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2018)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130002-03","Ambetter Balanced Care 1 (2018)","Limited Cost Sharing Plan Variation",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130002-03.pdf","https://api.centene.com/Brochures/2018/21663FL0130002-03.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2018)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130002-04","Ambetter Balanced Care 1 (2018)","73% AV Level Silver Plan",,"0.739812128349422","Yes","Yes","No","100%",,"$3,000","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130002-04.pdf","https://api.centene.com/Brochures/2018/21663FL0130002-04.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2018)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130002-05","Ambetter Balanced Care 1 (2018)","87% AV Level Silver Plan",,"0.87931537568396","Yes","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$300","$400","$60","$750","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130002-05.pdf","https://api.centene.com/Brochures/2018/21663FL0130002-05.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2018)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130002-06","Ambetter Balanced Care 1 (2018)","94% AV Level Silver Plan",,"0.949528260595198","Yes","Yes","No","100%",,"$0","$0","$950","$60","$0","$300","$400","$60","$0","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130002-06.pdf","https://api.centene.com/Brochures/2018/21663FL0130002-06.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2018)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130003-00","Ambetter Balanced Care 2 (2018)","Standard Silver Off Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130003-00.pdf","https://api.centene.com/Brochures/2018/21663FL0130003-00.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2018)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130003-01","Ambetter Balanced Care 2 (2018)","Standard Silver On Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130003-01.pdf","https://api.centene.com/Brochures/2018/21663FL0130003-01.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2018)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130003-02","Ambetter Balanced Care 2 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130003-02.pdf","https://api.centene.com/Brochures/2018/21663FL0130003-02.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2018)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130003-03","Ambetter Balanced Care 2 (2018)","Limited Cost Sharing Plan Variation",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130003-03.pdf","https://api.centene.com/Brochures/2018/21663FL0130003-03.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2018)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130003-04","Ambetter Balanced Care 2 (2018)","73% AV Level Silver Plan",,"0.729896135538709","Yes","Yes","No","100%",,"$4,600","$400","$0","$60","$1,900","$1,400","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130003-04.pdf","https://api.centene.com/Brochures/2018/21663FL0130003-04.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2018)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130003-05","Ambetter Balanced Care 2 (2018)","87% AV Level Silver Plan",,"0.867181007012531","Yes","Yes","No","100%",,"$1,700","$10","$0","$60","$1,500","$250","$0","$60","$1,600","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130003-05.pdf","https://api.centene.com/Brochures/2018/21663FL0130003-05.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2018)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130003-06","Ambetter Balanced Care 2 (2018)","94% AV Level Silver Plan",,"0.942313720589882","Yes","Yes","No","100%",,"$572","$3","$0","$60","$500","$70","$0","$60","$575","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130003-06.pdf","https://api.centene.com/Brochures/2018/21663FL0130003-06.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2018)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130005-00","Ambetter Balanced Care 10 (2018)","Standard Silver Off Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130005-00.pdf","https://api.centene.com/Brochures/2018/21663FL0130005-00.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2018)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130005-01","Ambetter Balanced Care 10 (2018)","Standard Silver On Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130005-01.pdf","https://api.centene.com/Brochures/2018/21663FL0130005-01.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2018)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130005-02","Ambetter Balanced Care 10 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130005-02.pdf","https://api.centene.com/Brochures/2018/21663FL0130005-02.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2018)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130005-03","Ambetter Balanced Care 10 (2018)","Limited Cost Sharing Plan Variation",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130005-03.pdf","https://api.centene.com/Brochures/2018/21663FL0130005-03.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2018)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130005-04","Ambetter Balanced Care 10 (2018)","73% AV Level Silver Plan",,"0.73985223196154","Yes","Yes","No","100%",,"$3,700","$100","$2,000","$60","$1,500","$900","$400","$60","$1,300","$90","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130005-04.pdf","https://api.centene.com/Brochures/2018/21663FL0130005-04.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2018)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130005-05","Ambetter Balanced Care 10 (2018)","87% AV Level Silver Plan",,"0.879858510990049","Yes","Yes","No","100%",,"$800","$0","$1,400","$60","$850","$300","$400","$60","$850","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130005-05.pdf","https://api.centene.com/Brochures/2018/21663FL0130005-05.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2018)","21663FL013",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130005-06","Ambetter Balanced Care 10 (2018)","94% AV Level Silver Plan",,"0.949794807417026","Yes","Yes","No","100%",,"$250","$0","$300","$60","$250","$160","$185","$60","$250","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$595","$595 per person","$1190 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130005-06.pdf","https://api.centene.com/Brochures/2018/21663FL0130005-06.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130008","Ambetter Balanced Care 3 (2018)","21663FL013",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130008-00","Ambetter Balanced Care 3 (2018)","Standard Silver Off Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130008-00.pdf","https://api.centene.com/Brochures/2018/21663FL0130008-00.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130008","Ambetter Balanced Care 3 (2018)","21663FL013",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130008-01","Ambetter Balanced Care 3 (2018)","Standard Silver On Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130008-01.pdf","https://api.centene.com/Brochures/2018/21663FL0130008-01.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130008","Ambetter Balanced Care 3 (2018)","21663FL013",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130008-02","Ambetter Balanced Care 3 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130008-02.pdf","https://api.centene.com/Brochures/2018/21663FL0130008-02.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130008","Ambetter Balanced Care 3 (2018)","21663FL013",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130008-03","Ambetter Balanced Care 3 (2018)","Limited Cost Sharing Plan Variation",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130008-03.pdf","https://api.centene.com/Brochures/2018/21663FL0130008-03.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130008","Ambetter Balanced Care 3 (2018)","21663FL013",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130008-04","Ambetter Balanced Care 3 (2018)","73% AV Level Silver Plan",,"0.739635889295605","Yes","Yes","No","100%",,"$1,950","$1,300","$300","$60","$1,300","$1,700","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130008-04.pdf","https://api.centene.com/Brochures/2018/21663FL0130008-04.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130008","Ambetter Balanced Care 3 (2018)","21663FL013",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130008-05","Ambetter Balanced Care 3 (2018)","87% AV Level Silver Plan",,"0.879959544313859","Yes","Yes","No","100%",,"$675","$200","$300","$60","$675","$300","$600","$60","$675","$20","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130008-05.pdf","https://api.centene.com/Brochures/2018/21663FL0130008-05.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130008","Ambetter Balanced Care 3 (2018)","21663FL013",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130008-06","Ambetter Balanced Care 3 (2018)","94% AV Level Silver Plan",,"0.949879112635725","Yes","Yes","No","100%",,"$200","$90","$300","$60","$200","$200","$200","$60","$200","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130008-06.pdf","https://api.centene.com/Brochures/2018/21663FL0130008-06.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130009","Ambetter Balanced Care 4 (2018)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130009-00","Ambetter Balanced Care 4 (2018)","Standard Silver Off Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130009-00.pdf","https://api.centene.com/Brochures/2018/21663FL0130009-00.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130009","Ambetter Balanced Care 4 (2018)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130009-01","Ambetter Balanced Care 4 (2018)","Standard Silver On Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130009-01.pdf","https://api.centene.com/Brochures/2018/21663FL0130009-01.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130009","Ambetter Balanced Care 4 (2018)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130009-02","Ambetter Balanced Care 4 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130009-02.pdf","https://api.centene.com/Brochures/2018/21663FL0130009-02.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130009","Ambetter Balanced Care 4 (2018)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130009-03","Ambetter Balanced Care 4 (2018)","Limited Cost Sharing Plan Variation",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130009-03.pdf","https://api.centene.com/Brochures/2018/21663FL0130009-03.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130009","Ambetter Balanced Care 4 (2018)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130009-04","Ambetter Balanced Care 4 (2018)","73% AV Level Silver Plan",,"0.727430168333116","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$1,800","$1,300","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130009-04.pdf","https://api.centene.com/Brochures/2018/21663FL0130009-04.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130009","Ambetter Balanced Care 4 (2018)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130009-05","Ambetter Balanced Care 4 (2018)","87% AV Level Silver Plan",,"0.863154651499334","Yes","Yes","No","100%",,"$1,850","$0","$0","$60","$1,850","$0","$0","$60","$1,630","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130009-05.pdf","https://api.centene.com/Brochures/2018/21663FL0130009-05.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130009","Ambetter Balanced Care 4 (2018)","21663FL013",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130009-06","Ambetter Balanced Care 4 (2018)","94% AV Level Silver Plan",,"0.940719200046497","Yes","Yes","No","100%",,"$600","$0","$0","$60","$600","$0","$0","$60","$600","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130009-06.pdf","https://api.centene.com/Brochures/2018/21663FL0130009-06.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130010","Ambetter Balanced Care 12 (2018)","21663FL013",,"FLN001","FLS001","FLF005","Existing","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130010-00","Ambetter Balanced Care 12 (2018)","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/21663FL0130010-00.pdf","https://api.centene.com/Brochures/2018/21663FL0130010-00.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130010","Ambetter Balanced Care 12 (2018)","21663FL013",,"FLN001","FLS001","FLF005","Existing","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130010-01","Ambetter Balanced Care 12 (2018)","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/21663FL0130010-01.pdf","https://api.centene.com/Brochures/2018/21663FL0130010-01.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130010","Ambetter Balanced Care 12 (2018)","21663FL013",,"FLN001","FLS001","FLF005","Existing","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130010-02","Ambetter Balanced Care 12 (2018)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/21663FL0130010-02.pdf","https://api.centene.com/Brochures/2018/21663FL0130010-02.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130010","Ambetter Balanced Care 12 (2018)","21663FL013",,"FLN001","FLS001","FLF005","Existing","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130010-03","Ambetter Balanced Care 12 (2018)","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/21663FL0130010-03.pdf","https://api.centene.com/Brochures/2018/21663FL0130010-03.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130010","Ambetter Balanced Care 12 (2018)","21663FL013",,"FLN001","FLS001","FLF005","Existing","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130010-04","Ambetter Balanced Care 12 (2018)","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/21663FL0130010-04.pdf","https://api.centene.com/Brochures/2018/21663FL0130010-04.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130010","Ambetter Balanced Care 12 (2018)","21663FL013",,"FLN001","FLS001","FLF005","Existing","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130010-05","Ambetter Balanced Care 12 (2018)","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$100","$1,600","$60","$700","$600","$400","$60","$700","$80","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/21663FL0130010-05.pdf","https://api.centene.com/Brochures/2018/21663FL0130010-05.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130010","Ambetter Balanced Care 12 (2018)","21663FL013",,"FLN001","FLS001","FLF005","Existing","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130010-06","Ambetter Balanced Care 12 (2018)","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$100","$500","$60","$250","$200","$90","$60","$250","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/21663FL0130010-06.pdf","https://api.centene.com/Brochures/2018/21663FL0130010-06.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130006","Ambetter Essential Care 1 (2018)","21663FL013",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130006-00","Ambetter Essential Care 1 (2018)","Standard Bronze Off Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130006-00.pdf","https://api.centene.com/Brochures/2018/21663FL0130006-00.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130006","Ambetter Essential Care 1 (2018)","21663FL013",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130006-01","Ambetter Essential Care 1 (2018)","Standard Bronze On Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130006-01.pdf","https://api.centene.com/Brochures/2018/21663FL0130006-01.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130006","Ambetter Essential Care 1 (2018)","21663FL013",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130006-02","Ambetter Essential Care 1 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130006-02.pdf","https://api.centene.com/Brochures/2018/21663FL0130006-02.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130006","Ambetter Essential Care 1 (2018)","21663FL013",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130006-03","Ambetter Essential Care 1 (2018)","Limited Cost Sharing Plan Variation",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130006-03.pdf","https://api.centene.com/Brochures/2018/21663FL0130006-03.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130070","Ambetter Balanced Care 5 (2018)","21663FL013",,"FLN001","FLS001","FLF007","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130070-00","Ambetter Balanced Care 5 (2018)","Standard Silver Off Exchange Plan","66.25%","0.661631852049009","Yes","Yes","No","100%",,"$6,800","$550","$0","$60","$1,900","$1,900","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130070-00.pdf","https://api.centene.com/Brochures/2018/21663FL0130070-00.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130070","Ambetter Balanced Care 5 (2018)","21663FL013",,"FLN001","FLS001","FLF007","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130070-01","Ambetter Balanced Care 5 (2018)","Standard Silver On Exchange Plan","66.25%","0.661631852049009","Yes","Yes","No","100%",,"$6,800","$550","$0","$60","$1,900","$1,900","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130070-01.pdf","https://api.centene.com/Brochures/2018/21663FL0130070-01.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130070","Ambetter Balanced Care 5 (2018)","21663FL013",,"FLN001","FLS001","FLF007","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130070-02","Ambetter Balanced Care 5 (2018)","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130070-02.pdf","https://api.centene.com/Brochures/2018/21663FL0130070-02.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130070","Ambetter Balanced Care 5 (2018)","21663FL013",,"FLN001","FLS001","FLF007","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130070-03","Ambetter Balanced Care 5 (2018)","Limited Cost Sharing Plan Variation","66.25%","0.661631852049009","Yes","Yes","No","100%",,"$6,800","$550","$0","$60","$1,900","$1,900","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130070-03.pdf","https://api.centene.com/Brochures/2018/21663FL0130070-03.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130070","Ambetter Balanced Care 5 (2018)","21663FL013",,"FLN001","FLS001","FLF007","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130070-04","Ambetter Balanced Care 5 (2018)","73% AV Level Silver Plan","72.15%","0.718557057101132","Yes","Yes","No","100%",,"$5,000","$300","$0","$60","$1,900","$1,500","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130070-04.pdf","https://api.centene.com/Brochures/2018/21663FL0130070-04.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130070","Ambetter Balanced Care 5 (2018)","21663FL013",,"FLN001","FLS001","FLF007","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130070-05","Ambetter Balanced Care 5 (2018)","87% AV Level Silver Plan","86.18%","0.858472329117886","Yes","Yes","No","100%",,"$1,950","$0","$0","$60","$1,600","$300","$0","$60","$1,600","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130070-05.pdf","https://api.centene.com/Brochures/2018/21663FL0130070-05.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0130070","Ambetter Balanced Care 5 (2018)","21663FL013",,"FLN001","FLS001","FLF007","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0130070-06","Ambetter Balanced Care 5 (2018)","94% AV Level Silver Plan","93.63%","0.935092701963358","Yes","Yes","No","100%",,"$675","$0","$0","$60","$565","$100","$0","$60","$675","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0130070-06.pdf","https://api.centene.com/Brochures/2018/21663FL0130070-06.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140001-00","Ambetter Balanced Care 1 (2018) + Vision","Standard Silver Off Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140001-00.pdf","https://api.centene.com/Brochures/2018/21663FL0140001-00.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140001-01","Ambetter Balanced Care 1 (2018) + Vision","Standard Silver On Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140001-01.pdf","https://api.centene.com/Brochures/2018/21663FL0140001-01.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140001-02","Ambetter Balanced Care 1 (2018) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140001-02.pdf","https://api.centene.com/Brochures/2018/21663FL0140001-02.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140001-03","Ambetter Balanced Care 1 (2018) + Vision","Limited Cost Sharing Plan Variation",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140001-03.pdf","https://api.centene.com/Brochures/2018/21663FL0140001-03.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140001-04","Ambetter Balanced Care 1 (2018) + Vision","73% AV Level Silver Plan",,"0.739812128349422","Yes","Yes","No","100%",,"$3,000","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140001-04.pdf","https://api.centene.com/Brochures/2018/21663FL0140001-04.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140001-05","Ambetter Balanced Care 1 (2018) + Vision","87% AV Level Silver Plan",,"0.87931537568396","Yes","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$300","$400","$60","$750","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140001-05.pdf","https://api.centene.com/Brochures/2018/21663FL0140001-05.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140001-06","Ambetter Balanced Care 1 (2018) + Vision","94% AV Level Silver Plan",,"0.949528260595198","Yes","Yes","No","100%",,"$0","$0","$950","$60","$0","$300","$400","$60","$0","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140001-06.pdf","https://api.centene.com/Brochures/2018/21663FL0140001-06.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140002-00","Ambetter Balanced Care 2 (2018) + Vision","Standard Silver Off Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140002-00.pdf","https://api.centene.com/Brochures/2018/21663FL0140002-00.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140002-01","Ambetter Balanced Care 2 (2018) + Vision","Standard Silver On Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140002-01.pdf","https://api.centene.com/Brochures/2018/21663FL0140002-01.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140002-02","Ambetter Balanced Care 2 (2018) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140002-02.pdf","https://api.centene.com/Brochures/2018/21663FL0140002-02.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140002-03","Ambetter Balanced Care 2 (2018) + Vision","Limited Cost Sharing Plan Variation",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140002-03.pdf","https://api.centene.com/Brochures/2018/21663FL0140002-03.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140002-04","Ambetter Balanced Care 2 (2018) + Vision","73% AV Level Silver Plan",,"0.729896135538709","Yes","Yes","No","100%",,"$4,600","$400","$0","$60","$1,900","$1,400","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140002-04.pdf","https://api.centene.com/Brochures/2018/21663FL0140002-04.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140002-05","Ambetter Balanced Care 2 (2018) + Vision","87% AV Level Silver Plan",,"0.867181007012531","Yes","Yes","No","100%",,"$1,700","$10","$0","$60","$1,500","$250","$0","$60","$1,600","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140002-05.pdf","https://api.centene.com/Brochures/2018/21663FL0140002-05.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140002-06","Ambetter Balanced Care 2 (2018) + Vision","94% AV Level Silver Plan",,"0.942313720589882","Yes","Yes","No","100%",,"$572","$3","$0","$60","$500","$70","$0","$60","$575","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140002-06.pdf","https://api.centene.com/Brochures/2018/21663FL0140002-06.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140003-00","Ambetter Balanced Care 10 (2018) + Vision","Standard Silver Off Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140003-00.pdf","https://api.centene.com/Brochures/2018/21663FL0140003-00.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140003-01","Ambetter Balanced Care 10 (2018) + Vision","Standard Silver On Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140003-01.pdf","https://api.centene.com/Brochures/2018/21663FL0140003-01.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140003-02","Ambetter Balanced Care 10 (2018) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140003-02.pdf","https://api.centene.com/Brochures/2018/21663FL0140003-02.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140003-03","Ambetter Balanced Care 10 (2018) + Vision","Limited Cost Sharing Plan Variation",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140003-03.pdf","https://api.centene.com/Brochures/2018/21663FL0140003-03.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140003-04","Ambetter Balanced Care 10 (2018) + Vision","73% AV Level Silver Plan",,"0.73985223196154","Yes","Yes","No","100%",,"$3,700","$100","$2,000","$60","$1,500","$900","$400","$60","$1,300","$90","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140003-04.pdf","https://api.centene.com/Brochures/2018/21663FL0140003-04.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140003-05","Ambetter Balanced Care 10 (2018) + Vision","87% AV Level Silver Plan",,"0.879858510990049","Yes","Yes","No","100%",,"$800","$0","$1,400","$60","$850","$300","$400","$60","$850","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140003-05.pdf","https://api.centene.com/Brochures/2018/21663FL0140003-05.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140003-06","Ambetter Balanced Care 10 (2018) + Vision","94% AV Level Silver Plan",,"0.949794807417026","Yes","Yes","No","100%",,"$250","$0","$300","$60","$250","$160","$185","$60","$250","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$595","$595 per person","$1190 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140003-06.pdf","https://api.centene.com/Brochures/2018/21663FL0140003-06.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140006","Ambetter Balanced Care 3 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140006-00","Ambetter Balanced Care 3 (2018) + Vision","Standard Silver Off Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140006-00.pdf","https://api.centene.com/Brochures/2018/21663FL0140006-00.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140006","Ambetter Balanced Care 3 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140006-01","Ambetter Balanced Care 3 (2018) + Vision","Standard Silver On Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140006-01.pdf","https://api.centene.com/Brochures/2018/21663FL0140006-01.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140006","Ambetter Balanced Care 3 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140006-02","Ambetter Balanced Care 3 (2018) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140006-02.pdf","https://api.centene.com/Brochures/2018/21663FL0140006-02.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140006","Ambetter Balanced Care 3 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140006-03","Ambetter Balanced Care 3 (2018) + Vision","Limited Cost Sharing Plan Variation",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140006-03.pdf","https://api.centene.com/Brochures/2018/21663FL0140006-03.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140006","Ambetter Balanced Care 3 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140006-04","Ambetter Balanced Care 3 (2018) + Vision","73% AV Level Silver Plan",,"0.739635889295605","Yes","Yes","No","100%",,"$1,950","$1,300","$300","$60","$1,300","$1,700","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140006-04.pdf","https://api.centene.com/Brochures/2018/21663FL0140006-04.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140006","Ambetter Balanced Care 3 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140006-05","Ambetter Balanced Care 3 (2018) + Vision","87% AV Level Silver Plan",,"0.879959544313859","Yes","Yes","No","100%",,"$675","$200","$300","$60","$675","$300","$600","$60","$675","$20","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140006-05.pdf","https://api.centene.com/Brochures/2018/21663FL0140006-05.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140006","Ambetter Balanced Care 3 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140006-06","Ambetter Balanced Care 3 (2018) + Vision","94% AV Level Silver Plan",,"0.949879112635725","Yes","Yes","No","100%",,"$200","$90","$300","$60","$200","$200","$200","$60","$200","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140006-06.pdf","https://api.centene.com/Brochures/2018/21663FL0140006-06.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140004","Ambetter Essential Care 1 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140004-00","Ambetter Essential Care 1 (2018) + Vision","Standard Bronze Off Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140004-00.pdf","https://api.centene.com/Brochures/2018/21663FL0140004-00.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140004","Ambetter Essential Care 1 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140004-01","Ambetter Essential Care 1 (2018) + Vision","Standard Bronze On Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140004-01.pdf","https://api.centene.com/Brochures/2018/21663FL0140004-01.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140004","Ambetter Essential Care 1 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140004-02","Ambetter Essential Care 1 (2018) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140004-02.pdf","https://api.centene.com/Brochures/2018/21663FL0140004-02.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0140004","Ambetter Essential Care 1 (2018) + Vision","21663FL014",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9886",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0140004-03","Ambetter Essential Care 1 (2018) + Vision","Limited Cost Sharing Plan Variation",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0140004-03.pdf","https://api.centene.com/Brochures/2018/21663FL0140004-03.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150001-00","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150001-00.pdf","https://api.centene.com/Brochures/2018/21663FL0150001-00.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150001-01","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150001-01.pdf","https://api.centene.com/Brochures/2018/21663FL0150001-01.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150001-02","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150001-02.pdf","https://api.centene.com/Brochures/2018/21663FL0150001-02.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150001-03","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150001-03.pdf","https://api.centene.com/Brochures/2018/21663FL0150001-03.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150001-04","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.739812128349422","Yes","Yes","No","100%",,"$3,000","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150001-04.pdf","https://api.centene.com/Brochures/2018/21663FL0150001-04.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150001-05","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.87931537568396","Yes","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$300","$400","$60","$750","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150001-05.pdf","https://api.centene.com/Brochures/2018/21663FL0150001-05.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150001-06","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949528260595198","Yes","Yes","No","100%",,"$0","$0","$950","$60","$0","$300","$400","$60","$0","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150001-06.pdf","https://api.centene.com/Brochures/2018/21663FL0150001-06.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150002-00","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150002-00.pdf","https://api.centene.com/Brochures/2018/21663FL0150002-00.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150002-01","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150002-01.pdf","https://api.centene.com/Brochures/2018/21663FL0150002-01.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150002-02","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150002-02.pdf","https://api.centene.com/Brochures/2018/21663FL0150002-02.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150002-03","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150002-03.pdf","https://api.centene.com/Brochures/2018/21663FL0150002-03.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150002-04","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.729896135538709","Yes","Yes","No","100%",,"$4,600","$400","$0","$60","$1,900","$1,400","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150002-04.pdf","https://api.centene.com/Brochures/2018/21663FL0150002-04.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150002-05","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.867181007012531","Yes","Yes","No","100%",,"$1,700","$10","$0","$60","$1,500","$250","$0","$60","$1,600","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150002-05.pdf","https://api.centene.com/Brochures/2018/21663FL0150002-05.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150002-06","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.942313720589882","Yes","Yes","No","100%",,"$572","$3","$0","$60","$500","$70","$0","$60","$575","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150002-06.pdf","https://api.centene.com/Brochures/2018/21663FL0150002-06.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150003-00","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150003-00.pdf","https://api.centene.com/Brochures/2018/21663FL0150003-00.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150003-01","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150003-01.pdf","https://api.centene.com/Brochures/2018/21663FL0150003-01.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150003-02","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150003-02.pdf","https://api.centene.com/Brochures/2018/21663FL0150003-02.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150003-03","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150003-03.pdf","https://api.centene.com/Brochures/2018/21663FL0150003-03.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150003-04","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.73985223196154","Yes","Yes","No","100%",,"$3,700","$100","$2,000","$60","$1,500","$900","$400","$60","$1,300","$90","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150003-04.pdf","https://api.centene.com/Brochures/2018/21663FL0150003-04.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150003-05","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.879858510990049","Yes","Yes","No","100%",,"$800","$0","$1,400","$60","$850","$300","$400","$60","$850","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150003-05.pdf","https://api.centene.com/Brochures/2018/21663FL0150003-05.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150003-06","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949794807417026","Yes","Yes","No","100%",,"$250","$0","$300","$60","$250","$160","$185","$60","$250","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$595","$595 per person","$1190 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150003-06.pdf","https://api.centene.com/Brochures/2018/21663FL0150003-06.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150006","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150006-00","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150006-00.pdf","https://api.centene.com/Brochures/2018/21663FL0150006-00.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150006","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150006-01","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150006-01.pdf","https://api.centene.com/Brochures/2018/21663FL0150006-01.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150006","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150006-02","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150006-02.pdf","https://api.centene.com/Brochures/2018/21663FL0150006-02.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150006","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150006-03","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150006-03.pdf","https://api.centene.com/Brochures/2018/21663FL0150006-03.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150006","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150006-04","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.739635889295605","Yes","Yes","No","100%",,"$1,950","$1,300","$300","$60","$1,300","$1,700","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150006-04.pdf","https://api.centene.com/Brochures/2018/21663FL0150006-04.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150006","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150006-05","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.879959544313859","Yes","Yes","No","100%",,"$675","$200","$300","$60","$675","$300","$600","$60","$675","$20","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150006-05.pdf","https://api.centene.com/Brochures/2018/21663FL0150006-05.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150006","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF004","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150006-06","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949879112635725","Yes","Yes","No","100%",,"$200","$90","$300","$60","$200","$200","$200","$60","$200","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150006-06.pdf","https://api.centene.com/Brochures/2018/21663FL0150006-06.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150004","Ambetter Essential Care 1 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150004-00","Ambetter Essential Care 1 (2018) + Vision + Adult Dental","Standard Bronze Off Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150004-00.pdf","https://api.centene.com/Brochures/2018/21663FL0150004-00.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150004","Ambetter Essential Care 1 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150004-01","Ambetter Essential Care 1 (2018) + Vision + Adult Dental","Standard Bronze On Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150004-01.pdf","https://api.centene.com/Brochures/2018/21663FL0150004-01.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150004","Ambetter Essential Care 1 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150004-02","Ambetter Essential Care 1 (2018) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150004-02.pdf","https://api.centene.com/Brochures/2018/21663FL0150004-02.pdf"
"2018","FL","21663","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","21663FL0150004","Ambetter Essential Care 1 (2018) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF006","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.963",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","https://ambetter.sunshinehealth.com/resources/pharmacy-resources.html","21663FL0150004-03","Ambetter Essential Care 1 (2018) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/21663FL0150004-03.pdf","https://api.centene.com/Brochures/2018/21663FL0150004-03.pdf"
"2018","FL","30115","HIOS","2017-08-17 02:20:39","Individual","Yes","59-2876465","30115FL0010001","BlueDental Copayment Q","30115FL001",,"FLN002","FLS001",,"existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"yes","Out of area service benefits are available as defined in the Policy but members may have a higher cost share","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","","30115FL0010001-00","BlueDental Copayment Q","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.floridabluedental.com/~/media/FloridaBlueDental/Files/TransparencyInCoverage/16772-0118%20BlueDental%20Copayment%20Q%20Plan.ashx",
"2018","FL","30115","HIOS","2017-08-17 02:20:39","Individual","Yes","59-2876465","30115FL0010001","BlueDental Copayment Q","30115FL001",,"FLN002","FLS001",,"existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"yes","Out of area service benefits are available as defined in the Policy but members may have a higher cost share","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","","30115FL0010001-01","BlueDental Copayment Q","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.floridabluedental.com/~/media/FloridaBlueDental/Files/TransparencyInCoverage/16772-0118%20BlueDental%20Copayment%20Q%20Plan.ashx",
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020033","BlueCare Silver 1490","30252FL002","7346243208","FLN001","FLS001","FLF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020033-03","BlueCare Silver 1490","Limited Cost Sharing Plan Variation",,"0.681109567456173","No","Yes","No","100%",,"$6,000","$700","$0","$60","$3,000","$2,100","$0","$60","$200","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1490O.pdf","https://www.flblue.com/plan-brochure/bc?id=1490O"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020033","BlueCare Silver 1490","30252FL002","7346243208","FLN001","FLS001","FLF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020033-04","BlueCare Silver 1490","73% AV Level Silver Plan",,"0.737386190993512","No","Yes","No","100%",,"$3,000","$700","$0","$60","$3,000","$1,600","$0","$60","$200","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1490A.pdf","https://www.flblue.com/plan-brochure/bc?id=1490A"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020033","BlueCare Silver 1490","30252FL002","7346243208","FLN001","FLS001","FLF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020033-05","BlueCare Silver 1490","87% AV Level Silver Plan",,"0.873151773834928","No","Yes","No","100%",,"$600","$600","$0","$60","$0","$2,200","$0","$60","$200","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1490B.pdf","https://www.flblue.com/plan-brochure/bc?id=1490B"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020033","BlueCare Silver 1490","30252FL002","7346243208","FLN001","FLS001","FLF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020033-06","BlueCare Silver 1490","94% AV Level Silver Plan",,"0.939893168760571","No","Yes","No","100%",,"$0","$400","$0","$60","$0","$800","$0","$60","$0","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","$1050 per person","$2100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1490C.pdf","https://www.flblue.com/plan-brochure/bc?id=1490C"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020044","BlueCare Bronze 1486","30252FL002","7346243208","FLN001","FLS001","FLF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020044-00","BlueCare Bronze 1486","Standard Bronze Off Exchange Plan",,"0.599723362353384","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$5,600","$800","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1486.pdf","https://www.flblue.com/plan-brochure/bc?id=1486"
"2018","FL","30115","HIOS","2017-08-17 02:20:39","Individual","Yes","59-2876465","30115FL0020001","BlueDental Choice Q","30115FL002",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Out of service area benefits are available as defined in the Policy but may have a higher members cost share","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","","30115FL0020001-00","BlueDental Choice Q","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.floridabluedental.com/~/media/FloridaBlueDental/Files/TransparencyInCoverage/16771-0118%20BlueDental%20Choice%20Q%20Plan.ashx",
"2018","FL","30115","HIOS","2017-08-17 02:20:39","Individual","Yes","59-2876465","30115FL0020001","BlueDental Choice Q","30115FL002",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Out of service area benefits are available as defined in the Policy but may have a higher members cost share","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","","30115FL0020001-01","BlueDental Choice Q","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.floridabluedental.com/~/media/FloridaBlueDental/Files/TransparencyInCoverage/16771-0118%20BlueDental%20Choice%20Q%20Plan.ashx",
"2018","FL","30115","HIOS","2017-08-17 02:20:39","Individual","Yes","59-2876465","30115FL0040001","BlueDental Copayment QF","30115FL004",,"FLN002","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Out of service areas benefits are available as defined in the Policy buy may have a higher member cost share","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","","30115FL0040001-00","BlueDental Copayment QF","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.floridabluedental.com/~/media/FloridaBlueDental/Files/TransparencyInCoverage/16769-0118%20Copayment%20QF%20plan.ashx",
"2018","FL","30115","HIOS","2017-08-17 02:20:39","Individual","Yes","59-2876465","30115FL0040001","BlueDental Copayment QF","30115FL004",,"FLN002","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Out of service areas benefits are available as defined in the Policy buy may have a higher member cost share","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","","30115FL0040001-01","BlueDental Copayment QF","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.floridabluedental.com/~/media/FloridaBlueDental/Files/TransparencyInCoverage/16769-0118%20Copayment%20QF%20plan.ashx",
"2018","FL","30115","HIOS","2017-08-17 02:20:39","Individual","Yes","59-2876465","30115FL0050001","BlueDental Choice QF","30115FL005",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Out of service area benefits are available as defined in the Policy but may have a higher member cost share","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","","30115FL0050001-00","BlueDental Choice QF","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.floridabluedental.com/~/media/FloridaBlueDental/Files/TransparencyInCoverage/16768-0118%20Choice%20QF%20Plan.ashx",
"2018","FL","30115","HIOS","2017-08-17 02:20:39","Individual","Yes","59-2876465","30115FL0050001","BlueDental Choice QF","30115FL005",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Out of service area benefits are available as defined in the Policy but may have a higher member cost share","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","","30115FL0050001-01","BlueDental Choice QF","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.floridabluedental.com/~/media/FloridaBlueDental/Files/TransparencyInCoverage/16768-0118%20Choice%20QF%20Plan.ashx",
"2018","FL","30219","HIOS","2017-07-22 03:08:11","SHOP (Small Group)","Yes","65-0073323","30219FL0030001","Family Basic Dental Plan (Low)","30219FL003",,"FLN001","FLS001",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","30219FL0030001-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020033","BlueCare Silver 1490","30252FL002","7346243208","FLN001","FLS001","FLF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020033-00","BlueCare Silver 1490","Standard Silver Off Exchange Plan",,"0.681109567456173","No","Yes","No","100%",,"$6,000","$700","$0","$60","$3,000","$2,100","$0","$60","$200","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1490.pdf","https://www.flblue.com/plan-brochure/bc?id=1490"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020033","BlueCare Silver 1490","30252FL002","7346243208","FLN001","FLS001","FLF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020033-01","BlueCare Silver 1490","Standard Silver On Exchange Plan",,"0.681109567456173","No","Yes","No","100%",,"$6,000","$700","$0","$60","$3,000","$2,100","$0","$60","$200","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1490.pdf","https://www.flblue.com/plan-brochure/bc?id=1490"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020033","BlueCare Silver 1490","30252FL002","7346243208","FLN001","FLS001","FLF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020033-02","BlueCare Silver 1490","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1490U.pdf","https://www.flblue.com/plan-brochure/bc?id=1490U"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020044","BlueCare Bronze 1486","30252FL002","7346243208","FLN001","FLS001","FLF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020044-01","BlueCare Bronze 1486","Standard Bronze On Exchange Plan",,"0.599723362353384","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$5,600","$800","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1486.pdf","https://www.flblue.com/plan-brochure/bc?id=1486"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020044","BlueCare Bronze 1486","30252FL002","7346243208","FLN001","FLS001","FLF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020044-02","BlueCare Bronze 1486","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1486U.pdf","https://www.flblue.com/plan-brochure/bc?id=1486U"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020044","BlueCare Bronze 1486","30252FL002","7346243208","FLN001","FLS001","FLF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020044-03","BlueCare Bronze 1486","Limited Cost Sharing Plan Variation",,"0.599723362353384","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$5,600","$800","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1486O.pdf","https://www.flblue.com/plan-brochure/bc?id=1486O"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020060","BlueCare Silver 1498","30252FL002","7346243208","FLN001","FLS001","FLF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020060-00","BlueCare Silver 1498","Standard Silver Off Exchange Plan",,"0.718066851628673","No","Yes","No","100%",,"$5,500","$100","$600","$60","$0","$3,100","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1498.pdf","https://www.flblue.com/plan-brochure/bc?id=1498"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020060","BlueCare Silver 1498","30252FL002","7346243208","FLN001","FLS001","FLF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020060-01","BlueCare Silver 1498","Standard Silver On Exchange Plan",,"0.718066851628673","No","Yes","No","100%",,"$5,500","$100","$600","$60","$0","$3,100","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1498.pdf","https://www.flblue.com/plan-brochure/bc?id=1498"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020060","BlueCare Silver 1498","30252FL002","7346243208","FLN001","FLS001","FLF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020060-02","BlueCare Silver 1498","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1498U.pdf","https://www.flblue.com/plan-brochure/bc?id=1498U"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020060","BlueCare Silver 1498","30252FL002","7346243208","FLN001","FLS001","FLF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020060-03","BlueCare Silver 1498","Limited Cost Sharing Plan Variation",,"0.718066851628673","No","Yes","No","100%",,"$5,500","$100","$600","$60","$0","$3,100","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1498O.pdf","https://www.flblue.com/plan-brochure/bc?id=1498O"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020060","BlueCare Silver 1498","30252FL002","7346243208","FLN001","FLS001","FLF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020060-04","BlueCare Silver 1498","73% AV Level Silver Plan",,"0.738565054351971","No","Yes","No","100%",,"$5,000","$100","$700","$60","$0","$3,000","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,950","$4950 per person","$9900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1498A.pdf","https://www.flblue.com/plan-brochure/bc?id=1498A"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020060","BlueCare Silver 1498","30252FL002","7346243208","FLN001","FLS001","FLF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020060-05","BlueCare Silver 1498","87% AV Level Silver Plan",,"0.874952450630743","No","Yes","No","100%",,"$1,500","$0","$800","$60","$0","$900","$0","$60","$600","$400","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1498B.pdf","https://www.flblue.com/plan-brochure/bc?id=1498B"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020060","BlueCare Silver 1498","30252FL002","7346243208","FLN001","FLS001","FLF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020060-06","BlueCare Silver 1498","94% AV Level Silver Plan",,"0.939738336098804","No","Yes","No","100%",,"$400","$20","$600","$60","$0","$500","$0","$60","$400","$200","$10","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1498C.pdf","https://www.flblue.com/plan-brochure/bc?id=1498C"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020062","BlueCare Platinum 1485","30252FL002","7346243208","FLN001","FLS001","FLF003","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020062-00","BlueCare Platinum 1485","Standard Platinum Off Exchange Plan",,"0.907557078777632","No","Yes","No","100%",,"$800","$30","$800","$60","$0","$1,500","$0","$60","$800","$100","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1485.pdf","https://www.flblue.com/plan-brochure/bc?id=1485"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020062","BlueCare Platinum 1485","30252FL002","7346243208","FLN001","FLS001","FLF003","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020062-01","BlueCare Platinum 1485","Standard Platinum On Exchange Plan",,"0.907557078777632","No","Yes","No","100%",,"$800","$30","$800","$60","$0","$1,500","$0","$60","$800","$100","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1485.pdf","https://www.flblue.com/plan-brochure/bc?id=1485"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020062","BlueCare Platinum 1485","30252FL002","7346243208","FLN001","FLS001","FLF003","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020062-02","BlueCare Platinum 1485","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1485U.pdf","https://www.flblue.com/plan-brochure/bc?id=1485U"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020062","BlueCare Platinum 1485","30252FL002","7346243208","FLN001","FLS001","FLF003","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020062-03","BlueCare Platinum 1485","Limited Cost Sharing Plan Variation",,"0.907557078777632","No","Yes","No","100%",,"$800","$30","$800","$60","$0","$1,500","$0","$60","$800","$100","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1485O.pdf","https://www.flblue.com/plan-brochure/bc?id=1485O"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020066","BlueCare Bronze 1483","30252FL002","7346243208","FLN001","FLS001","FLF002","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020066-00","BlueCare Bronze 1483","Standard Bronze Off Exchange Plan",,"0.64851616055622","Yes","Yes","No","100%",,"$6,400","$200","$0","$60","$4,600","$1,200","$0","$60","$1,300","$300","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1483.pdf","https://www.flblue.com/plan-brochure/bc?id=1483"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020066","BlueCare Bronze 1483","30252FL002","7346243208","FLN001","FLS001","FLF002","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020066-01","BlueCare Bronze 1483","Standard Bronze On Exchange Plan",,"0.64851616055622","Yes","Yes","No","100%",,"$6,400","$200","$0","$60","$4,600","$1,200","$0","$60","$1,300","$300","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1483.pdf","https://www.flblue.com/plan-brochure/bc?id=1483"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020066","BlueCare Bronze 1483","30252FL002","7346243208","FLN001","FLS001","FLF002","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020066-02","BlueCare Bronze 1483","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1483U.pdf","https://www.flblue.com/plan-brochure/bc?id=1483U"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020066","BlueCare Bronze 1483","30252FL002","7346243208","FLN001","FLS001","FLF002","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020066-03","BlueCare Bronze 1483","Limited Cost Sharing Plan Variation",,"0.64851616055622","Yes","Yes","No","100%",,"$6,400","$200","$0","$60","$4,600","$1,200","$0","$60","$1,300","$300","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1483O.pdf","https://www.flblue.com/plan-brochure/bc?id=1483O"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020068","BlueCare Platinum 1491","30252FL002","7346243208","FLN001","FLS001","FLF003","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020068-00","BlueCare Platinum 1491","Standard Platinum Off Exchange Plan",,"0.898778496100588","Yes","Yes","No","100%",,"$0","$400","$0","$60","$0","$1,500","$0","$60","$0","$500","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1491.pdf","https://www.flblue.com/plan-brochure/bc?id=1491"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020068","BlueCare Platinum 1491","30252FL002","7346243208","FLN001","FLS001","FLF003","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020068-01","BlueCare Platinum 1491","Standard Platinum On Exchange Plan",,"0.898778496100588","Yes","Yes","No","100%",,"$0","$400","$0","$60","$0","$1,500","$0","$60","$0","$500","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1491.pdf","https://www.flblue.com/plan-brochure/bc?id=1491"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020068","BlueCare Platinum 1491","30252FL002","7346243208","FLN001","FLS001","FLF003","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020068-02","BlueCare Platinum 1491","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1491U.pdf","https://www.flblue.com/plan-brochure/bc?id=1491U"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020068","BlueCare Platinum 1491","30252FL002","7346243208","FLN001","FLS001","FLF003","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020068-03","BlueCare Platinum 1491","Limited Cost Sharing Plan Variation",,"0.898778496100588","Yes","Yes","No","100%",,"$0","$400","$0","$60","$0","$1,500","$0","$60","$0","$500","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1491O.pdf","https://www.flblue.com/plan-brochure/bc?id=1491O"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020070","BlueCare Silver 1477","30252FL002","7346243208","FLN001","FLS001","FLF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020070-00","BlueCare Silver 1477","Standard Silver Off Exchange Plan",,"0.660137929082671","Yes","Yes","No","100%",,"$6,100","$0","$1,300","$60","$1,100","$2,000","$0","$60","$1,400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1477.pdf","https://www.flblue.com/plan-brochure/bc?id=1477"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020070","BlueCare Silver 1477","30252FL002","7346243208","FLN001","FLS001","FLF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020070-01","BlueCare Silver 1477","Standard Silver On Exchange Plan",,"0.660137929082671","Yes","Yes","No","100%",,"$6,100","$0","$1,300","$60","$1,100","$2,000","$0","$60","$1,400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1477.pdf","https://www.flblue.com/plan-brochure/bc?id=1477"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020070","BlueCare Silver 1477","30252FL002","7346243208","FLN001","FLS001","FLF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020070-02","BlueCare Silver 1477","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1477U.pdf","https://www.flblue.com/plan-brochure/bc?id=1477U"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020070","BlueCare Silver 1477","30252FL002","7346243208","FLN001","FLS001","FLF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020070-03","BlueCare Silver 1477","Limited Cost Sharing Plan Variation",,"0.660137929082671","Yes","Yes","No","100%",,"$6,100","$0","$1,300","$60","$1,100","$2,000","$0","$60","$1,400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1477O.pdf","https://www.flblue.com/plan-brochure/bc?id=1477O"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020070","BlueCare Silver 1477","30252FL002","7346243208","FLN001","FLS001","FLF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020070-04","BlueCare Silver 1477","73% AV Level Silver Plan",,"0.738962761332475","Yes","Yes","No","100%",,"$5,000","$0","$600","$60","$0","$2,400","$0","$60","$600","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$5550 per person","$11100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1477A.pdf","https://www.flblue.com/plan-brochure/bc?id=1477A"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020070","BlueCare Silver 1477","30252FL002","7346243208","FLN001","FLS001","FLF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020070-05","BlueCare Silver 1477","87% AV Level Silver Plan",,"0.878972613666946","Yes","Yes","No","100%",,"$0","$0","$2,500","$60","$0","$1,800","$0","$60","$0","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1477B.pdf","https://www.flblue.com/plan-brochure/bc?id=1477B"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020070","BlueCare Silver 1477","30252FL002","7346243208","FLN001","FLS001","FLF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020070-06","BlueCare Silver 1477","94% AV Level Silver Plan",,"0.949963752401131","Yes","Yes","No","100%",,"$0","$0","$1,300","$60","$0","$800","$0","$60","$0","$200","$100","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1477C.pdf","https://www.flblue.com/plan-brochure/bc?id=1477C"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020074","BlueCare Gold 1565","30252FL002","7346243208","FLN001","FLS001","FLF007","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020074-00","BlueCare Gold 1565","Standard Gold Off Exchange Plan",,"0.793559831541356","Yes","Yes","No","100%",,"$0","$700","$0","$60","$0","$2,200","$0","$60","$0","$800","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1565.pdf","https://www.flblue.com/plan-brochure/bc?id=1565"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020074","BlueCare Gold 1565","30252FL002","7346243208","FLN001","FLS001","FLF007","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020074-01","BlueCare Gold 1565","Standard Gold On Exchange Plan",,"0.793559831541356","Yes","Yes","No","100%",,"$0","$700","$0","$60","$0","$2,200","$0","$60","$0","$800","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1565.pdf","https://www.flblue.com/plan-brochure/bc?id=1565"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020074","BlueCare Gold 1565","30252FL002","7346243208","FLN001","FLS001","FLF007","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020074-02","BlueCare Gold 1565","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1565U.pdf","https://www.flblue.com/plan-brochure/bc?id=1565U"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020074","BlueCare Gold 1565","30252FL002","7346243208","FLN001","FLS001","FLF007","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020074-03","BlueCare Gold 1565","Limited Cost Sharing Plan Variation",,"0.793559831541356","Yes","Yes","No","100%",,"$0","$700","$0","$60","$0","$2,200","$0","$60","$0","$800","$0","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1565O.pdf","https://www.flblue.com/plan-brochure/bc?id=1565O"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020076","BlueCare Bronze (HSA) 1765","30252FL002","7346243208","FLN001","FLS001","FLF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices_HSA.pdf","30252FL0020076-00","BlueCare Bronze (HSA) 1765","Standard Bronze Off Exchange Plan",,"0.61972055561931","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$5,400","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1765.pdf","https://www.flblue.com/plan-brochure/bc?id=1765"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020076","BlueCare Bronze (HSA) 1765","30252FL002","7346243208","FLN001","FLS001","FLF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices_HSA.pdf","30252FL0020076-01","BlueCare Bronze (HSA) 1765","Standard Bronze On Exchange Plan",,"0.61972055561931","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$5,400","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1765.pdf","https://www.flblue.com/plan-brochure/bc?id=1765"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020076","BlueCare Bronze (HSA) 1765","30252FL002","7346243208","FLN001","FLS001","FLF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices_HSA.pdf","30252FL0020076-02","BlueCare Bronze (HSA) 1765","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1765U.pdf","https://www.flblue.com/plan-brochure/bc?id=1765U"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020076","BlueCare Bronze (HSA) 1765","30252FL002","7346243208","FLN001","FLS001","FLF008","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices_HSA.pdf","30252FL0020076-03","BlueCare Bronze (HSA) 1765","Limited Cost Sharing Plan Variation",,"0.61972055561931","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$5,400","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1765O.pdf","https://www.flblue.com/plan-brochure/bc?id=1765O"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020078","BlueCare Silver 1766S","30252FL002","7346243208","FLN001","FLS001","FLF009","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020078-00","BlueCare Silver 1766S","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$40","$1,800","$60","$100","$2,400","$0","$60","$800","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1766S.pdf","https://www.flblue.com/plan-brochure/bc?id=1766S"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020078","BlueCare Silver 1766S","30252FL002","7346243208","FLN001","FLS001","FLF009","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020078-01","BlueCare Silver 1766S","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$40","$1,800","$60","$100","$2,400","$0","$60","$800","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1766S.pdf","https://www.flblue.com/plan-brochure/bc?id=1766S"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020078","BlueCare Silver 1766S","30252FL002","7346243208","FLN001","FLS001","FLF009","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020078-02","BlueCare Silver 1766S","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1766US.pdf","https://www.flblue.com/plan-brochure/bc?id=1766US"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020078","BlueCare Silver 1766S","30252FL002","7346243208","FLN001","FLS001","FLF009","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020078-03","BlueCare Silver 1766S","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$40","$1,800","$60","$100","$2,400","$0","$60","$800","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1766OS.pdf","https://www.flblue.com/plan-brochure/bc?id=1766OS"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020078","BlueCare Silver 1766S","30252FL002","7346243208","FLN001","FLS001","FLF009","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020078-04","BlueCare Silver 1766S","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$40","$1,900","$60","$100","$2,400","$0","$60","$800","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1766AS.pdf","https://www.flblue.com/plan-brochure/bc?id=1766AS"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020078","BlueCare Silver 1766S","30252FL002","7346243208","FLN001","FLS001","FLF009","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020078-05","BlueCare Silver 1766S","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,800","$60","$100","$1,300","$0","$60","$700","$100","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1766BS.pdf","https://www.flblue.com/plan-brochure/bc?id=1766BS"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020078","BlueCare Silver 1766S","30252FL002","7346243208","FLN001","FLS001","FLF009","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020078-06","BlueCare Silver 1766S","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$300","$10","$600","$60","$100","$400","$0","$60","$300","$50","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1766CS.pdf","https://www.flblue.com/plan-brochure/bc?id=1766CS"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020080","BlueCare Bronze 1767S","30252FL002","7346243208","FLN001","FLS001","FLF010","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020080-00","BlueCare Bronze 1767S","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,700","$0","$700","$60","$5,700","$700","$0","$60","$1,300","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1767S.pdf","https://www.flblue.com/plan-brochure/bc?id=1767S"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020080","BlueCare Bronze 1767S","30252FL002","7346243208","FLN001","FLS001","FLF010","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020080-01","BlueCare Bronze 1767S","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,700","$0","$700","$60","$5,700","$700","$0","$60","$1,300","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1767S.pdf","https://www.flblue.com/plan-brochure/bc?id=1767S"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020080","BlueCare Bronze 1767S","30252FL002","7346243208","FLN001","FLS001","FLF010","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020080-02","BlueCare Bronze 1767S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1767US.pdf","https://www.flblue.com/plan-brochure/bc?id=1767US"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020080","BlueCare Bronze 1767S","30252FL002","7346243208","FLN001","FLS001","FLF010","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020080-03","BlueCare Bronze 1767S","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,700","$0","$700","$60","$5,700","$700","$0","$60","$1,300","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1767OS.pdf","https://www.flblue.com/plan-brochure/bc?id=1767OS"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020084","BlueCare Gold 1865","30252FL002","7346243208","FLN001","FLS001","FLF011","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020084-00","BlueCare Gold 1865","Standard Gold Off Exchange Plan",,"0.782585041781306","No","Yes","No","100%",,"$2,000","$100","$1,400","$60","$0","$2,800","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1865.pdf","https://www.flblue.com/plan-brochure/bc?id=1865"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020084","BlueCare Gold 1865","30252FL002","7346243208","FLN001","FLS001","FLF011","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020084-01","BlueCare Gold 1865","Standard Gold On Exchange Plan",,"0.782585041781306","No","Yes","No","100%",,"$2,000","$100","$1,400","$60","$0","$2,800","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1865.pdf","https://www.flblue.com/plan-brochure/bc?id=1865"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020084","BlueCare Gold 1865","30252FL002","7346243208","FLN001","FLS001","FLF011","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020084-02","BlueCare Gold 1865","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1865U.pdf","https://www.flblue.com/plan-brochure/bc?id=1865U"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0020084","BlueCare Gold 1865","30252FL002","7346243208","FLN001","FLS001","FLF011","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_7T_CareChoices.pdf","30252FL0020084-03","BlueCare Gold 1865","Limited Cost Sharing Plan Variation",,"0.782585041781306","No","Yes","No","100%",,"$2,000","$100","$1,400","$60","$0","$2,800","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1865O.pdf","https://www.flblue.com/plan-brochure/bc?id=1865O"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070001","myBlue Bronze 1601","30252FL007","7346243208","FLN002","FLS002","FLF012","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070001-00","myBlue Bronze 1601","Standard Bronze Off Exchange Plan",,"0.647460325171002","Yes","Yes","No","100%",,"$6,400","$200","$0","$60","$4,600","$1,200","$0","$60","$1,300","$300","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1601.pdf","https://www.flblue.com/plan-brochure/myblue?type=bronze1"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070001","myBlue Bronze 1601","30252FL007","7346243208","FLN002","FLS002","FLF012","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070001-01","myBlue Bronze 1601","Standard Bronze On Exchange Plan",,"0.647460325171002","Yes","Yes","No","100%",,"$6,400","$200","$0","$60","$4,600","$1,200","$0","$60","$1,300","$300","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1601.pdf","https://www.flblue.com/plan-brochure/myblue?type=bronze1"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070001","myBlue Bronze 1601","30252FL007","7346243208","FLN002","FLS002","FLF012","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070001-02","myBlue Bronze 1601","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1601U.pdf","https://www.flblue.com/plan-brochure/myblue?type=U"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070001","myBlue Bronze 1601","30252FL007","7346243208","FLN002","FLS002","FLF012","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070001-03","myBlue Bronze 1601","Limited Cost Sharing Plan Variation",,"0.647460325171002","Yes","Yes","No","100%",,"$6,400","$200","$0","$60","$4,600","$1,200","$0","$60","$1,300","$300","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1601O.pdf","https://www.flblue.com/plan-brochure/myblue?type=bronze1"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070003","myBlue Bronze 1602","30252FL007","7346243208","FLN002","FLS002","FLF013","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070003-00","myBlue Bronze 1602","Standard Bronze Off Exchange Plan",,"0.599723362353384","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$5,600","$700","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1602.pdf","https://www.flblue.com/plan-brochure/myblue?type=bronze2"
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070003","Florida Hospital Bronze HMO 100 HSA 5419","36194FL007",,"FLN004","FLS003","FLF014","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070003-01","Florida Hospital Bronze HMO 100 HSA 5419","Standard Bronze On Exchange Plan",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5419",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130001","Health First GYM ACCESS Bronze POS 100 HSA 1659","36194FL013",,"FLN001","FLS001","FLF001","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9878",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130001-03","Health First GYM ACCESS Bronze POS 100 HSA 1659","Limited Cost Sharing Plan Variation",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2018_sbc_1659_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150001","Florida Hospital GYM ACCESS Bronze POS 100 HSA 1661","36194FL015",,"FLN002","FLS002","FLF014","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9878",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150001-00","Florida Hospital GYM ACCESS Bronze POS 100 HSA 1661","Standard Bronze Off Exchange Plan",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2018_sbc_1661",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150001","Florida Hospital GYM ACCESS Bronze POS 100 HSA 1661","36194FL015",,"FLN002","FLS002","FLF014","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9878",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150001-01","Florida Hospital GYM ACCESS Bronze POS 100 HSA 1661","Standard Bronze On Exchange Plan",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2018_sbc_1661",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120005","Health First GYM ACCESS Silver HMO 100 1672","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120005-01","Health First GYM ACCESS Silver HMO 100 1672","Standard Silver On Exchange Plan",,"0.716411559317853","No","Yes","No","100%",,"$4,000","$60","$0","$60","$1,200","$1,700","$0","$60","$1,800","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1672",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120005","Health First GYM ACCESS Silver HMO 100 1672","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120005-02","Health First GYM ACCESS Silver HMO 100 1672","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1672_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050005","Florida Hospital Silver POS 50 5429","36194FL005",,"FLN004","FLS003","FLF022","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9808",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050005-00","Florida Hospital Silver POS 50 5429","Standard Silver Off Exchange Plan",,"0.707091433647515","No","Yes","No","100%",,"$1,300","$0","$5,000","$60","$200","$1,700","$200","$60","$800","$200","$800","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50.00%",,,,,"$4,400","$4400 per person","$8800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5429",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050005","Florida Hospital Silver POS 50 5429","36194FL005",,"FLN004","FLS003","FLF022","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9808",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050005-01","Florida Hospital Silver POS 50 5429","Standard Silver On Exchange Plan",,"0.707091433647515","No","Yes","No","100%",,"$1,300","$0","$5,000","$60","$200","$1,700","$200","$60","$800","$200","$800","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50.00%",,,,,"$4,400","$4400 per person","$8800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5429",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120005","Health First GYM ACCESS Silver HMO 100 1672","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120005-03","Health First GYM ACCESS Silver HMO 100 1672","Limited Cost Sharing Plan Variation",,"0.716411559317853","No","Yes","No","100%",,"$4,000","$60","$0","$60","$1,200","$1,700","$0","$60","$1,800","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1672_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120005","Health First GYM ACCESS Silver HMO 100 1672","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120005-06","Health First GYM ACCESS Silver AV94 HMO 100 1675","94% AV Level Silver Plan",,"0.947808860461562","No","Yes","No","100%",,"$100","$20","$0","$60","$300","$200","$0","$60","$100","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$475","$475 per person","$950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1675",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140005","Florida Hospital GYM ACCESS Silver HMO 100 1676","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140005-00","Florida Hospital GYM ACCESS Silver HMO 100 1676","Standard Silver Off Exchange Plan",,"0.716411559317853","No","Yes","No","100%",,"$4,000","$60","$0","$60","$1,200","$1,700","$0","$60","$1,800","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1676",
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070003","myBlue Bronze 1602","30252FL007","7346243208","FLN002","FLS002","FLF013","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070003-01","myBlue Bronze 1602","Standard Bronze On Exchange Plan",,"0.599723362353384","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$5,600","$700","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1602.pdf","https://www.flblue.com/plan-brochure/myblue?type=bronze2"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070003","myBlue Bronze 1602","30252FL007","7346243208","FLN002","FLS002","FLF013","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070003-02","myBlue Bronze 1602","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1602U.pdf","https://www.flblue.com/plan-brochure/myblue?type=U"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070003","myBlue Bronze 1602","30252FL007","7346243208","FLN002","FLS002","FLF013","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070003-03","myBlue Bronze 1602","Limited Cost Sharing Plan Variation",,"0.599723362353384","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$5,600","$700","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1602O.pdf","https://www.flblue.com/plan-brochure/myblue?type=bronze2"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070005","myBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF014","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070005-00","myBlue Silver 1603","Standard Silver Off Exchange Plan",,"0.681109567456173","No","Yes","No","100%",,"$6,000","$700","$0","$60","$3,000","$2,100","$0","$60","$200","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1603.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver3"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070005","myBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF014","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070005-01","myBlue Silver 1603","Standard Silver On Exchange Plan",,"0.681109567456173","No","Yes","No","100%",,"$6,000","$700","$0","$60","$3,000","$2,100","$0","$60","$200","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1603.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver3"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070005","myBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF014","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070005-02","myBlue Silver 1603","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1603U.pdf","https://www.flblue.com/plan-brochure/myblue?type=U"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070005","myBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF014","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070005-03","myBlue Silver 1603","Limited Cost Sharing Plan Variation",,"0.681109567456173","No","Yes","No","100%",,"$6,000","$700","$0","$60","$3,000","$2,100","$0","$60","$200","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,950","$5950 per person","$11900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1603O.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver3"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070005","myBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF014","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070005-04","myBlue Silver 1603","73% AV Level Silver Plan",,"0.736050827067632","No","Yes","No","100%",,"$3,000","$700","$0","$60","$3,000","$1,600","$0","$60","$200","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1603A.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver3a"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070005","myBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF014","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070005-05","myBlue Silver 1603","87% AV Level Silver Plan",,"0.871832317781161","No","Yes","No","100%",,"$600","$600","$0","$60","$0","$2,200","$0","$60","$200","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1603B.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver3b"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070005","myBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF014","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070005-06","myBlue Silver 1603","94% AV Level Silver Plan",,"0.938155893932501","No","Yes","No","100%",,"$0","$400","$0","$60","$0","$700","$0","$60","$0","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","$1050 per person","$2100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1603C.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver3c"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070007","myBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF015","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070007-00","myBlue Silver 1604","Standard Silver Off Exchange Plan","66.08%","0.656693679562202","Yes","Yes","No","100%",,"$6,800","$0","$600","$60","$5,600","$700","$0","$60","$1,400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1604.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver4"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070007","myBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF015","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070007-01","myBlue Silver 1604","Standard Silver On Exchange Plan","66.08%","0.656693679562202","Yes","Yes","No","100%",,"$6,800","$0","$600","$60","$5,600","$700","$0","$60","$1,400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1604.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver4"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070007","myBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF015","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070007-02","myBlue Silver 1604","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1604U.pdf","https://www.flblue.com/plan-brochure/myblue?type=U"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070007","myBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF015","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070007-03","myBlue Silver 1604","Limited Cost Sharing Plan Variation","66.08%","0.656693679562202","Yes","Yes","No","100%",,"$6,800","$0","$600","$60","$5,600","$700","$0","$60","$1,400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1604O.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver4"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070007","myBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF015","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070007-04","myBlue Silver 1604","73% AV Level Silver Plan","73.97%","0.738131392056822","Yes","Yes","No","100%",,"$5,000","$0","$600","$60","$4,200","$1,400","$0","$60","$600","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1604A.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver4a"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070007","myBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF015","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070007-05","myBlue Silver 1604","87% AV Level Silver Plan","87.96%","0.879003586547104","Yes","Yes","No","100%",,"$0","$0","$2,500","$60","$0","$1,800","$0","$60","$0","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1604B.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver4b"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070007","myBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF015","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070007-06","myBlue Silver 1604","94% AV Level Silver Plan","94.98%","0.949713309074678","Yes","Yes","No","100%",,"$0","$0","$1,300","$60","$0","$600","$0","$60","$0","$200","$100","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1604C.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver4c"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070009","myBlue Gold 1605","30252FL007","7346243208","FLN002","FLS002","FLF016","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070009-00","myBlue Gold 1605","Standard Gold Off Exchange Plan",,"0.777676334366255","Yes","Yes","No","100%",,"$900","$40","$2,100","$60","$900","$1,600","$500","$60","$900","$400","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$940","$940 per person","$1880 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1605.pdf","https://www.flblue.com/plan-brochure/myblue?type=gold5"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070009","myBlue Gold 1605","30252FL007","7346243208","FLN002","FLS002","FLF016","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070009-01","myBlue Gold 1605","Standard Gold On Exchange Plan",,"0.777676334366255","Yes","Yes","No","100%",,"$900","$40","$2,100","$60","$900","$1,600","$500","$60","$900","$400","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$940","$940 per person","$1880 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1605.pdf","https://www.flblue.com/plan-brochure/myblue?type=gold5"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070009","myBlue Gold 1605","30252FL007","7346243208","FLN002","FLS002","FLF016","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070009-02","myBlue Gold 1605","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1605U.pdf","https://www.flblue.com/plan-brochure/myblue?type=U"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070009","myBlue Gold 1605","30252FL007","7346243208","FLN002","FLS002","FLF016","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070009-03","myBlue Gold 1605","Limited Cost Sharing Plan Variation",,"0.777676334366255","Yes","Yes","No","100%",,"$900","$40","$2,100","$60","$900","$1,600","$500","$60","$900","$400","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$940","$940 per person","$1880 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1605O.pdf","https://www.flblue.com/plan-brochure/myblue?type=gold5"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070013","myBlue Silver 1710","30252FL007","7346243208","FLN002","FLS002","FLF017","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070013-00","myBlue Silver 1710","Standard Silver Off Exchange Plan",,"0.716102728253083","No","Yes","No","100%",,"$5,500","$100","$600","$60","$0","$3,100","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1710.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver10"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070013","myBlue Silver 1710","30252FL007","7346243208","FLN002","FLS002","FLF017","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070013-01","myBlue Silver 1710","Standard Silver On Exchange Plan",,"0.716102728253083","No","Yes","No","100%",,"$5,500","$100","$600","$60","$0","$3,100","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1710.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver10"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070013","myBlue Silver 1710","30252FL007","7346243208","FLN002","FLS002","FLF017","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070013-02","myBlue Silver 1710","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1710U.pdf","https://www.flblue.com/plan-brochure/myblue?type=U"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070013","myBlue Silver 1710","30252FL007","7346243208","FLN002","FLS002","FLF017","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070013-03","myBlue Silver 1710","Limited Cost Sharing Plan Variation",,"0.716102728253083","No","Yes","No","100%",,"$5,500","$100","$600","$60","$0","$3,100","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1710O.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver10"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070013","myBlue Silver 1710","30252FL007","7346243208","FLN002","FLS002","FLF017","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070013-04","myBlue Silver 1710","73% AV Level Silver Plan",,"0.736566323522381","No","Yes","No","100%",,"$5,000","$100","$700","$60","$0","$3,000","$0","$60","$600","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,950","$4950 per person","$9900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1710A.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver10a"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070013","myBlue Silver 1710","30252FL007","7346243208","FLN002","FLS002","FLF017","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070013-05","myBlue Silver 1710","87% AV Level Silver Plan",,"0.876706287854054","No","Yes","No","100%",,"$1,500","$0","$800","$60","$0","$800","$0","$60","$600","$300","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1710B.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver10b"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070013","myBlue Silver 1710","30252FL007","7346243208","FLN002","FLS002","FLF017","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript.pdf","30252FL0070013-06","myBlue Silver 1710","94% AV Level Silver Plan",,"0.93637312775469","No","Yes","No","100%",,"$400","$20","$600","$60","$0","$500","$0","$60","$400","$200","$10","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1710C.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver10c"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070015","myBlue Bronze 1711S","30252FL007","7346243208","FLN002","FLS002","FLF018","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript_Simple_Choices.pdf","30252FL0070015-00","myBlue Bronze 1711S","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,700","$0","$700","$60","$5,700","$700","$0","$60","$1,300","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1711S.pdf","https://www.flblue.com/plan-brochure/myblue?type=bronze11"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070015","myBlue Bronze 1711S","30252FL007","7346243208","FLN002","FLS002","FLF018","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript_Simple_Choices.pdf","30252FL0070015-01","myBlue Bronze 1711S","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,700","$0","$700","$60","$5,700","$700","$0","$60","$1,300","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1711S.pdf","https://www.flblue.com/plan-brochure/myblue?type=bronze11"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070015","myBlue Bronze 1711S","30252FL007","7346243208","FLN002","FLS002","FLF018","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript_Simple_Choices.pdf","30252FL0070015-02","myBlue Bronze 1711S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1711US.pdf","https://www.flblue.com/plan-brochure/myblue?type=U"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070015","myBlue Bronze 1711S","30252FL007","7346243208","FLN002","FLS002","FLF018","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript_Simple_Choices.pdf","30252FL0070015-03","myBlue Bronze 1711S","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,700","$0","$700","$60","$5,700","$700","$0","$60","$1,300","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1711OS.pdf","https://www.flblue.com/plan-brochure/myblue?type=bronze11"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070017","myBlue Silver 1712S","30252FL007","7346243208","FLN002","FLS002","FLF019","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript_Simple_Choices.pdf","30252FL0070017-00","myBlue Silver 1712S","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$40","$1,800","$60","$100","$2,400","$0","$60","$800","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1712S.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver12"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070017","myBlue Silver 1712S","30252FL007","7346243208","FLN002","FLS002","FLF019","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript_Simple_Choices.pdf","30252FL0070017-01","myBlue Silver 1712S","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$40","$1,800","$60","$100","$2,400","$0","$60","$800","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1712S.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver12"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070017","myBlue Silver 1712S","30252FL007","7346243208","FLN002","FLS002","FLF019","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript_Simple_Choices.pdf","30252FL0070017-02","myBlue Silver 1712S","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1712US.pdf","https://www.flblue.com/plan-brochure/myblue?type=U"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070017","myBlue Silver 1712S","30252FL007","7346243208","FLN002","FLS002","FLF019","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript_Simple_Choices.pdf","30252FL0070017-03","myBlue Silver 1712S","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$40","$1,800","$60","$100","$2,400","$0","$60","$800","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1712OS.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver12"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070017","myBlue Silver 1712S","30252FL007","7346243208","FLN002","FLS002","FLF019","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript_Simple_Choices.pdf","30252FL0070017-04","myBlue Silver 1712S","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$40","$1,900","$60","$100","$2,400","$0","$60","$800","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1712AS.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver12as"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070017","myBlue Silver 1712S","30252FL007","7346243208","FLN002","FLS002","FLF019","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript_Simple_Choices.pdf","30252FL0070017-05","myBlue Silver 1712S","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,800","$60","$100","$1,300","$0","$60","$700","$100","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1712BS.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver12bs"
"2018","FL","30252","HIOS","2017-09-06 02:20:26","Individual","No","59-2403696","30252FL0070017","myBlue Silver 1712S","30252FL007","7346243208","FLN002","FLS002","FLF019","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_FL_6T_ValueScript_Simple_Choices.pdf","30252FL0070017-06","myBlue Silver 1712S","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$300","$10","$600","$60","$100","$400","$0","$60","$300","$50","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2018/1712CS.pdf","https://www.flblue.com/plan-brochure/myblue?type=silver12cs"
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120001","Health First GYM ACCESS Bronze HMO 70 1656","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9878",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120001-00","Health First GYM ACCESS Bronze HMO 70 1656","Standard Bronze Off Exchange Plan",,"0.64563885797871","No","Yes","No","100%",,"$4,600","$0","$2,700","$60","$800","$2,100","$100","$60","$1,100","$500","$500","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1656",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010001","Health First Bronze POS 50 5410","36194FL001",,"FLN003","FLS001","FLF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010001-00","Health First Bronze POS 50 5410","Standard Bronze Off Exchange Plan",,"0.597966864091973","Yes","Yes","No","100%",,"$2,200","$0","$5,000","$60","$3,200","$400","$3,200","$60","$800","$300","$800","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group",,,,"$14,500","$14500 per person","$29000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50.00%",,,,,"$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myHFHP.org/2018_sbc_5410",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010001","Health First Bronze POS 50 5410","36194FL001",,"FLN003","FLS001","FLF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010001-01","Health First Bronze POS 50 5410","Standard Bronze On Exchange Plan",,"0.597966864091973","Yes","Yes","No","100%",,"$2,200","$0","$5,000","$60","$3,200","$400","$3,200","$60","$800","$300","$800","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group",,,,"$14,500","$14500 per person","$29000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50.00%",,,,,"$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myHFHP.org/2018_sbc_5410",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120001","Health First GYM ACCESS Bronze HMO 70 1656","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9878",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120001-01","Health First GYM ACCESS Bronze HMO 70 1656","Standard Bronze On Exchange Plan",,"0.64563885797871","No","Yes","No","100%",,"$4,600","$0","$2,700","$60","$800","$2,100","$100","$60","$1,100","$500","$500","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1656",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120001","Health First GYM ACCESS Bronze HMO 70 1656","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9878",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120001-02","Health First GYM ACCESS Bronze HMO 70 1656","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1656_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050001","Florida Hospital Bronze POS 50 5412","36194FL005",,"FLN004","FLS003","FLF018","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050001-00","Florida Hospital Bronze POS 50 5412","Standard Bronze Off Exchange Plan",,"0.597966864091973","Yes","Yes","No","100%",,"$2,200","$0","$5,000","$60","$3,200","$400","$3,200","$60","$800","$300","$800","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group",,,,"$14,500","$14500 per person","$29000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50.00%",,,,,"$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myFHCA.org/2018_sbc_5412",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050001","Florida Hospital Bronze POS 50 5412","36194FL005",,"FLN004","FLS003","FLF018","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050001-01","Florida Hospital Bronze POS 50 5412","Standard Bronze On Exchange Plan",,"0.597966864091973","Yes","Yes","No","100%",,"$2,200","$0","$5,000","$60","$3,200","$400","$3,200","$60","$800","$300","$800","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group",,,,"$14,500","$14500 per person","$29000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50.00%",,,,,"$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myFHCA.org/2018_sbc_5412",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120001","Health First GYM ACCESS Bronze HMO 70 1656","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9878",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120001-03","Health First GYM ACCESS Bronze HMO 70 1656","Limited Cost Sharing Plan Variation",,"0.64563885797871","No","Yes","No","100%",,"$4,600","$0","$2,700","$60","$800","$2,100","$100","$60","$1,100","$500","$500","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1656_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140001","Florida Hospital GYM ACCESS Bronze HMO 70 1657","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9878",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140001-00","Florida Hospital GYM ACCESS Bronze HMO 70 1657","Standard Bronze Off Exchange Plan",,"0.64563885797871","No","Yes","No","100%",,"$4,600","$0","$2,700","$60","$800","$2,100","$100","$60","$1,100","$500","$500","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1657",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140001","Florida Hospital GYM ACCESS Bronze HMO 70 1657","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9878",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140001-01","Florida Hospital GYM ACCESS Bronze HMO 70 1657","Standard Bronze On Exchange Plan",,"0.64563885797871","No","Yes","No","100%",,"$4,600","$0","$2,700","$60","$800","$2,100","$100","$60","$1,100","$500","$500","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1657",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140001","Florida Hospital GYM ACCESS Bronze HMO 70 1657","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9878",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140001-02","Florida Hospital GYM ACCESS Bronze HMO 70 1657","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1657_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140001","Florida Hospital GYM ACCESS Bronze HMO 70 1657","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9878",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140001-03","Florida Hospital GYM ACCESS Bronze HMO 70 1657","Limited Cost Sharing Plan Variation",,"0.64563885797871","No","Yes","No","100%",,"$4,600","$0","$2,700","$60","$800","$2,100","$100","$60","$1,100","$500","$500","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1657_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120002","Health First GYM ACCESS Bronze HMO 100 HSA 1658","36194FL012",,"FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.987",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120002-00","Health First GYM ACCESS Bronze HMO 100 HSA 1658","Standard Bronze Off Exchange Plan",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2018_sbc_1658",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030002","Health First Bronze HMO 90 HSA 5413","36194FL003",,"FLN003","FLS001","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.978",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030002-00","Health First Bronze HMO 90 HSA 5413","Standard Bronze Off Exchange Plan",,"0.611728272568227","Yes","Yes","No","100%",,"$5,500","$0","$1,000","$60","$5,800","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","per person not applicable","$11600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5413",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030002","Health First Bronze HMO 90 HSA 5413","36194FL003",,"FLN003","FLS001","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.978",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030002-01","Health First Bronze HMO 90 HSA 5413","Standard Bronze On Exchange Plan",,"0.611728272568227","Yes","Yes","No","100%",,"$5,500","$0","$1,000","$60","$5,800","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","per person not applicable","$11600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5413",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120002","Health First GYM ACCESS Bronze HMO 100 HSA 1658","36194FL012",,"FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.987",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120002-01","Health First GYM ACCESS Bronze HMO 100 HSA 1658","Standard Bronze On Exchange Plan",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2018_sbc_1658",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120002","Health First GYM ACCESS Bronze HMO 100 HSA 1658","36194FL012",,"FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.987",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120002-02","Health First GYM ACCESS Bronze HMO 100 HSA 1658","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1658_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070002","Florida Hospital Bronze HMO 90 HSA 5415","36194FL007",,"FLN004","FLS003","FLF015","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.978",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070002-00","Florida Hospital Bronze HMO 90 HSA 5415","Standard Bronze Off Exchange Plan",,"0.611728272568227","Yes","Yes","No","100%",,"$5,500","$0","$1,000","$60","$5,800","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","per person not applicable","$11600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5415",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070002","Florida Hospital Bronze HMO 90 HSA 5415","36194FL007",,"FLN004","FLS003","FLF015","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.978",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070002-01","Florida Hospital Bronze HMO 90 HSA 5415","Standard Bronze On Exchange Plan",,"0.611728272568227","Yes","Yes","No","100%",,"$5,500","$0","$1,000","$60","$5,800","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","per person not applicable","$11600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5415",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120002","Health First GYM ACCESS Bronze HMO 100 HSA 1658","36194FL012",,"FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.987",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120002-03","Health First GYM ACCESS Bronze HMO 100 HSA 1658","Limited Cost Sharing Plan Variation",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2018_sbc_1658_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140002","Florida Hospital GYM ACCESS Bronze HMO 100 HSA 1660","36194FL014",,"FLN002","FLS002","FLF014","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.987",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140002-00","Florida Hospital GYM ACCESS Bronze HMO 100 HSA 1660","Standard Bronze Off Exchange Plan",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2018_sbc_1660",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140002","Florida Hospital GYM ACCESS Bronze HMO 100 HSA 1660","36194FL014",,"FLN002","FLS002","FLF014","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.987",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140002-01","Florida Hospital GYM ACCESS Bronze HMO 100 HSA 1660","Standard Bronze On Exchange Plan",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2018_sbc_1660",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140002","Florida Hospital GYM ACCESS Bronze HMO 100 HSA 1660","36194FL014",,"FLN002","FLS002","FLF014","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.987",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140002-02","Florida Hospital GYM ACCESS Bronze HMO 100 HSA 1660","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1660_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140002","Florida Hospital GYM ACCESS Bronze HMO 100 HSA 1660","36194FL014",,"FLN002","FLS002","FLF014","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.987",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140002-03","Florida Hospital GYM ACCESS Bronze HMO 100 HSA 1660","Limited Cost Sharing Plan Variation",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2018_sbc_1660_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130001","Health First GYM ACCESS Bronze POS 100 HSA 1659","36194FL013",,"FLN001","FLS001","FLF001","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9878",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130001-00","Health First GYM ACCESS Bronze POS 100 HSA 1659","Standard Bronze Off Exchange Plan",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2018_sbc_1659",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030003","Health First Bronze HMO 100 HSA 5417","36194FL003",,"FLN003","FLS001","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030003-00","Health First Bronze HMO 100 HSA 5417","Standard Bronze Off Exchange Plan",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5417",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030003","Health First Bronze HMO 100 HSA 5417","36194FL003",,"FLN003","FLS001","FLF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030003-01","Health First Bronze HMO 100 HSA 5417","Standard Bronze On Exchange Plan",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5417",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130001","Health First GYM ACCESS Bronze POS 100 HSA 1659","36194FL013",,"FLN001","FLS001","FLF001","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9878",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130001-01","Health First GYM ACCESS Bronze POS 100 HSA 1659","Standard Bronze On Exchange Plan",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2018_sbc_1659",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130001","Health First GYM ACCESS Bronze POS 100 HSA 1659","36194FL013",,"FLN001","FLS001","FLF001","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9878",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130001-02","Health First GYM ACCESS Bronze POS 100 1659","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1659_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070003","Florida Hospital Bronze HMO 100 HSA 5419","36194FL007",,"FLN004","FLS003","FLF014","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9779",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070003-00","Florida Hospital Bronze HMO 100 HSA 5419","Standard Bronze Off Exchange Plan",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5419",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150001","Florida Hospital GYM ACCESS Bronze POS 100 HSA 1661","36194FL015",,"FLN002","FLS002","FLF014","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9878",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150001-02","Florida Hospital GYM ACCESS Bronze POS 100 1661","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1661_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150001","Florida Hospital GYM ACCESS Bronze POS 100 HSA 1661","36194FL015",,"FLN002","FLS002","FLF014","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9878",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150001-03","Florida Hospital GYM ACCESS Bronze POS 100 HSA 1661","Limited Cost Sharing Plan Variation",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2018_sbc_1661_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120003","Health First GYM ACCESS Bronze HMO 70 HSA 1662","36194FL012",,"FLN001","FLS001","FLF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9871",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120003-00","Health First GYM ACCESS Bronze HMO 70 HSA 1662","Standard Bronze Off Exchange Plan",,"0.613951045716537","Yes","Yes","No","100%",,"$3,500","$0","$3,000","$60","$4,500","$0","$2,000","$60","$1,300","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","per person not applicable","$10300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2018_sbc_1662",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010003","Health First Bronze POS 100 HSA 5418","36194FL001",,"FLN003","FLS001","FLF001","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9789",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010003-00","Health First Bronze POS 100 HSA 5418","Standard Bronze Off Exchange Plan",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5418",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010003","Health First Bronze POS 100 HSA 5418","36194FL001",,"FLN003","FLS001","FLF001","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9789",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010003-01","Health First Bronze POS 100 HSA 5418","Standard Bronze On Exchange Plan",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5418",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120003","Health First GYM ACCESS Bronze HMO 70 HSA 1662","36194FL012",,"FLN001","FLS001","FLF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9871",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120003-01","Health First GYM ACCESS Bronze HMO 70 HSA 1662","Standard Bronze On Exchange Plan",,"0.613951045716537","Yes","Yes","No","100%",,"$3,500","$0","$3,000","$60","$4,500","$0","$2,000","$60","$1,300","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","per person not applicable","$10300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2018_sbc_1662",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120003","Health First GYM ACCESS Bronze HMO 70 HSA 1662","36194FL012",,"FLN001","FLS001","FLF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9871",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120003-02","Health First GYM ACCESS Bronze HMO 70 1662","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1662_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050003","Florida Hospital Bronze POS 100 HSA 5420","36194FL005",,"FLN004","FLS003","FLF014","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9789",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050003-00","Florida Hospital Bronze POS 100 HSA 5420","Standard Bronze Off Exchange Plan",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5420",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050003","Florida Hospital Bronze POS 100 HSA 5420","36194FL005",,"FLN004","FLS003","FLF014","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9789",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050003-01","Florida Hospital Bronze POS 100 HSA 5420","Standard Bronze On Exchange Plan",,"0.610301791739307","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0.00%",,,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5420",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120003","Health First GYM ACCESS Bronze HMO 70 HSA 1662","36194FL012",,"FLN001","FLS001","FLF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9871",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120003-03","Health First GYM ACCESS Bronze HMO 70 HSA 1662","Limited Cost Sharing Plan Variation",,"0.613951045716537","Yes","Yes","No","100%",,"$3,500","$0","$3,000","$60","$4,500","$0","$2,000","$60","$1,300","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","per person not applicable","$10300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2018_sbc_1662_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140003","Florida Hospital GYM ACCESS Bronze HMO 70 HSA 1663","36194FL014",,"FLN002","FLS002","FLF017","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9871",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140003-00","Florida Hospital GYM ACCESS Bronze HMO 70 HSA 1663","Standard Bronze Off Exchange Plan",,"0.613951045716537","Yes","Yes","No","100%",,"$3,500","$0","$3,000","$60","$4,500","$0","$2,000","$60","$1,300","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","per person not applicable","$10300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2018_sbc_1663",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140003","Florida Hospital GYM ACCESS Bronze HMO 70 HSA 1663","36194FL014",,"FLN002","FLS002","FLF017","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9871",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140003-01","Florida Hospital GYM ACCESS Bronze HMO 70 HSA 1663","Standard Bronze On Exchange Plan",,"0.613951045716537","Yes","Yes","No","100%",,"$3,500","$0","$3,000","$60","$4,500","$0","$2,000","$60","$1,300","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","per person not applicable","$10300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2018_sbc_1663",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140003","Florida Hospital GYM ACCESS Bronze HMO 70 HSA 1663","36194FL014",,"FLN002","FLS002","FLF017","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9871",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140003-02","Florida Hospital GYM ACCESS Bronze HMO 70 1663","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1663_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140003","Florida Hospital GYM ACCESS Bronze HMO 70 HSA 1663","36194FL014",,"FLN002","FLS002","FLF017","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9871",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140003-03","Florida Hospital GYM ACCESS Bronze HMO 70 HSA 1663","Limited Cost Sharing Plan Variation",,"0.613951045716537","Yes","Yes","No","100%",,"$3,500","$0","$3,000","$60","$4,500","$0","$2,000","$60","$1,300","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","per person not applicable","$10300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2018_sbc_1663_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120004","Health First GYM ACCESS Silver HMO 100 1664","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120004-00","Health First GYM ACCESS Silver HMO 100 1664","Standard Silver Off Exchange Plan",,"0.715742811674541","No","Yes","No","100%",,"$5,000","$100","$0","$60","$1,000","$1,700","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1664",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030004","Health First Silver HMO 50 5421","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9803",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030004-00","Health First Silver HMO 50 5421","Standard Silver Off Exchange Plan",,"0.715997220537007","No","Yes","No","100%",,"$500","$0","$5,000","$60","$400","$1,700","$200","$60","$800","$200","$800","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5421",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030004","Health First Silver HMO 50 5421","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9803",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030004-01","Health First Silver HMO 50 5421","Standard Silver On Exchange Plan",,"0.715997220537007","No","Yes","No","100%",,"$500","$0","$5,000","$60","$400","$1,700","$200","$60","$800","$200","$800","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5421",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120004","Health First GYM ACCESS Silver HMO 100 1664","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120004-01","Health First GYM ACCESS Silver HMO 100 1664","Standard Silver On Exchange Plan",,"0.715742811674541","No","Yes","No","100%",,"$5,000","$100","$0","$60","$1,000","$1,700","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1664",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120004","Health First GYM ACCESS Silver HMO 100 1664","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120004-02","Health First GYM ACCESS Silver HMO 100 1664","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1664_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070004","Florida Hospital Silver HMO 50 5424","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9803",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070004-00","Florida Hospital Silver HMO 50 5424","Standard Silver Off Exchange Plan",,"0.715997220537007","No","Yes","No","100%",,"$500","$0","$5,000","$60","$400","$1,700","$200","$60","$800","$200","$800","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5424",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070004","Florida Hospital Silver HMO 50 5424","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9803",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070004-01","Florida Hospital Silver HMO 50 5424","Standard Silver On Exchange Plan",,"0.715997220537007","No","Yes","No","100%",,"$500","$0","$5,000","$60","$400","$1,700","$200","$60","$800","$200","$800","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5424",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120004","Health First GYM ACCESS Silver HMO 100 1664","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120004-03","Health First GYM ACCESS Silver HMO 100 1664","Limited Cost Sharing Plan Variation",,"0.715742811674541","No","Yes","No","100%",,"$5,000","$100","$0","$60","$1,000","$1,700","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1664_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120004","Health First GYM ACCESS Silver HMO 100 1664","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120004-04","Health First GYM ACCESS Silver AV73 HMO 100 1665","73% AV Level Silver Plan",,"0.73842821186858","No","Yes","No","100%",,"$4,100","$100","$0","$60","$1,000","$1,700","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,100","$4100 per person","$8200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1665",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120004","Health First GYM ACCESS Silver HMO 100 1664","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120004-05","Health First GYM ACCESS Silver AV87 HMO 100 1666","87% AV Level Silver Plan",,"0.877088941568333","No","Yes","No","100%",,"$900","$20","$0","$60","$800","$800","$0","$60","$900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1666",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120004","Health First GYM ACCESS Silver HMO 100 1664","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120004-06","Health First GYM ACCESS Silver AV94 HMO 100 1667","94% AV Level Silver Plan",,"0.946823460397816","No","Yes","No","100%",,"$200","$20","$0","$60","$300","$200","$0","$60","$200","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1667",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140004","Florida Hospital GYM ACCESS Silver HMO 100 1668","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140004-00","Florida Hospital GYM ACCESS Silver HMO 100 1668","Standard Silver Off Exchange Plan",,"0.715742811674541","No","Yes","No","100%",,"$5,000","$100","$0","$60","$1,000","$1,700","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1668",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140004","Florida Hospital GYM ACCESS Silver HMO 100 1668","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140004-01","Florida Hospital GYM ACCESS Silver HMO 100 1668","Standard Silver On Exchange Plan",,"0.715742811674541","No","Yes","No","100%",,"$5,000","$100","$0","$60","$1,000","$1,700","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1668",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140004","Florida Hospital GYM ACCESS Silver HMO 100 1668","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140004-02","Florida Hospital GYM ACCESS Silver HMO 100 1668","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1668_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140004","Florida Hospital GYM ACCESS Silver HMO 100 1668","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140004-03","Florida Hospital GYM ACCESS Silver HMO 100 1668","Limited Cost Sharing Plan Variation",,"0.715742811674541","No","Yes","No","100%",,"$5,000","$100","$0","$60","$1,000","$1,700","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1668_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140004","Florida Hospital GYM ACCESS Silver HMO 100 1668","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140004-04","Florida Hospital GYM ACCESS Silver AV73 HMO 100 1669","73% AV Level Silver Plan",,"0.73842821186858","No","Yes","No","100%",,"$4,100","$100","$0","$60","$1,000","$1,700","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,100","$4100 per person","$8200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1669",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140004","Florida Hospital GYM ACCESS Silver HMO 100 1668","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140004-05","Florida Hospital GYM ACCESS Silver AV87 HMO 100 1670","87% AV Level Silver Plan",,"0.877088941568333","No","Yes","No","100%",,"$900","$20","$0","$60","$800","$800","$0","$60","$900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1670",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140004","Florida Hospital GYM ACCESS Silver HMO 100 1668","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140004-06","Florida Hospital GYM ACCESS Silver AV94 HMO 100 1671","94% AV Level Silver Plan",,"0.946823460397816","No","Yes","No","100%",,"$200","$20","$0","$60","$300","$200","$0","$60","$200","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1671",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120005","Health First GYM ACCESS Silver HMO 100 1672","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120005-00","Health First GYM ACCESS Silver HMO 100 1672","Standard Silver Off Exchange Plan",,"0.716411559317853","No","Yes","No","100%",,"$4,000","$60","$0","$60","$1,200","$1,700","$0","$60","$1,800","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1672",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010005","Health First Silver POS 50 5427","36194FL001",,"FLN003","FLS001","FLF009","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9808",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010005-00","Health First Silver POS 50 5427","Standard Silver Off Exchange Plan",,"0.707091433647515","No","Yes","No","100%",,"$1,300","$0","$5,000","$60","$200","$1,700","$200","$60","$800","$200","$800","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50.00%",,,,,"$4,400","$4400 per person","$8800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5427",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010005","Health First Silver POS 50 5427","36194FL001",,"FLN003","FLS001","FLF009","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9808",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010005-01","Health First Silver POS 50 5427","Standard Silver On Exchange Plan",,"0.707091433647515","No","Yes","No","100%",,"$1,300","$0","$5,000","$60","$200","$1,700","$200","$60","$800","$200","$800","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50.00%",,,,,"$4,400","$4400 per person","$8800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5427",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120005","Health First GYM ACCESS Silver HMO 100 1672","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120005-04","Health First GYM ACCESS Silver AV73 HMO 100 1673","73% AV Level Silver Plan",,"0.737693780761533","No","Yes","No","100%",,"$3,200","$60","$0","$60","$1,200","$1,700","$0","$60","$1,800","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,150","$3150 per person","$6300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1673",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120005","Health First GYM ACCESS Silver HMO 100 1672","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120005-05","Health First GYM ACCESS Silver AV87 HMO 100 1674","87% AV Level Silver Plan",,"0.877380538317884","No","Yes","No","100%",,"$900","$20","$0","$60","$700","$900","$0","$60","$900","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1674",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140005","Florida Hospital GYM ACCESS Silver HMO 100 1676","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140005-01","Florida Hospital GYM ACCESS Silver HMO 100 1676","Standard Silver On Exchange Plan",,"0.716411559317853","No","Yes","No","100%",,"$4,000","$60","$0","$60","$1,200","$1,700","$0","$60","$1,800","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1676",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140005","Florida Hospital GYM ACCESS Silver HMO 100 1676","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140005-02","Florida Hospital GYM ACCESS Silver HMO 100 1676","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1676_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140005","Florida Hospital GYM ACCESS Silver HMO 100 1676","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140005-03","Florida Hospital GYM ACCESS Silver HMO 100 1676","Limited Cost Sharing Plan Variation",,"0.716411559317853","No","Yes","No","100%",,"$4,000","$60","$0","$60","$1,200","$1,700","$0","$60","$1,800","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1676_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140005","Florida Hospital GYM ACCESS Silver HMO 100 1676","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140005-04","Florida Hospital GYM ACCESS Silver AV73 HMO 100 1677","73% AV Level Silver Plan",,"0.737693780761533","No","Yes","No","100%",,"$3,200","$60","$0","$60","$1,200","$1,700","$0","$60","$1,800","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,150","$3150 per person","$6300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1677",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140005","Florida Hospital GYM ACCESS Silver HMO 100 1676","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140005-05","Florida Hospital GYM ACCESS Silver AV87 HMO 100 1678","87% AV Level Silver Plan",,"0.877380538317884","No","Yes","No","100%",,"$900","$20","$0","$60","$700","$900","$0","$60","$900","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1678",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140005","Florida Hospital GYM ACCESS Silver HMO 100 1676","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140005-06","Florida Hospital GYM ACCESS Silver AV94 HMO 100 1679","94% AV Level Silver Plan",,"0.947808860461562","No","Yes","No","100%",,"$100","$20","$0","$60","$300","$200","$0","$60","$100","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$475","$475 per person","$950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1679",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120006","Health First GYM ACCESS Silver HMO 90 1680","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120006-00","Health First GYM ACCESS Silver HMO 90 1680","Standard Silver Off Exchange Plan","71.81%","0.721348279787353","No","Yes","No","100%",,"$4,300","$200","$900","$60","$1,100","$1,900","$40","$60","$900","$300","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1680",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030006","Health First Silver HMO 50 5430","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9806",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030006-00","Health First Silver HMO 50 5430","Standard Silver Off Exchange Plan",,"0.717925930471802","No","Yes","No","100%",,"$2,000","$0","$4,600","$60","$500","$1,600","$300","$60","$1,000","$0","$1,000","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5430",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030006","Health First Silver HMO 50 5430","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9806",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030006-01","Health First Silver HMO 50 5430","Standard Silver On Exchange Plan",,"0.717925930471802","No","Yes","No","100%",,"$2,000","$0","$4,600","$60","$500","$1,600","$300","$60","$1,000","$0","$1,000","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5430",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120006","Health First GYM ACCESS Silver HMO 90 1680","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120006-01","Health First GYM ACCESS Silver HMO 90 1680","Standard Silver On Exchange Plan","71.81%","0.721348279787353","No","Yes","No","100%",,"$4,300","$200","$900","$60","$1,100","$1,900","$40","$60","$900","$300","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1680",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120006","Health First GYM ACCESS Silver HMO 90 1680","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120006-02","Health First GYM ACCESS Silver HMO 90 1680","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1680_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070006","Florida Hospital Silver HMO 50 5432","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9806",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070006-00","Florida Hospital Silver HMO 50 5432","Standard Silver Off Exchange Plan",,"0.717925930471802","No","Yes","No","100%",,"$2,000","$0","$4,600","$60","$500","$1,600","$300","$60","$1,000","$0","$1,000","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5432",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070006","Florida Hospital Silver HMO 50 5432","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9806",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070006-01","Florida Hospital Silver HMO 50 5432","Standard Silver On Exchange Plan",,"0.717925930471802","No","Yes","No","100%",,"$2,000","$0","$4,600","$60","$500","$1,600","$300","$60","$1,000","$0","$1,000","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5432",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120006","Health First GYM ACCESS Silver HMO 90 1680","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120006-03","Health First GYM ACCESS Silver HMO 90 1680","Limited Cost Sharing Plan Variation","71.81%","0.721348279787353","No","Yes","No","100%",,"$4,300","$200","$900","$60","$1,100","$1,900","$40","$60","$900","$300","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1680_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120006","Health First GYM ACCESS Silver HMO 90 1680","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120006-04","Health First GYM ACCESS Silver AV73 HMO 90 1681","73% AV Level Silver Plan","73.85%","0.739496432147389","No","Yes","No","100%",,"$4,300","$200","$900","$60","$1,100","$1,900","$40","$60","$900","$300","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1681",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120006","Health First GYM ACCESS Silver HMO 90 1680","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120006-05","Health First GYM ACCESS Silver AV87 HMO 90 1682","87% AV Level Silver Plan","87.94%","0.891487111166156","No","Yes","No","100%",,"$400","$50","$900","$60","$400","$1,000","$20","$60","$400","$300","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1682",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120006","Health First GYM ACCESS Silver HMO 90 1680","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120006-06","Health First GYM ACCESS Silver AV94 HMO 90 1683","94% AV Level Silver Plan","93.16%","0.935172615656375","No","Yes","No","100%",,"$0","$50","$600","$60","$200","$400","$20","$60","$0","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1683",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140006","Florida Hospital GYM ACCESS Silver HMO 90 1684","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140006-00","Florida Hospital GYM ACCESS Silver HMO 90 1684","Standard Silver Off Exchange Plan","71.81%","0.721348279787353","No","Yes","No","100%",,"$4,300","$200","$900","$60","$1,100","$1,900","$40","$60","$900","$300","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1684",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140006","Florida Hospital GYM ACCESS Silver HMO 90 1684","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140006-01","Florida Hospital GYM ACCESS Silver HMO 90 1684","Standard Silver On Exchange Plan","71.81%","0.721348279787353","No","Yes","No","100%",,"$4,300","$200","$900","$60","$1,100","$1,900","$40","$60","$900","$300","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1684",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140006","Florida Hospital GYM ACCESS Silver HMO 90 1684","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140006-02","Florida Hospital GYM ACCESS Silver HMO 90 1684","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1684_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140006","Florida Hospital GYM ACCESS Silver HMO 90 1684","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140006-03","Florida Hospital GYM ACCESS Silver HMO 90 1684","Limited Cost Sharing Plan Variation","71.81%","0.721348279787353","No","Yes","No","100%",,"$4,300","$200","$900","$60","$1,100","$1,900","$40","$60","$900","$300","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1684_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140006","Florida Hospital GYM ACCESS Silver HMO 90 1684","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140006-04","Florida Hospital GYM ACCESS Silver AV73 HMO 90 1685","73% AV Level Silver Plan","73.85%","0.739496432147389","No","Yes","No","100%",,"$4,300","$200","$900","$60","$1,100","$1,900","$40","$60","$900","$300","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1685",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140006","Florida Hospital GYM ACCESS Silver HMO 90 1684","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140006-05","Florida Hospital GYM ACCESS Silver AV87 HMO 90 1686","87% AV Level Silver Plan","87.94%","0.891487111166156","No","Yes","No","100%",,"$400","$50","$900","$60","$400","$1,000","$20","$60","$400","$300","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1686",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140006","Florida Hospital GYM ACCESS Silver HMO 90 1684","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140006-06","Florida Hospital GYM ACCESS Silver AV94 HMO 90 1687","94% AV Level Silver Plan","93.16%","0.935172615656375","No","Yes","No","100%",,"$0","$50","$600","$60","$200","$400","$20","$60","$0","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1687",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120007","Health First GYM ACCESS Silver HMO 80 1688","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120007-00","Health First GYM ACCESS Silver HMO 80 1688","Standard Silver Off Exchange Plan",,"0.693236218527532","No","Yes","No","100%",,"$3,100","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1688",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030007","Health First Silver HMO 80 5433","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9816",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030007-00","Health First Silver HMO 80 5433","Standard Silver Off Exchange Plan","71.90%","0.744206576077059","No","Yes","No","100%",,"$5,000","$40","$1,800","$60","$500","$1,800","$70","$60","$800","$600","$200","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5433",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030007","Health First Silver HMO 80 5433","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9816",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030007-01","Health First Silver HMO 80 5433","Standard Silver On Exchange Plan","71.90%","0.744206576077059","No","Yes","No","100%",,"$5,000","$40","$1,800","$60","$500","$1,800","$70","$60","$800","$600","$200","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5433",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120007","Health First GYM ACCESS Silver HMO 80 1688","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120007-01","Health First GYM ACCESS Silver HMO 80 1688","Standard Silver On Exchange Plan",,"0.693236218527532","No","Yes","No","100%",,"$3,100","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1688",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120007","Health First GYM ACCESS Silver HMO 80 1688","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120007-02","Health First GYM ACCESS Silver HMO 80 1688","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1688_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070007","Florida Hospital Silver HMO 80 5435","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9816",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070007-00","Florida Hospital Silver HMO 80 5435","Standard Silver Off Exchange Plan","71.90%","0.744206576077059","No","Yes","No","100%",,"$5,000","$40","$1,800","$60","$500","$1,800","$70","$60","$800","$600","$200","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5435",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070007","Florida Hospital Silver HMO 80 5435","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9816",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070007-01","Florida Hospital Silver HMO 80 5435","Standard Silver On Exchange Plan","71.90%","0.744206576077059","No","Yes","No","100%",,"$5,000","$40","$1,800","$60","$500","$1,800","$70","$60","$800","$600","$200","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5435",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120007","Health First GYM ACCESS Silver HMO 80 1688","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120007-03","Health First GYM ACCESS Silver HMO 80 1688","Limited Cost Sharing Plan Variation",,"0.693236218527532","No","Yes","No","100%",,"$3,100","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1688_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120007","Health First GYM ACCESS Silver HMO 80 1688","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120007-04","Health First GYM ACCESS Silver AV73 HMO 80 1689","73% AV Level Silver Plan",,"0.735046514226566","No","Yes","No","100%",,"$1,900","$0","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1689",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120007","Health First GYM ACCESS Silver HMO 80 1688","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120007-05","Health First GYM ACCESS Silver AV87 HMO 80 1690","87% AV Level Silver Plan",,"0.876404739759582","No","Yes","No","100%",,"$500","$0","$800","$60","$800","$400","$100","$60","$500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1690",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120007","Health First GYM ACCESS Silver HMO 80 1688","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120007-06","Health First GYM ACCESS Silver AV94 HMO 80 1691","94% AV Level Silver Plan",,"0.939124549641805","No","Yes","No","100%",,"$200","$0","$300","$60","$300","$200","$10","$60","$200","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1691",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140007","Florida Hospital GYM ACCESS Silver HMO 80 1696","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140007-00","Florida Hospital GYM ACCESS Silver HMO 80 1696","Standard Silver Off Exchange Plan",,"0.693236218527532","No","Yes","No","100%",,"$3,100","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1696",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140007","Florida Hospital GYM ACCESS Silver HMO 80 1696","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140007-01","Florida Hospital GYM ACCESS Silver HMO 80 1696","Standard Silver On Exchange Plan",,"0.693236218527532","No","Yes","No","100%",,"$3,100","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1696",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140007","Florida Hospital GYM ACCESS Silver HMO 80 1696","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140007-02","Florida Hospital GYM ACCESS Silver HMO 80 1696","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1696_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140007","Florida Hospital GYM ACCESS Silver HMO 80 1696","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140007-03","Florida Hospital GYM ACCESS Silver HMO 80 1696","Limited Cost Sharing Plan Variation",,"0.693236218527532","No","Yes","No","100%",,"$3,100","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1696_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140007","Florida Hospital GYM ACCESS Silver HMO 80 1696","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140007-04","Florida Hospital GYM ACCESS Silver AV73 HMO 80 1697","73% AV Level Silver Plan",,"0.735046514226566","No","Yes","No","100%",,"$1,900","$0","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1697",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140007","Florida Hospital GYM ACCESS Silver HMO 80 1696","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140007-05","Florida Hospital GYM ACCESS Silver AV87 HMO 80 1698","87% AV Level Silver Plan",,"0.876404739759582","No","Yes","No","100%",,"$500","$0","$800","$60","$800","$400","$100","$60","$500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1698",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140007","Florida Hospital GYM ACCESS Silver HMO 80 1696","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140007-06","Florida Hospital GYM ACCESS Silver AV94 HMO 80 1699","94% AV Level Silver Plan",,"0.939124549641805","No","Yes","No","100%",,"$200","$0","$300","$60","$300","$200","$10","$60","$200","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1699",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130002","Health First GYM ACCESS Silver POS 80 1692","36194FL013",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130002-00","Health First GYM ACCESS Silver POS 80 1692","Standard Silver Off Exchange Plan",,"0.693236218527532","No","Yes","No","100%",,"$3,100","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1692",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010007","Health First Silver POS 80 5434","36194FL001",,"FLN003","FLS001","FLF009","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9825",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010007-00","Health First Silver POS 80 5434","Standard Silver Off Exchange Plan","71.90%","0.744206576077059","No","Yes","No","100%",,"$5,000","$40","$1,800","$60","$500","$1,800","$70","$60","$800","$600","$200","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"$14,200","$14200 per person","$28400 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5434",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010007","Health First Silver POS 80 5434","36194FL001",,"FLN003","FLS001","FLF009","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9825",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010007-01","Health First Silver POS 80 5434","Standard Silver On Exchange Plan","71.90%","0.744206576077059","No","Yes","No","100%",,"$5,000","$40","$1,800","$60","$500","$1,800","$70","$60","$800","$600","$200","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"$14,200","$14200 per person","$28400 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5434",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130002","Health First GYM ACCESS Silver POS 80 1692","36194FL013",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130002-01","Health First GYM ACCESS Silver POS 80 1692","Standard Silver On Exchange Plan",,"0.693236218527532","No","Yes","No","100%",,"$3,100","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1692",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130002","Health First GYM ACCESS Silver POS 80 1692","36194FL013",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130002-02","Health First GYM ACCESS Silver POS 80 1692","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1692_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050007","Florida Hospital Silver POS 80 5436","36194FL005",,"FLN004","FLS003","FLF022","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9825",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050007-00","Florida Hospital Silver POS 80 5436","Standard Silver Off Exchange Plan","71.90%","0.744206576077059","No","Yes","No","100%",,"$5,000","$40","$1,800","$60","$500","$1,800","$70","$60","$800","$600","$200","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"$14,200","$14200 per person","$28400 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5436",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150002","Florida Hospital GYM ACCESS Silver POS 80 1700","36194FL015",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150002-02","Florida Hospital GYM ACCESS Silver POS 80 1700","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1700_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150002","Florida Hospital GYM ACCESS Silver POS 80 1700","36194FL015",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150002-03","Florida Hospital GYM ACCESS Silver POS 80 1700","Limited Cost Sharing Plan Variation",,"0.693236218527532","No","Yes","No","100%",,"$3,100","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1700_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150002","Florida Hospital GYM ACCESS Silver POS 80 1700","36194FL015",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150002-04","Florida Hospital GYM ACCESS Silver AV73 POS 80 1701","73% AV Level Silver Plan",,"0.735046514226566","No","Yes","No","100%",,"$1,900","$0","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1701",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150002","Florida Hospital GYM ACCESS Silver POS 80 1700","36194FL015",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150002-05","Florida Hospital GYM ACCESS Silver AV87 POS 80 1702","87% AV Level Silver Plan",,"0.876404739759582","No","Yes","No","100%",,"$500","$0","$800","$60","$800","$400","$100","$60","$500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1702",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150002","Florida Hospital GYM ACCESS Silver POS 80 1700","36194FL015",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150002-06","Florida Hospital GYM ACCESS Silver AV94 POS 80 1703","94% AV Level Silver Plan",,"0.939124549641805","No","Yes","No","100%",,"$200","$0","$300","$60","$300","$200","$10","$60","$200","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1703",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120008","Health First GYM ACCESS Silver HMO 70 1704","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120008-00","Health First GYM ACCESS Silver HMO 70 1704","Standard Silver Off Exchange Plan",,"0.713069156556918","No","Yes","No","100%",,"$3,300","$0","$3,000","$60","$800","$1,700","$100","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1704",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030008","Health First Silver HMO 50 5437","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9802",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030008-00","Health First Silver HMO 50 5437","Standard Silver Off Exchange Plan",,"0.718892772779188","No","Yes","No","100%",,"$2,200","$0","$4,600","$60","$300","$1,600","$300","$60","$1,000","$0","$1,000","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5437",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030008","Health First Silver HMO 50 5437","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9802",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030008-01","Health First Silver HMO 50 5437","Standard Silver On Exchange Plan",,"0.718892772779188","No","Yes","No","100%",,"$2,200","$0","$4,600","$60","$300","$1,600","$300","$60","$1,000","$0","$1,000","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5437",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050007","Florida Hospital Silver POS 80 5436","36194FL005",,"FLN004","FLS003","FLF022","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9825",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050007-01","Florida Hospital Silver POS 80 5436","Standard Silver On Exchange Plan","71.90%","0.744206576077059","No","Yes","No","100%",,"$5,000","$40","$1,800","$60","$500","$1,800","$70","$60","$800","$600","$200","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"$14,200","$14200 per person","$28400 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5436",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130002","Health First GYM ACCESS Silver POS 80 1692","36194FL013",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130002-03","Health First GYM ACCESS Silver POS 80 1692","Limited Cost Sharing Plan Variation",,"0.693236218527532","No","Yes","No","100%",,"$3,100","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1692_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130002","Health First GYM ACCESS Silver POS 80 1692","36194FL013",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130002-04","Health First GYM ACCESS Silver AV73 POS 80 1693","73% AV Level Silver Plan",,"0.735046514226566","No","Yes","No","100%",,"$1,900","$0","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1693",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130002","Health First GYM ACCESS Silver POS 80 1692","36194FL013",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130002-05","Health First GYM ACCESS Silver AV87 POS 80 1694","87% AV Level Silver Plan",,"0.876404739759582","No","Yes","No","100%",,"$500","$0","$800","$60","$800","$400","$100","$60","$500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1694",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130002","Health First GYM ACCESS Silver POS 80 1692","36194FL013",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130002-06","Health First GYM ACCESS Silver AV94 POS 80 1695","94% AV Level Silver Plan",,"0.939124549641805","No","Yes","No","100%",,"$200","$0","$300","$60","$300","$200","$10","$60","$200","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1695",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150002","Florida Hospital GYM ACCESS Silver POS 80 1700","36194FL015",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150002-00","Florida Hospital GYM ACCESS Silver POS 80 1700","Standard Silver Off Exchange Plan",,"0.693236218527532","No","Yes","No","100%",,"$3,100","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1700",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150002","Florida Hospital GYM ACCESS Silver POS 80 1700","36194FL015",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9918",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150002-01","Florida Hospital GYM ACCESS Silver POS 80 1700","Standard Silver On Exchange Plan",,"0.693236218527532","No","Yes","No","100%",,"$3,100","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1700",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120008","Health First GYM ACCESS Silver HMO 70 1704","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120008-01","Health First GYM ACCESS Silver HMO 70 1704","Standard Silver On Exchange Plan",,"0.713069156556918","No","Yes","No","100%",,"$3,300","$0","$3,000","$60","$800","$1,700","$100","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1704",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120008","Health First GYM ACCESS Silver HMO 70 1704","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120008-02","Health First GYM ACCESS Silver HMO 70 1704","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1704_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070008","Florida Hospital Silver HMO 50 5438","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9802",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070008-00","Florida Hospital Silver HMO 50 5438","Standard Silver Off Exchange Plan",,"0.718892772779188","No","Yes","No","100%",,"$2,200","$0","$4,600","$60","$300","$1,600","$300","$60","$1,000","$0","$1,000","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5438",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070008","Florida Hospital Silver HMO 50 5438","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9802",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070008-01","Florida Hospital Silver HMO 50 5438","Standard Silver On Exchange Plan",,"0.718892772779188","No","Yes","No","100%",,"$2,200","$0","$4,600","$60","$300","$1,600","$300","$60","$1,000","$0","$1,000","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5438",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120008","Health First GYM ACCESS Silver HMO 70 1704","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120008-03","Health First GYM ACCESS Silver HMO 70 1704","Limited Cost Sharing Plan Variation",,"0.713069156556918","No","Yes","No","100%",,"$3,300","$0","$3,000","$60","$800","$1,700","$100","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1704_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120008","Health First GYM ACCESS Silver HMO 70 1704","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120008-04","Health First GYM ACCESS Silver AV73 HMO 70 1705","73% AV Level Silver Plan",,"0.734935354598374","No","Yes","No","100%",,"$2,500","$0","$3,000","$60","$800","$1,700","$100","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1705",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120008","Health First GYM ACCESS Silver HMO 70 1704","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120008-05","Health First GYM ACCESS Silver AV87 HMO 70 1706","87% AV Level Silver Plan",,"0.860588633514247","No","Yes","No","100%",,"$700","$0","$900","$60","$700","$800","$80","$60","$800","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1706",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120008","Health First GYM ACCESS Silver HMO 70 1704","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120008-06","Health First GYM ACCESS Silver AV94 HMO 70 1707","94% AV Level Silver Plan",,"0.935797747011881","No","Yes","No","100%",,"$0","$0","$600","$60","$200","$300","$80","$60","$0","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1707",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140008","Florida Hospital GYM ACCESS Silver HMO 70 1712","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140008-00","Florida Hospital GYM ACCESS Silver HMO 70 1712","Standard Silver Off Exchange Plan",,"0.713069156556918","No","Yes","No","100%",,"$3,300","$0","$3,000","$60","$800","$1,700","$100","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1712",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140008","Florida Hospital GYM ACCESS Silver HMO 70 1712","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140008-01","Florida Hospital GYM ACCESS Silver HMO 70 1712","Standard Silver On Exchange Plan",,"0.713069156556918","No","Yes","No","100%",,"$3,300","$0","$3,000","$60","$800","$1,700","$100","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1712",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140008","Florida Hospital GYM ACCESS Silver HMO 70 1712","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140008-02","Florida Hospital GYM ACCESS Silver HMO 70 1712","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1712_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140008","Florida Hospital GYM ACCESS Silver HMO 70 1712","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140008-03","Florida Hospital GYM ACCESS Silver HMO 70 1712","Limited Cost Sharing Plan Variation",,"0.713069156556918","No","Yes","No","100%",,"$3,300","$0","$3,000","$60","$800","$1,700","$100","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1712_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140008","Florida Hospital GYM ACCESS Silver HMO 70 1712","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140008-04","Florida Hospital GYM ACCESS Silver AV73 HMO 70 1713","73% AV Level Silver Plan",,"0.734935354598374","No","Yes","No","100%",,"$2,500","$0","$3,000","$60","$800","$1,700","$100","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1713",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140008","Florida Hospital GYM ACCESS Silver HMO 70 1712","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140008-05","Florida Hospital GYM ACCESS Silver AV87 HMO 70 1714","87% AV Level Silver Plan",,"0.860588633514247","No","Yes","No","100%",,"$700","$0","$900","$60","$700","$800","$80","$60","$800","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1714",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140008","Florida Hospital GYM ACCESS Silver HMO 70 1712","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140008-06","Florida Hospital GYM ACCESS Silver AV94 HMO 70 1715","94% AV Level Silver Plan",,"0.935797747011881","No","Yes","No","100%",,"$0","$0","$600","$60","$200","$300","$80","$60","$0","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1715",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130003","Health First GYM ACCESS Silver POS 70 1708","36194FL013",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9919",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130003-00","Health First GYM ACCESS Silver POS 70 1708","Standard Silver Off Exchange Plan",,"0.713069156556918","No","Yes","No","100%",,"$3,300","$0","$3,000","$60","$800","$1,700","$100","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1708",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010009","Health First Silver POS 100 HSA 5440","36194FL001",,"FLN003","FLS001","FLF001","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.982",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010009-00","Health First Silver POS 100 HSA 5440","Standard Silver Off Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,600","$0","$0","$60","$3,600","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","per person not applicable","$7200 per group","0.00%",,,,,"$7,200","per person not applicable","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5440",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010009","Health First Silver POS 100 HSA 5440","36194FL001",,"FLN003","FLS001","FLF001","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.982",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010009-01","Health First Silver POS 100 HSA 5440","Standard Silver On Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,600","$0","$0","$60","$3,600","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","per person not applicable","$7200 per group","0.00%",,,,,"$7,200","per person not applicable","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5440",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130003","Health First GYM ACCESS Silver POS 70 1708","36194FL013",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9919",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130003-01","Health First GYM ACCESS Silver POS 70 1708","Standard Silver On Exchange Plan",,"0.713069156556918","No","Yes","No","100%",,"$3,300","$0","$3,000","$60","$800","$1,700","$100","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1708",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130003","Health First GYM ACCESS Silver POS 70 1708","36194FL013",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9919",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130003-02","Health First GYM ACCESS Silver POS 70 1708","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1708_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150003","Florida Hospital GYM ACCESS Silver POS 70 1716","36194FL015",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9919",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150003-02","Florida Hospital GYM ACCESS Silver POS 70 1716","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1716_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050009","Florida Hospital Silver POS 100 HSA 5442","36194FL005",,"FLN004","FLS003","FLF014","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.982",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050009-00","Florida Hospital Silver POS 100 HSA 5442","Standard Silver Off Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,600","$0","$0","$60","$3,600","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","per person not applicable","$7200 per group","0.00%",,,,,"$7,200","per person not applicable","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5442",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050009","Florida Hospital Silver POS 100 HSA 5442","36194FL005",,"FLN004","FLS003","FLF014","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.982",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050009-01","Florida Hospital Silver POS 100 HSA 5442","Standard Silver On Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,600","$0","$0","$60","$3,600","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","per person not applicable","$7200 per group","0.00%",,,,,"$7,200","per person not applicable","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5442",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130003","Health First GYM ACCESS Silver POS 70 1708","36194FL013",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9919",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130003-03","Health First GYM ACCESS Silver POS 70 1708","Limited Cost Sharing Plan Variation",,"0.713069156556918","No","Yes","No","100%",,"$3,300","$0","$3,000","$60","$800","$1,700","$100","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1708_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150003","Florida Hospital GYM ACCESS Silver POS 70 1716","36194FL015",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9919",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150003-05","Florida Hospital GYM ACCESS Silver AV87 POS 70 1718","87% AV Level Silver Plan",,"0.860588633514247","No","Yes","No","100%",,"$700","$0","$900","$60","$700","$800","$80","$60","$800","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1718",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150003","Florida Hospital GYM ACCESS Silver POS 70 1716","36194FL015",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9919",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150003-06","Florida Hospital GYM ACCESS Silver AV94 POS 70 1719","94% AV Level Silver Plan",,"0.935797747011881","No","Yes","No","100%",,"$0","$0","$600","$60","$200","$300","$80","$60","$0","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1719",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130003","Health First GYM ACCESS Silver POS 70 1708","36194FL013",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9919",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130003-04","Health First GYM ACCESS Silver AV73 POS 70 1709","73% AV Level Silver Plan",,"0.734935354598374","No","Yes","No","100%",,"$2,500","$0","$3,000","$60","$800","$1,700","$100","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1709",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130003","Health First GYM ACCESS Silver POS 70 1708","36194FL013",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9919",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130003-05","Health First GYM ACCESS Silver AV87 POS 70 1710","87% AV Level Silver Plan",,"0.860588633514247","No","Yes","No","100%",,"$700","$0","$900","$60","$700","$800","$80","$60","$800","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1710",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130003","Health First GYM ACCESS Silver POS 70 1708","36194FL013",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9919",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130003-06","Health First GYM ACCESS Silver AV94 POS 70 1711","94% AV Level Silver Plan",,"0.935797747011881","No","Yes","No","100%",,"$0","$0","$600","$60","$200","$300","$80","$60","$0","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1711",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150003","Florida Hospital GYM ACCESS Silver POS 70 1716","36194FL015",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9919",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150003-00","Florida Hospital GYM ACCESS Silver POS 70 1716","Standard Silver Off Exchange Plan",,"0.713069156556918","No","Yes","No","100%",,"$3,300","$0","$3,000","$60","$800","$1,700","$100","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1716",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150003","Florida Hospital GYM ACCESS Silver POS 70 1716","36194FL015",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9919",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150003-01","Florida Hospital GYM ACCESS Silver POS 70 1716","Standard Silver On Exchange Plan",,"0.713069156556918","No","Yes","No","100%",,"$3,300","$0","$3,000","$60","$800","$1,700","$100","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1716",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150003","Florida Hospital GYM ACCESS Silver POS 70 1716","36194FL015",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9919",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150003-03","Florida Hospital GYM ACCESS Silver POS 70 1716","Limited Cost Sharing Plan Variation",,"0.713069156556918","No","Yes","No","100%",,"$3,300","$0","$3,000","$60","$800","$1,700","$100","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1716_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150003","Florida Hospital GYM ACCESS Silver POS 70 1716","36194FL015",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9919",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150003-04","Florida Hospital GYM ACCESS Silver AV73 POS 70 1717","73% AV Level Silver Plan",,"0.734935354598374","No","Yes","No","100%",,"$2,500","$0","$3,000","$60","$800","$1,700","$100","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1717",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120009","Health First GYM ACCESS Silver HMO 70 1720","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120009-00","Health First GYM ACCESS Silver HMO 70 1720","Standard Silver Off Exchange Plan","71.30%","0.707992188614285","No","Yes","No","100%",,"$2,000","$10","$3,100","$60","$1,300","$1,500","$400","$60","$1,300","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1720",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030010","Health First Silver HMO 90 HSA 5443","36194FL003",,"FLN003","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.981",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030010-00","Health First Silver HMO 90 HSA 5443","Standard Silver Off Exchange Plan",,"0.719795359849575","Yes","Yes","No","100%",,"$2,600","$0","$1,000","$60","$2,600","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5443",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030010","Health First Silver HMO 90 HSA 5443","36194FL003",,"FLN003","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.981",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030010-01","Health First Silver HMO 90 HSA 5443","Standard Silver On Exchange Plan",,"0.719795359849575","Yes","Yes","No","100%",,"$2,600","$0","$1,000","$60","$2,600","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5443",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120009","Health First GYM ACCESS Silver HMO 70 1720","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120009-01","Health First GYM ACCESS Silver HMO 70 1720","Standard Silver On Exchange Plan","71.30%","0.707992188614285","No","Yes","No","100%",,"$2,000","$10","$3,100","$60","$1,300","$1,500","$400","$60","$1,300","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1720",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120009","Health First GYM ACCESS Silver HMO 70 1720","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120009-02","Health First GYM ACCESS Silver HMO 70 1720","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1720_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070010","Florida Hospital Silver HMO 90 HSA 5445","36194FL007",,"FLN004","FLS003","FLF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.981",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070010-00","Florida Hospital Silver HMO 90 HSA 5445","Standard Silver Off Exchange Plan",,"0.719795359849575","Yes","Yes","No","100%",,"$2,600","$0","$1,000","$60","$2,600","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5445",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070010","Florida Hospital Silver HMO 90 HSA 5445","36194FL007",,"FLN004","FLS003","FLF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.981",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070010-01","Florida Hospital Silver HMO 90 HSA 5445","Standard Silver On Exchange Plan",,"0.719795359849575","Yes","Yes","No","100%",,"$2,600","$0","$1,000","$60","$2,600","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5445",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120009","Health First GYM ACCESS Silver HMO 70 1720","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120009-03","Health First GYM ACCESS Silver HMO 70 1720","Limited Cost Sharing Plan Variation","71.30%","0.707992188614285","No","Yes","No","100%",,"$2,000","$10","$3,100","$60","$1,300","$1,500","$400","$60","$1,300","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1720_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120009","Health First GYM ACCESS Silver HMO 70 1720","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120009-04","Health First GYM ACCESS Silver AV73 HMO 70 1721","73% AV Level Silver Plan","73.90%","0.733540372720307","No","Yes","No","100%",,"$1,300","$10","$3,100","$60","$1,300","$1,500","$400","$60","$1,300","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1721",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120009","Health First GYM ACCESS Silver HMO 70 1720","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120009-05","Health First GYM ACCESS Silver AV87 HMO 70 1722","87% AV Level Silver Plan","86.26%","0.855211308812002","No","Yes","No","100%",,"$30","$0","$2,300","$60","$500","$1,500","$400","$60","$30","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1722",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120009","Health First GYM ACCESS Silver HMO 70 1720","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120009-06","Health First GYM ACCESS Silver AV94 HMO 70 1723","94% AV Level Silver Plan","93.89%","0.936614676354437","No","Yes","No","100%",,"$0","$0","$600","$60","$200","$200","$200","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1723",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140009","Florida Hospital GYM ACCESS Silver HMO 70 1724","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140009-00","Florida Hospital GYM ACCESS Silver HMO 70 1724","Standard Silver Off Exchange Plan","71.30%","0.707992188614285","No","Yes","No","100%",,"$2,000","$10","$3,100","$60","$1,300","$1,500","$400","$60","$1,300","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1724",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140009","Florida Hospital GYM ACCESS Silver HMO 70 1724","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140009-01","Florida Hospital GYM ACCESS Silver HMO 70 1724","Standard Silver On Exchange Plan","71.30%","0.707992188614285","No","Yes","No","100%",,"$2,000","$10","$3,100","$60","$1,300","$1,500","$400","$60","$1,300","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1724",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140009","Florida Hospital GYM ACCESS Silver HMO 70 1724","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140009-02","Florida Hospital GYM ACCESS Silver HMO 70 1724","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1724_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140009","Florida Hospital GYM ACCESS Silver HMO 70 1724","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140009-03","Florida Hospital GYM ACCESS Silver HMO 70 1724","Limited Cost Sharing Plan Variation","71.30%","0.707992188614285","No","Yes","No","100%",,"$2,000","$10","$3,100","$60","$1,300","$1,500","$400","$60","$1,300","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1724_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140009","Florida Hospital GYM ACCESS Silver HMO 70 1724","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140009-04","Florida Hospital GYM ACCESS Silver AV73 HMO 70 1725","73% AV Level Silver Plan","73.90%","0.733540372720307","No","Yes","No","100%",,"$1,300","$10","$3,100","$60","$1,300","$1,500","$400","$60","$1,300","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1725",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140009","Florida Hospital GYM ACCESS Silver HMO 70 1724","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140009-05","Florida Hospital GYM ACCESS Silver AV87 HMO 70 1726","87% AV Level Silver Plan","86.26%","0.855211308812002","No","Yes","No","100%",,"$30","$0","$2,300","$60","$500","$1,500","$400","$60","$30","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1726",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140009","Florida Hospital GYM ACCESS Silver HMO 70 1724","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140009-06","Florida Hospital GYM ACCESS Silver AV94 HMO 70 1727","94% AV Level Silver Plan","93.89%","0.936614676354437","No","Yes","No","100%",,"$0","$0","$600","$60","$200","$200","$200","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1727",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120010","Health First GYM ACCESS Silver HMO 80 HSA 1728","36194FL012",,"FLN001","FLS001","FLF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120010-00","Health First GYM ACCESS Silver HMO 80 HSA 1728","Standard Silver Off Exchange Plan",,"0.702028746128548","Yes","Yes","No","100%",,"$2,500","$0","$2,000","$60","$2,500","$0","$800","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2018_sbc_1728",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030011","Health First Silver HMO 90 HSA 5446","36194FL003",,"FLN003","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9806",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030011-00","Health First Silver HMO 90 HSA 5446","Standard Silver Off Exchange Plan",,"0.700565969544512","Yes","Yes","No","100%",,"$3,000","$0","$1,000","$60","$3,000","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5446",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030011","Health First Silver HMO 90 HSA 5446","36194FL003",,"FLN003","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9806",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030011-01","Health First Silver HMO 90 HSA 5446","Standard Silver On Exchange Plan",,"0.700565969544512","Yes","Yes","No","100%",,"$3,000","$0","$1,000","$60","$3,000","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5446",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120010","Health First GYM ACCESS Silver HMO 80 HSA 1728","36194FL012",,"FLN001","FLS001","FLF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120010-01","Health First GYM ACCESS Silver HMO 80 HSA 1728","Standard Silver On Exchange Plan",,"0.702028746128548","Yes","Yes","No","100%",,"$2,500","$0","$2,000","$60","$2,500","$0","$800","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2018_sbc_1728",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120010","Health First GYM ACCESS Silver HMO 80 HSA 1728","36194FL012",,"FLN001","FLS001","FLF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120010-02","Health First GYM ACCESS Silver HMO 80 1728","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1728_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070011","Florida Hospital Silver HMO 90 HSA 5448","36194FL007",,"FLN004","FLS003","FLF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9806",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070011-00","Florida Hospital Silver HMO 90 HSA 5448","Standard Silver Off Exchange Plan",,"0.700565969544512","Yes","Yes","No","100%",,"$3,000","$0","$1,000","$60","$3,000","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5448",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070011","Florida Hospital Silver HMO 90 HSA 5448","36194FL007",,"FLN004","FLS003","FLF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9806",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070011-01","Florida Hospital Silver HMO 90 HSA 5448","Standard Silver On Exchange Plan",,"0.700565969544512","Yes","Yes","No","100%",,"$3,000","$0","$1,000","$60","$3,000","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5448",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120010","Health First GYM ACCESS Silver HMO 80 HSA 1728","36194FL012",,"FLN001","FLS001","FLF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120010-03","Health First GYM ACCESS Silver HMO 80 HSA 1728","Limited Cost Sharing Plan Variation",,"0.702028746128548","Yes","Yes","No","100%",,"$2,500","$0","$2,000","$60","$2,500","$0","$800","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2018_sbc_1728_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120010","Health First GYM ACCESS Silver HMO 80 HSA 1728","36194FL012",,"FLN001","FLS001","FLF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120010-04","Health First GYM ACCESS Silver AV73 HMO 80 HSA 1729","73% AV Level Silver Plan",,"0.739683343713351","Yes","Yes","No","100%",,"$2,000","$0","$2,000","$60","$2,000","$0","$800","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2018_sbc_1729",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120010","Health First GYM ACCESS Silver HMO 80 HSA 1728","36194FL012",,"FLN001","FLS001","FLF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120010-05","Health First GYM ACCESS Silver AV87 HMO 80 1730","87% AV Level Silver Plan",,"0.879136610111109","Yes","Yes","No","100%",,"$300","$0","$2,000","$60","$300","$0","$800","$60","$300","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1730",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120010","Health First GYM ACCESS Silver HMO 80 HSA 1728","36194FL012",,"FLN001","FLS001","FLF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120010-06","Health First GYM ACCESS Silver AV94 HMO 80 1731","94% AV Level Silver Plan",,"0.942847970513733","Yes","Yes","No","100%",,"$0","$0","$900","$60","$0","$0","$800","$60","$0","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1731",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140010","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1732","36194FL014",,"FLN002","FLS002","FLF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140010-00","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1732","Standard Silver Off Exchange Plan",,"0.702028746128548","Yes","Yes","No","100%",,"$2,500","$0","$2,000","$60","$2,500","$0","$800","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2018_sbc_1732",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140010","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1732","36194FL014",,"FLN002","FLS002","FLF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140010-01","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1732","Standard Silver On Exchange Plan",,"0.702028746128548","Yes","Yes","No","100%",,"$2,500","$0","$2,000","$60","$2,500","$0","$800","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2018_sbc_1732",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140010","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1732","36194FL014",,"FLN002","FLS002","FLF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140010-02","Florida Hospital GYM ACCESS Silver HMO 80 1732","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1732_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140010","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1732","36194FL014",,"FLN002","FLS002","FLF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140010-03","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1732","Limited Cost Sharing Plan Variation",,"0.702028746128548","Yes","Yes","No","100%",,"$2,500","$0","$2,000","$60","$2,500","$0","$800","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2018_sbc_1732_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140010","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1732","36194FL014",,"FLN002","FLS002","FLF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140010-04","Florida Hospital GYM ACCESS Silver AV73 HMO 80 HSA 1733","73% AV Level Silver Plan",,"0.739683343713351","Yes","Yes","No","100%",,"$2,000","$0","$2,000","$60","$2,000","$0","$800","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2018_sbc_1733",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140010","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1732","36194FL014",,"FLN002","FLS002","FLF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140010-05","Florida Hospital GYM ACCESS Silver AV87 HMO 80 1734","87% AV Level Silver Plan",,"0.879136610111109","Yes","Yes","No","100%",,"$300","$0","$2,000","$60","$300","$0","$800","$60","$300","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1734",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140010","Florida Hospital GYM ACCESS Silver HMO 80 HSA 1732","36194FL014",,"FLN002","FLS002","FLF015","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140010-06","Florida Hospital GYM ACCESS Silver AV94 HMO 80 1735","94% AV Level Silver Plan",,"0.942847970513733","Yes","Yes","No","100%",,"$0","$0","$900","$60","$0","$0","$800","$60","$0","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1735",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120011","Health First GYM ACCESS Gold HMO 100 1736","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120011-00","Health First GYM ACCESS Gold HMO 100 1736","Standard Gold Off Exchange Plan",,"0.81228402023802","No","Yes","No","100%",,"$2,500","$50","$0","$60","$700","$1,600","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1736",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010011","Health First Silver POS 90 HSA 5447","36194FL001",,"FLN003","FLS001","FLF002","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9814",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010011-00","Health First Silver POS 90 HSA 5447","Standard Silver Off Exchange Plan",,"0.700565969544512","Yes","Yes","No","100%",,"$3,000","$0","$1,000","$60","$3,000","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5447",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010011","Health First Silver POS 90 HSA 5447","36194FL001",,"FLN003","FLS001","FLF002","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9814",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010011-01","Health First Silver POS 90 HSA 5447","Standard Silver On Exchange Plan",,"0.700565969544512","Yes","Yes","No","100%",,"$3,000","$0","$1,000","$60","$3,000","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5447",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120011","Health First GYM ACCESS Gold HMO 100 1736","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120011-01","Health First GYM ACCESS Gold HMO 100 1736","Standard Gold On Exchange Plan",,"0.81228402023802","No","Yes","No","100%",,"$2,500","$50","$0","$60","$700","$1,600","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1736",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120011","Health First GYM ACCESS Gold HMO 100 1736","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120011-02","Health First GYM ACCESS Gold HMO 100 1736","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1736_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050011","Florida Hospital Silver POS 90 HSA 5449","36194FL005",,"FLN004","FLS003","FLF015","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9814",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050011-00","Florida Hospital Silver POS 90 HSA 5449","Standard Silver Off Exchange Plan",,"0.700565969544512","Yes","Yes","No","100%",,"$3,000","$0","$1,000","$60","$3,000","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5449",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050011","Florida Hospital Silver POS 90 HSA 5449","36194FL005",,"FLN004","FLS003","FLF015","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9814",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050011-01","Florida Hospital Silver POS 90 HSA 5449","Standard Silver On Exchange Plan",,"0.700565969544512","Yes","Yes","No","100%",,"$3,000","$0","$1,000","$60","$3,000","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5449",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120011","Health First GYM ACCESS Gold HMO 100 1736","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120011-03","Health First GYM ACCESS Gold HMO 100 1736","Limited Cost Sharing Plan Variation",,"0.81228402023802","No","Yes","No","100%",,"$2,500","$50","$0","$60","$700","$1,600","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1736_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140011","Florida Hospital GYM ACCESS Gold HMO 100 1738","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140011-00","Florida Hospital GYM ACCESS Gold HMO 100 1738","Standard Gold Off Exchange Plan",,"0.81228402023802","No","Yes","No","100%",,"$2,500","$50","$0","$60","$700","$1,600","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1738",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140011","Florida Hospital GYM ACCESS Gold HMO 100 1738","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140011-01","Florida Hospital GYM ACCESS Gold HMO 100 1738","Standard Gold On Exchange Plan",,"0.81228402023802","No","Yes","No","100%",,"$2,500","$50","$0","$60","$700","$1,600","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1738",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140011","Florida Hospital GYM ACCESS Gold HMO 100 1738","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140011-02","Florida Hospital GYM ACCESS Gold HMO 100 1738","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1738_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140011","Florida Hospital GYM ACCESS Gold HMO 100 1738","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140011-03","Florida Hospital GYM ACCESS Gold HMO 100 1738","Limited Cost Sharing Plan Variation",,"0.81228402023802","No","Yes","No","100%",,"$2,500","$50","$0","$60","$700","$1,600","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1738_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120012","Health First GYM ACCESS Gold HMO 80 1740","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9909",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120012-01","Health First GYM ACCESS Gold HMO 80 1740","Standard Gold On Exchange Plan",,"0.807662361402355","No","Yes","No","100%",,"$2,000","$0","$1,800","$60","$500","$1,600","$70","$60","$1,300","$90","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1740",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120012","Health First GYM ACCESS Gold HMO 80 1740","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9909",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120012-02","Health First GYM ACCESS Gold HMO 80 1740","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1740_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070016","Florida Hospital Gold HMO 80 5468","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9834",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070016-00","Florida Hospital Gold HMO 80 5468","Standard Gold Off Exchange Plan",,"0.811517909555757","No","Yes","No","100%",,"$800","$60","$1,800","$60","$500","$1,700","$70","$60","$80","$800","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5468",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130004","Health First GYM ACCESS Gold POS 100 1737","36194FL013",,"FLN001","FLS001","FLF009","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9916",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130004-00","Health First GYM ACCESS Gold POS 100 1737","Standard Gold Off Exchange Plan",,"0.812592989407404","No","Yes","No","100%",,"$2,500","$50","$0","$60","$700","$1,600","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1737",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010015","Health First Gold POS 70 5463","36194FL001",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9843",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010015-00","Health First Gold POS 70 5463","Standard Gold Off Exchange Plan","81.50%","0.838502929433886","No","Yes","No","100%",,"$800","$60","$2,700","$60","$300","$1,700","$100","$60","$800","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5463",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010015","Health First Gold POS 70 5463","36194FL001",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9843",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010015-01","Health First Gold POS 70 5463","Standard Gold On Exchange Plan","81.50%","0.838502929433886","No","Yes","No","100%",,"$800","$60","$2,700","$60","$300","$1,700","$100","$60","$800","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5463",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130004","Health First GYM ACCESS Gold POS 100 1737","36194FL013",,"FLN001","FLS001","FLF009","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9916",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130004-01","Health First GYM ACCESS Gold POS 100 1737","Standard Gold On Exchange Plan",,"0.812592989407404","No","Yes","No","100%",,"$2,500","$50","$0","$60","$700","$1,600","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1737",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140012","Florida Hospital GYM ACCESS Gold HMO 80 1741","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9909",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140012-02","Florida Hospital GYM ACCESS Gold HMO 80 1741","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1741_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140012","Florida Hospital GYM ACCESS Gold HMO 80 1741","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9909",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140012-03","Florida Hospital GYM ACCESS Gold HMO 80 1741","Limited Cost Sharing Plan Variation",,"0.807662361402355","No","Yes","No","100%",,"$2,000","$0","$1,800","$60","$500","$1,600","$70","$60","$1,300","$90","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1741_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120013","Health First GYM ACCESS Gold HMO 70 1742","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120013-00","Health First GYM ACCESS Gold HMO 70 1742","Standard Gold Off Exchange Plan","80.72%","0.834988715059138","No","Yes","No","100%",,"$0","$800","$0","$60","$500","$1,800","$100","$60","$700","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1742",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130004","Health First GYM ACCESS Gold POS 100 1737","36194FL013",,"FLN001","FLS001","FLF009","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9916",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130004-02","Health First GYM ACCESS Gold POS 100 1737","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1737_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050015","Florida Hospital Gold POS 70 5465","36194FL005",,"FLN004","FLS003","FLF022","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9843",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050015-00","Florida Hospital Gold POS 70 5465","Standard Gold Off Exchange Plan","81.50%","0.838502929433886","No","Yes","No","100%",,"$800","$60","$2,700","$60","$300","$1,700","$100","$60","$800","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5465",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050015","Florida Hospital Gold POS 70 5465","36194FL005",,"FLN004","FLS003","FLF022","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9843",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050015-01","Florida Hospital Gold POS 70 5465","Standard Gold On Exchange Plan","81.50%","0.838502929433886","No","Yes","No","100%",,"$800","$60","$2,700","$60","$300","$1,700","$100","$60","$800","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5465",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130004","Health First GYM ACCESS Gold POS 100 1737","36194FL013",,"FLN001","FLS001","FLF009","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9916",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130004-03","Health First GYM ACCESS Gold POS 100 1737","Limited Cost Sharing Plan Variation",,"0.812592989407404","No","Yes","No","100%",,"$2,500","$50","$0","$60","$700","$1,600","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1737_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150004","Florida Hospital GYM ACCESS Gold POS 100 1739","36194FL015",,"FLN002","FLS002","FLF022","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9916",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150004-00","Florida Hospital GYM ACCESS Gold POS 100 1739","Standard Gold Off Exchange Plan",,"0.812592989407404","No","Yes","No","100%",,"$2,500","$50","$0","$60","$700","$1,600","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1739",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150004","Florida Hospital GYM ACCESS Gold POS 100 1739","36194FL015",,"FLN002","FLS002","FLF022","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9916",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150004-01","Florida Hospital GYM ACCESS Gold POS 100 1739","Standard Gold On Exchange Plan",,"0.812592989407404","No","Yes","No","100%",,"$2,500","$50","$0","$60","$700","$1,600","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1739",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150004","Florida Hospital GYM ACCESS Gold POS 100 1739","36194FL015",,"FLN002","FLS002","FLF022","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9916",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150004-02","Florida Hospital GYM ACCESS Gold POS 100 1739","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1739_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150004","Florida Hospital GYM ACCESS Gold POS 100 1739","36194FL015",,"FLN002","FLS002","FLF022","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9916",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150004-03","Florida Hospital GYM ACCESS Gold POS 100 1739","Limited Cost Sharing Plan Variation",,"0.812592989407404","No","Yes","No","100%",,"$2,500","$50","$0","$60","$700","$1,600","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1739_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120012","Health First GYM ACCESS Gold HMO 80 1740","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9909",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120012-00","Health First GYM ACCESS Gold HMO 80 1740","Standard Gold Off Exchange Plan",,"0.807662361402355","No","Yes","No","100%",,"$2,000","$0","$1,800","$60","$500","$1,600","$70","$60","$1,300","$90","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1740",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030016","Health First Gold HMO 80 5466","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9834",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030016-00","Health First Gold HMO 80 5466","Standard Gold Off Exchange Plan",,"0.811517909555757","No","Yes","No","100%",,"$800","$60","$1,800","$60","$500","$1,700","$70","$60","$80","$800","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5466",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030016","Health First Gold HMO 80 5466","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9834",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030016-01","Health First Gold HMO 80 5466","Standard Gold On Exchange Plan",,"0.811517909555757","No","Yes","No","100%",,"$800","$60","$1,800","$60","$500","$1,700","$70","$60","$80","$800","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5466",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070016","Florida Hospital Gold HMO 80 5468","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9834",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070016-01","Florida Hospital Gold HMO 80 5468","Standard Gold On Exchange Plan",,"0.811517909555757","No","Yes","No","100%",,"$800","$60","$1,800","$60","$500","$1,700","$70","$60","$80","$800","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5468",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120012","Health First GYM ACCESS Gold HMO 80 1740","36194FL012",,"FLN001","FLS001","FLF008","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9909",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120012-03","Health First GYM ACCESS Gold HMO 80 1740","Limited Cost Sharing Plan Variation",,"0.807662361402355","No","Yes","No","100%",,"$2,000","$0","$1,800","$60","$500","$1,600","$70","$60","$1,300","$90","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1740_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140012","Florida Hospital GYM ACCESS Gold HMO 80 1741","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9909",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140012-00","Florida Hospital GYM ACCESS Gold HMO 80 1741","Standard Gold Off Exchange Plan",,"0.807662361402355","No","Yes","No","100%",,"$2,000","$0","$1,800","$60","$500","$1,600","$70","$60","$1,300","$90","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1741",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140012","Florida Hospital GYM ACCESS Gold HMO 80 1741","36194FL014",,"FLN002","FLS002","FLF021","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9909",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140012-01","Florida Hospital GYM ACCESS Gold HMO 80 1741","Standard Gold On Exchange Plan",,"0.807662361402355","No","Yes","No","100%",,"$2,000","$0","$1,800","$60","$500","$1,600","$70","$60","$1,300","$90","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1741",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010016","Health First Gold POS 80 5467","36194FL001",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9841",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010016-00","Health First Gold POS 80 5467","Standard Gold Off Exchange Plan",,"0.811517909555757","No","Yes","No","100%",,"$800","$60","$1,800","$60","$500","$1,700","$70","$60","$80","$800","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5467",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010016","Health First Gold POS 80 5467","36194FL001",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9841",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010016-01","Health First Gold POS 80 5467","Standard Gold On Exchange Plan",,"0.811517909555757","No","Yes","No","100%",,"$800","$60","$1,800","$60","$500","$1,700","$70","$60","$80","$800","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5467",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120013","Health First GYM ACCESS Gold HMO 70 1742","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120013-01","Health First GYM ACCESS Gold HMO 70 1742","Standard Gold On Exchange Plan","80.72%","0.834988715059138","No","Yes","No","100%",,"$0","$800","$0","$60","$500","$1,800","$100","$60","$700","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1742",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120013","Health First GYM ACCESS Gold HMO 70 1742","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120013-02","Health First GYM ACCESS Gold HMO 70 1742","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1742_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050016","Florida Hospital Gold POS 80 5469","36194FL005",,"FLN004","FLS003","FLF022","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9841",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050016-00","Florida Hospital Gold POS 80 5469","Standard Gold Off Exchange Plan",,"0.811517909555757","No","Yes","No","100%",,"$800","$60","$1,800","$60","$500","$1,700","$70","$60","$80","$800","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5469",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050016","Florida Hospital Gold POS 80 5469","36194FL005",,"FLN004","FLS003","FLF022","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9841",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050016-01","Florida Hospital Gold POS 80 5469","Standard Gold On Exchange Plan",,"0.811517909555757","No","Yes","No","100%",,"$800","$60","$1,800","$60","$500","$1,700","$70","$60","$80","$800","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5469",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120013","Health First GYM ACCESS Gold HMO 70 1742","36194FL012",,"FLN001","FLS001","FLF009","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120013-03","Health First GYM ACCESS Gold HMO 70 1742","Limited Cost Sharing Plan Variation","80.72%","0.834988715059138","No","Yes","No","100%",,"$0","$800","$0","$60","$500","$1,800","$100","$60","$700","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1742_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140013","Florida Hospital GYM ACCESS Gold HMO 70 1743","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140013-00","Florida Hospital GYM ACCESS Gold HMO 70 1743","Standard Gold Off Exchange Plan","80.72%","0.834988715059138","No","Yes","No","100%",,"$0","$800","$0","$60","$500","$1,800","$100","$60","$700","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1743",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140013","Florida Hospital GYM ACCESS Gold HMO 70 1743","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140013-01","Florida Hospital GYM ACCESS Gold HMO 70 1743","Standard Gold On Exchange Plan","80.72%","0.834988715059138","No","Yes","No","100%",,"$0","$800","$0","$60","$500","$1,800","$100","$60","$700","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1743",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140013","Florida Hospital GYM ACCESS Gold HMO 70 1743","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140013-02","Florida Hospital GYM ACCESS Gold HMO 70 1743","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1743_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140013","Florida Hospital GYM ACCESS Gold HMO 70 1743","36194FL014",,"FLN002","FLS002","FLF022","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9912",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140013-03","Florida Hospital GYM ACCESS Gold HMO 70 1743","Limited Cost Sharing Plan Variation","80.72%","0.834988715059138","No","Yes","No","100%",,"$0","$800","$0","$60","$500","$1,800","$100","$60","$700","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1743_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120014","Health First GYM ACCESS Gold HMO 90 HSA 1744","36194FL012",,"FLN001","FLS001","FLF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9908",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120014-00","Health First GYM ACCESS Gold HMO 90 HSA 1744","Standard Gold Off Exchange Plan",,"0.80282684053177","Yes","Yes","No","100%",,"$1,500","$0","$1,000","$60","$1,500","$0","$700","$60","$1,500","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2018_sbc_1744",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030017","Health First Gold HMO 80 5470","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9834",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030017-00","Health First Gold HMO 80 5470","Standard Gold Off Exchange Plan",,"0.816502898296268","No","Yes","No","100%",,"$500","$90","$1,800","$60","$500","$1,800","$70","$60","$80","$1,500","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5470",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030017","Health First Gold HMO 80 5470","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9834",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030017-01","Health First Gold HMO 80 5470","Standard Gold On Exchange Plan",,"0.816502898296268","No","Yes","No","100%",,"$500","$90","$1,800","$60","$500","$1,800","$70","$60","$80","$1,500","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5470",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120014","Health First GYM ACCESS Gold HMO 90 HSA 1744","36194FL012",,"FLN001","FLS001","FLF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9908",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120014-01","Health First GYM ACCESS Gold HMO 90 HSA 1744","Standard Gold On Exchange Plan",,"0.80282684053177","Yes","Yes","No","100%",,"$1,500","$0","$1,000","$60","$1,500","$0","$700","$60","$1,500","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2018_sbc_1744",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120014","Health First GYM ACCESS Gold HMO 90 HSA 1744","36194FL012",,"FLN001","FLS001","FLF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9908",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120014-02","Health First GYM ACCESS Gold HMO 90 1744","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1744_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070017","Florida Hospital Gold HMO 80 5471","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9834",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070017-00","Florida Hospital Gold HMO 80 5471","Standard Gold Off Exchange Plan",,"0.816502898296268","No","Yes","No","100%",,"$500","$90","$1,800","$60","$500","$1,800","$70","$60","$80","$1,500","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5471",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070017","Florida Hospital Gold HMO 80 5471","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9834",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070017-01","Florida Hospital Gold HMO 80 5471","Standard Gold On Exchange Plan",,"0.816502898296268","No","Yes","No","100%",,"$500","$90","$1,800","$60","$500","$1,800","$70","$60","$80","$1,500","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5471",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120014","Health First GYM ACCESS Gold HMO 90 HSA 1744","36194FL012",,"FLN001","FLS001","FLF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9908",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120014-03","Health First GYM ACCESS Gold HMO 90 HSA 1744","Limited Cost Sharing Plan Variation",,"0.80282684053177","Yes","Yes","No","100%",,"$1,500","$0","$1,000","$60","$1,500","$0","$700","$60","$1,500","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2018_sbc_1744_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140014","Florida Hospital GYM ACCESS Gold HMO 90 HSA 1745","36194FL014",,"FLN002","FLS002","FLF015","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9908",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140014-00","Florida Hospital GYM ACCESS Gold HMO 90 HSA 1745","Standard Gold Off Exchange Plan",,"0.80282684053177","Yes","Yes","No","100%",,"$1,500","$0","$1,000","$60","$1,500","$0","$700","$60","$1,500","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2018_sbc_1745",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140014","Florida Hospital GYM ACCESS Gold HMO 90 HSA 1745","36194FL014",,"FLN002","FLS002","FLF015","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9908",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140014-01","Florida Hospital GYM ACCESS Gold HMO 90 HSA 1745","Standard Gold On Exchange Plan",,"0.80282684053177","Yes","Yes","No","100%",,"$1,500","$0","$1,000","$60","$1,500","$0","$700","$60","$1,500","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2018_sbc_1745",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140014","Florida Hospital GYM ACCESS Gold HMO 90 HSA 1745","36194FL014",,"FLN002","FLS002","FLF015","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9908",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140014-02","Florida Hospital GYM ACCESS Gold HMO 90 1745","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1745_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140014","Florida Hospital GYM ACCESS Gold HMO 90 HSA 1745","36194FL014",,"FLN002","FLS002","FLF015","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9908",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140014-03","Florida Hospital GYM ACCESS Gold HMO 90 HSA 1745","Limited Cost Sharing Plan Variation",,"0.80282684053177","Yes","Yes","No","100%",,"$1,500","$0","$1,000","$60","$1,500","$0","$700","$60","$1,500","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2018_sbc_1745_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120015","Health First GYM ACCESS Catastrophic HMO 1746","36194FL012",,"FLN001","FLS001","FLF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9694",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120015-00","Health First GYM ACCESS Catastrophic HMO 1746","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$6,800","$100","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1746",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030018","Health First Gold HMO 80 5472","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9835",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030018-00","Health First Gold HMO 80 5472","Standard Gold Off Exchange Plan","79.97%","0.834329959298954","No","Yes","No","100%",,"$1,000","$70","$2,000","$60","$900","$1,700","$100","$60","$900","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5472",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030018","Health First Gold HMO 80 5472","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9835",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030018-01","Health First Gold HMO 80 5472","Standard Gold On Exchange Plan","79.97%","0.834329959298954","No","Yes","No","100%",,"$1,000","$70","$2,000","$60","$900","$1,700","$100","$60","$900","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5472",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120015","Health First GYM ACCESS Catastrophic HMO 1746","36194FL012",,"FLN001","FLS001","FLF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9694",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120015-01","Health First GYM ACCESS Catastrophic HMO 1746","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$6,800","$100","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1746",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140015","Florida Hospital GYM ACCESS Catastrophic HMO 1748","36194FL014",,"FLN002","FLS002","FLF014","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9694",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140015-00","Florida Hospital GYM ACCESS Catastrophic HMO 1748","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$6,800","$100","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1748",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070018","Florida Hospital Gold HMO 80 5474","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9835",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070018-00","Florida Hospital Gold HMO 80 5474","Standard Gold Off Exchange Plan","79.97%","0.834329959298954","No","Yes","No","100%",,"$1,000","$70","$2,000","$60","$900","$1,700","$100","$60","$900","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5474",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070018","Florida Hospital Gold HMO 80 5474","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9835",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070018-01","Florida Hospital Gold HMO 80 5474","Standard Gold On Exchange Plan","79.97%","0.834329959298954","No","Yes","No","100%",,"$1,000","$70","$2,000","$60","$900","$1,700","$100","$60","$900","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5474",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140015","Florida Hospital GYM ACCESS Catastrophic HMO 1748","36194FL014",,"FLN002","FLS002","FLF014","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9694",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140015-01","Florida Hospital GYM ACCESS Catastrophic HMO 1748","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$6,800","$100","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1748",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130005","Health First GYM ACCESS Catastrophic POS 1747","36194FL013",,"FLN001","FLS001","FLF001","New","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9712",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130005-00","Health First GYM ACCESS Catastrophic POS 1747","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$6,800","$100","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1747",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030019","Health First Gold HMO 80 5476","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9833",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030019-00","Health First Gold HMO 80 5476","Standard Gold Off Exchange Plan","80.10%","0.841837748541801","No","Yes","No","100%",,"$1,500","$70","$2,000","$60","$600","$1,700","$100","$60","$900","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5476",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030019","Health First Gold HMO 80 5476","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9833",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030019-01","Health First Gold HMO 80 5476","Standard Gold On Exchange Plan","80.10%","0.841837748541801","No","Yes","No","100%",,"$1,500","$70","$2,000","$60","$600","$1,700","$100","$60","$900","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5476",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0130005","Health First GYM ACCESS Catastrophic POS 1747","36194FL013",,"FLN001","FLS001","FLF001","New","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9712",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0130005-01","Health First GYM ACCESS Catastrophic POS 1747","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$6,800","$100","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1747",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150005","Florida Hospital GYM ACCESS Catastrophic POS 1749","36194FL015",,"FLN002","FLS002","FLF014","New","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9712",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150005-00","Florida Hospital GYM ACCESS Catastrophic POS 1749","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$6,800","$100","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1749",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070019","Florida Hospital Gold HMO 80 5478","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9833",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070019-00","Florida Hospital Gold HMO 80 5478","Standard Gold Off Exchange Plan","80.10%","0.841837748541801","No","Yes","No","100%",,"$1,500","$70","$2,000","$60","$600","$1,700","$100","$60","$900","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5478",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070019","Florida Hospital Gold HMO 80 5478","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9833",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070019-01","Florida Hospital Gold HMO 80 5478","Standard Gold On Exchange Plan","80.10%","0.841837748541801","No","Yes","No","100%",,"$1,500","$70","$2,000","$60","$600","$1,700","$100","$60","$900","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5478",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0150005","Florida Hospital GYM ACCESS Catastrophic POS 1749","36194FL015",,"FLN002","FLS002","FLF014","New","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9712",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0150005-01","Florida Hospital GYM ACCESS Catastrophic POS 1749","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$6,800","$100","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1749",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160001","Health First Bronze HMO 60 1750","36194FL016",,"FLN001","FLS001","FLF006","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160001-00","Health First Bronze HMO 60 1750","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$3,300","$0","$4,000","$60","$3,700","$300","$2,100","$60","$1,000","$200","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1750",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010019","Health First Gold POS 80 5477","36194FL001",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9841",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010019-00","Health First Gold POS 80 5477","Standard Gold Off Exchange Plan","80.10%","0.841837748541801","No","Yes","No","100%",,"$1,500","$70","$2,000","$60","$600","$1,700","$100","$60","$900","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$8,300","$8300 per person","$16600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5477",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180003","Florida Hospital Gold HMO 80 1772","36194FL018",,"FLN002","FLS002","FLF020","New","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180003-03","Florida Hospital Gold HMO 80 1772","Limited Cost Sharing Plan Variation",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$50","$2,000","$60","$400","$2,100","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1772_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170003","Health First Gold POS 80 1771","36194FL017",,"FLN001","FLS001","FLF007","New","POS","Gold","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170003-00","Health First Gold POS 80 1771","Standard Gold Off Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$50","$2,000","$60","$400","$2,100","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1771",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170003","Health First Gold POS 80 1771","36194FL017",,"FLN001","FLS001","FLF007","New","POS","Gold","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170003-01","Health First Gold POS 80 1771","Standard Gold On Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$50","$2,000","$60","$400","$2,100","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1771",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170003","Health First Gold POS 80 1771","36194FL017",,"FLN001","FLS001","FLF007","New","POS","Gold","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170003-02","Health First Gold POS 80 1771","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1771_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170003","Health First Gold POS 80 1771","36194FL017",,"FLN001","FLS001","FLF007","New","POS","Gold","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170003-03","Health First Gold POS 80 1771","Limited Cost Sharing Plan Variation",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$50","$2,000","$60","$400","$2,100","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1771_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010019","Health First Gold POS 80 5477","36194FL001",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9841",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010019-01","Health First Gold POS 80 5477","Standard Gold On Exchange Plan","80.10%","0.841837748541801","No","Yes","No","100%",,"$1,500","$70","$2,000","$60","$600","$1,700","$100","$60","$900","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$8,300","$8300 per person","$16600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5477",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160001","Health First Bronze HMO 60 1750","36194FL016",,"FLN001","FLS001","FLF006","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160001-01","Health First Bronze HMO 60 1750","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$3,300","$0","$4,000","$60","$3,700","$300","$2,100","$60","$1,000","$200","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1750",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160001","Health First Bronze HMO 60 1750","36194FL016",,"FLN001","FLS001","FLF006","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160001-02","Health First Bronze HMO 60 1750","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1750_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050019","Florida Hospital Gold POS 80 5479","36194FL005",,"FLN004","FLS003","FLF022","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9841",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050019-00","Florida Hospital Gold POS 80 5479","Standard Gold Off Exchange Plan","80.10%","0.841837748541801","No","Yes","No","100%",,"$1,500","$70","$2,000","$60","$600","$1,700","$100","$60","$900","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$8,300","$8300 per person","$16600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5479",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050019","Florida Hospital Gold POS 80 5479","36194FL005",,"FLN004","FLS003","FLF022","Existing","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9841",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050019-01","Florida Hospital Gold POS 80 5479","Standard Gold On Exchange Plan","80.10%","0.841837748541801","No","Yes","No","100%",,"$1,500","$70","$2,000","$60","$600","$1,700","$100","$60","$900","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$8,300","$8300 per person","$16600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5479",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160001","Health First Bronze HMO 60 1750","36194FL016",,"FLN001","FLS001","FLF006","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160001-03","Health First Bronze HMO 60 1750","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$3,300","$0","$4,000","$60","$3,700","$300","$2,100","$60","$1,000","$200","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1750_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180001","Florida Hospital Bronze HMO 60 1752","36194FL018",,"FLN002","FLS002","FLF019","New","HMO","Expanded Bronze","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180001-00","Florida Hospital Bronze HMO 60 1752","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$3,300","$0","$4,000","$60","$3,700","$300","$2,100","$60","$1,000","$200","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1752",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180001","Florida Hospital Bronze HMO 60 1752","36194FL018",,"FLN002","FLS002","FLF019","New","HMO","Expanded Bronze","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180001-01","Florida Hospital Bronze HMO 60 1752","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$3,300","$0","$4,000","$60","$3,700","$300","$2,100","$60","$1,000","$200","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1752",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180001","Florida Hospital Bronze HMO 60 1752","36194FL018",,"FLN002","FLS002","FLF019","New","HMO","Expanded Bronze","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180001-02","Florida Hospital Bronze HMO 60 1752","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1752_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180001","Florida Hospital Bronze HMO 60 1752","36194FL018",,"FLN002","FLS002","FLF019","New","HMO","Expanded Bronze","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180001-03","Florida Hospital Bronze HMO 60 1752","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$3,300","$0","$4,000","$60","$3,700","$300","$2,100","$60","$1,000","$200","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1752_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170001","Health First Bronze POS 60 1751","36194FL017",,"FLN001","FLS001","FLF006","New","POS","Expanded Bronze","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170001-00","Health First Bronze POS 60 1751","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$3,300","$0","$4,000","$60","$3,700","$300","$2,100","$60","$1,000","$200","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1751",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030021","Health First Gold HMO 50 5485","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9836",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030021-00","Health First Gold HMO 50 5485","Standard Gold Off Exchange Plan","81.51%","0.84431306035822","No","Yes","No","100%",,"$500","$900","$500","$60","$200","$1,700","$200","$60","$400","$200","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5485",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030021","Health First Gold HMO 50 5485","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9836",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030021-01","Health First Gold HMO 50 5485","Standard Gold On Exchange Plan","81.51%","0.84431306035822","No","Yes","No","100%",,"$500","$900","$500","$60","$200","$1,700","$200","$60","$400","$200","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5485",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170001","Health First Bronze POS 60 1751","36194FL017",,"FLN001","FLS001","FLF006","New","POS","Expanded Bronze","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170001-01","Health First Bronze POS 60 1751","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$3,300","$0","$4,000","$60","$3,700","$300","$2,100","$60","$1,000","$200","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1751",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170001","Health First Bronze POS 60 1751","36194FL017",,"FLN001","FLS001","FLF006","New","POS","Expanded Bronze","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170001-02","Health First Bronze POS 60 1751","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1751_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070021","Florida Hospital Gold HMO 50 5487","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9836",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070021-00","Florida Hospital Gold HMO 50 5487","Standard Gold Off Exchange Plan","81.51%","0.84431306035822","No","Yes","No","100%",,"$500","$900","$500","$60","$200","$1,700","$200","$60","$400","$200","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5487",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070021","Florida Hospital Gold HMO 50 5487","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9836",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070021-01","Florida Hospital Gold HMO 50 5487","Standard Gold On Exchange Plan","81.51%","0.84431306035822","No","Yes","No","100%",,"$500","$900","$500","$60","$200","$1,700","$200","$60","$400","$200","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5487",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170001","Health First Bronze POS 60 1751","36194FL017",,"FLN001","FLS001","FLF006","New","POS","Expanded Bronze","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170001-03","Health First Bronze POS 60 1751","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$3,300","$0","$4,000","$60","$3,700","$300","$2,100","$60","$1,000","$200","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1751_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190001","Florida Hospital Bronze POS 60 1753","36194FL019",,"FLN002","FLS002","FLF019","New","POS","Expanded Bronze","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190001-00","Florida Hospital Bronze POS 60 1753","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$3,300","$0","$4,000","$60","$3,700","$300","$2,100","$60","$1,000","$200","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1753",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190001","Florida Hospital Bronze POS 60 1753","36194FL019",,"FLN002","FLS002","FLF019","New","POS","Expanded Bronze","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190001-01","Florida Hospital Bronze POS 60 1753","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$3,300","$0","$4,000","$60","$3,700","$300","$2,100","$60","$1,000","$200","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1753",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190001","Florida Hospital Bronze POS 60 1753","36194FL019",,"FLN002","FLS002","FLF019","New","POS","Expanded Bronze","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190001-02","Florida Hospital Bronze POS 60 1753","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1753_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190001","Florida Hospital Bronze POS 60 1753","36194FL019",,"FLN002","FLS002","FLF019","New","POS","Expanded Bronze","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190001-03","Florida Hospital Bronze POS 60 1753","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$3,300","$0","$4,000","$60","$3,700","$300","$2,100","$60","$1,000","$200","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1753_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160002","Health First Silver HMO 80 1754","36194FL016",,"FLN001","FLS001","FLF011","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160002-00","Health First Silver HMO 80 1754","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$70","$2,000","$60","$900","$1,700","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1754",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010024","Health First Gold POS 90 HSA 5495","36194FL001",,"FLN003","FLS001","FLF002","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9844",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010024-00","Health First Gold POS 90 HSA 5495","Standard Gold Off Exchange Plan",,"0.808518327856834","Yes","Yes","No","100%",,"$1,500","$0","$1,000","$60","$1,500","$0","$700","$60","$1,500","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5495",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010024","Health First Gold POS 90 HSA 5495","36194FL001",,"FLN003","FLS001","FLF002","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9844",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010024-01","Health First Gold POS 90 HSA 5495","Standard Gold On Exchange Plan",,"0.808518327856834","Yes","Yes","No","100%",,"$1,500","$0","$1,000","$60","$1,500","$0","$700","$60","$1,500","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5495",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160002","Health First Silver HMO 80 1754","36194FL016",,"FLN001","FLS001","FLF011","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160002-01","Health First Silver HMO 80 1754","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$70","$2,000","$60","$900","$1,700","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1754",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160002","Health First Silver HMO 80 1754","36194FL016",,"FLN001","FLS001","FLF011","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160002-02","Health First Silver HMO 80 1754","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1754_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190002","Florida Hospital Silver POS 80 1766","36194FL019",,"FLN002","FLS002","FLF024","New","POS","Silver","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190002-02","Florida Hospital Silver POS 80 1766","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1766_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190002","Florida Hospital Silver POS 80 1766","36194FL019",,"FLN002","FLS002","FLF024","New","POS","Silver","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190002-03","Florida Hospital Silver POS 80 1766","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$70","$2,000","$60","$900","$1,700","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1766_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190002","Florida Hospital Silver POS 80 1766","36194FL019",,"FLN002","FLS002","FLF024","New","POS","Silver","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190002-04","Florida Hospital Silver AV73 POS 80 1767","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$70","$2,000","$60","$600","$1,700","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1767",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190002","Florida Hospital Silver POS 80 1766","36194FL019",,"FLN002","FLS002","FLF024","New","POS","Silver","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190002-05","Florida Hospital Silver AV87 POS 80 1768","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,800","$60","$400","$1,300","$100","$60","$700","$80","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1768",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190002","Florida Hospital Silver POS 80 1766","36194FL019",,"FLN002","FLS002","FLF024","New","POS","Silver","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190002-06","Florida Hospital Silver AV94 POS 95 1769","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$300","$20","$500","$60","$300","$300","$20","$60","$300","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1769",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160003","Health First Gold HMO 80 1770","36194FL016",,"FLN001","FLS001","FLF007","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160003-00","Health First Gold HMO 80 1770","Standard Gold Off Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$50","$2,000","$60","$400","$2,100","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1770",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050024","Florida Hospital Gold POS 90 HSA 5496","36194FL005",,"FLN004","FLS003","FLF015","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9844",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050024-00","Florida Hospital Gold POS 90 HSA 5496","Standard Gold Off Exchange Plan",,"0.808518327856834","Yes","Yes","No","100%",,"$1,500","$0","$1,000","$60","$1,500","$0","$700","$60","$1,500","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5496",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050024","Florida Hospital Gold POS 90 HSA 5496","36194FL005",,"FLN004","FLS003","FLF015","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9844",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050024-01","Florida Hospital Gold POS 90 HSA 5496","Standard Gold On Exchange Plan",,"0.808518327856834","Yes","Yes","No","100%",,"$1,500","$0","$1,000","$60","$1,500","$0","$700","$60","$1,500","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10.00%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5496",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160002","Health First Silver HMO 80 1754","36194FL016",,"FLN001","FLS001","FLF011","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160002-03","Health First Silver HMO 80 1754","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$70","$2,000","$60","$900","$1,700","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1754_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160002","Health First Silver HMO 80 1754","36194FL016",,"FLN001","FLS001","FLF011","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160002-04","Health First Silver AV73 HMO 80 1755","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$70","$2,000","$60","$600","$1,700","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1755",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160002","Health First Silver HMO 80 1754","36194FL016",,"FLN001","FLS001","FLF011","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160002-05","Health First Silver AV87 HMO 80 1756","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,800","$60","$400","$1,300","$100","$60","$700","$80","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1756",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160002","Health First Silver HMO 80 1754","36194FL016",,"FLN001","FLS001","FLF011","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160002-06","Health First Silver AV94 HMO 95 1757","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$300","$20","$500","$60","$300","$300","$20","$60","$300","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1757",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180002","Florida Hospital Silver HMO 80 1762","36194FL018",,"FLN002","FLS002","FLF024","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180002-00","Florida Hospital Silver HMO 80 1762","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$70","$2,000","$60","$900","$1,700","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1762",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180002","Florida Hospital Silver HMO 80 1762","36194FL018",,"FLN002","FLS002","FLF024","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180002-01","Florida Hospital Silver HMO 80 1762","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$70","$2,000","$60","$900","$1,700","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1762",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180002","Florida Hospital Silver HMO 80 1762","36194FL018",,"FLN002","FLS002","FLF024","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180002-02","Florida Hospital Silver HMO 80 1762","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1762_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180002","Florida Hospital Silver HMO 80 1762","36194FL018",,"FLN002","FLS002","FLF024","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180002-03","Florida Hospital Silver HMO 80 1762","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$70","$2,000","$60","$900","$1,700","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1762_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180002","Florida Hospital Silver HMO 80 1762","36194FL018",,"FLN002","FLS002","FLF024","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180002-04","Florida Hospital Silver AV73 HMO 80 1763","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$70","$2,000","$60","$600","$1,700","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1763",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180002","Florida Hospital Silver HMO 80 1762","36194FL018",,"FLN002","FLS002","FLF024","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180002-05","Florida Hospital Silver AV87 HMO 80 1764","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,800","$60","$400","$1,300","$100","$60","$700","$80","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1764",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180002","Florida Hospital Silver HMO 80 1762","36194FL018",,"FLN002","FLS002","FLF024","New","HMO","Silver","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180002-06","Florida Hospital Silver AV94 HMO 95 1765","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$300","$20","$500","$60","$300","$300","$20","$60","$300","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1765",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170002","Health First Silver POS 80 1758","36194FL017",,"FLN001","FLS001","FLF011","New","POS","Silver","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170002-00","Health First Silver POS 80 1758","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$70","$2,000","$60","$900","$1,700","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1758",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030025","Health First Gold HMO 90 HSA 5497","36194FL003",,"FLN003","FLS001","FLF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9834",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030025-00","Health First Gold HMO 90 HSA 5497","Standard Gold Off Exchange Plan",,"0.796061538716931","Yes","Yes","No","100%",,"$1,600","$0","$1,000","$60","$1,800","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5497",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030025","Health First Gold HMO 90 HSA 5497","36194FL003",,"FLN003","FLS001","FLF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9834",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030025-01","Health First Gold HMO 90 HSA 5497","Standard Gold On Exchange Plan",,"0.796061538716931","Yes","Yes","No","100%",,"$1,600","$0","$1,000","$60","$1,800","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5497",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170002","Health First Silver POS 80 1758","36194FL017",,"FLN001","FLS001","FLF011","New","POS","Silver","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170002-01","Health First Silver POS 80 1758","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$70","$2,000","$60","$900","$1,700","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1758",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170002","Health First Silver POS 80 1758","36194FL017",,"FLN001","FLS001","FLF011","New","POS","Silver","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170002-02","Health First Silver POS 80 1758","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1758_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070025","Florida Hospital Gold HMO 90 HSA 5498","36194FL007",,"FLN004","FLS003","FLF015","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9834",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070025-00","Florida Hospital Gold HMO 90 HSA 5498","Standard Gold Off Exchange Plan",,"0.796061538716931","Yes","Yes","No","100%",,"$1,600","$0","$1,000","$60","$1,800","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5498",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070025","Florida Hospital Gold HMO 90 HSA 5498","36194FL007",,"FLN004","FLS003","FLF015","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9834",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070025-01","Florida Hospital Gold HMO 90 HSA 5498","Standard Gold On Exchange Plan",,"0.796061538716931","Yes","Yes","No","100%",,"$1,600","$0","$1,000","$60","$1,800","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5498",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170002","Health First Silver POS 80 1758","36194FL017",,"FLN001","FLS001","FLF011","New","POS","Silver","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170002-03","Health First Silver POS 80 1758","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$70","$2,000","$60","$900","$1,700","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1758_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170002","Health First Silver POS 80 1758","36194FL017",,"FLN001","FLS001","FLF011","New","POS","Silver","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170002-04","Health First Silver AV73 POS 80 1759","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$70","$2,000","$60","$600","$1,700","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1759",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170002","Health First Silver POS 80 1758","36194FL017",,"FLN001","FLS001","FLF011","New","POS","Silver","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170002-05","Health First Silver AV87 POS 80 1760","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,800","$60","$400","$1,300","$100","$60","$700","$80","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1760",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170002","Health First Silver POS 80 1758","36194FL017",,"FLN001","FLS001","FLF011","New","POS","Silver","Design 3","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170002-06","Health First Silver AV94 POS 95 1761","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$300","$20","$500","$60","$300","$300","$20","$60","$300","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1761",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190002","Florida Hospital Silver POS 80 1766","36194FL019",,"FLN002","FLS002","FLF024","New","POS","Silver","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190002-00","Florida Hospital Silver POS 80 1766","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$70","$2,000","$60","$900","$1,700","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1766",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190002","Florida Hospital Silver POS 80 1766","36194FL019",,"FLN002","FLS002","FLF024","New","POS","Silver","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190002-01","Florida Hospital Silver POS 80 1766","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$70","$2,000","$60","$900","$1,700","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1766",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160003","Health First Gold HMO 80 1770","36194FL016",,"FLN001","FLS001","FLF007","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160003-01","Health First Gold HMO 80 1770","Standard Gold On Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$50","$2,000","$60","$400","$2,100","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1770",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160003","Health First Gold HMO 80 1770","36194FL016",,"FLN001","FLS001","FLF007","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160003-02","Health First Gold HMO 80 1770","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1770_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160003","Health First Gold HMO 80 1770","36194FL016",,"FLN001","FLS001","FLF007","New","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160003-03","Health First Gold HMO 80 1770","Limited Cost Sharing Plan Variation",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$50","$2,000","$60","$400","$2,100","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1770_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180003","Florida Hospital Gold HMO 80 1772","36194FL018",,"FLN002","FLS002","FLF020","New","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180003-00","Florida Hospital Gold HMO 80 1772","Standard Gold Off Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$50","$2,000","$60","$400","$2,100","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1772",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180003","Florida Hospital Gold HMO 80 1772","36194FL018",,"FLN002","FLS002","FLF020","New","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180003-01","Florida Hospital Gold HMO 80 1772","Standard Gold On Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$50","$2,000","$60","$400","$2,100","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1772",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180003","Florida Hospital Gold HMO 80 1772","36194FL018",,"FLN002","FLS002","FLF020","New","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180003-02","Florida Hospital Gold HMO 80 1772","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1772_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190003","Florida Hospital Gold POS 80 1773","36194FL019",,"FLN002","FLS002","FLF020","New","POS","Gold","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190003-00","Florida Hospital Gold POS 80 1773","Standard Gold Off Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$50","$2,000","$60","$400","$2,100","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1773",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160005","Health First Silver HMO 80 1778","36194FL016",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160005-01","Health First Silver HMO 80 1778","Standard Silver On Exchange Plan",,"0.689389520749388","No","Yes","No","100%",,"$2,900","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1778",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160005","Health First Silver HMO 80 1778","36194FL016",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160005-02","Health First Silver HMO 80 1778","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1778_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070032","Florida Hospital Platinum HMO 80 5519","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9858",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070032-00","Florida Hospital Platinum HMO 80 5519","Standard Platinum Off Exchange Plan",,"0.899196852432918","No","Yes","No","100%",,"$0","$300","$30","$60","$0","$1,600","$70","$60","$0","$1,000","$20","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5519",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070032","Florida Hospital Platinum HMO 80 5519","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9858",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070032-01","Florida Hospital Platinum HMO 80 5519","Standard Platinum On Exchange Plan",,"0.899196852432918","No","Yes","No","100%",,"$0","$300","$30","$60","$0","$1,600","$70","$60","$0","$1,000","$20","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5519",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160005","Health First Silver HMO 80 1778","36194FL016",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160005-03","Health First Silver HMO 80 1778","Limited Cost Sharing Plan Variation",,"0.689389520749388","No","Yes","No","100%",,"$2,900","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1778_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160005","Health First Silver HMO 80 1778","36194FL016",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160005-04","Health First Silver AV73 HMO 80 1779","73% AV Level Silver Plan",,"0.735046514226566","No","Yes","No","100%",,"$1,900","$0","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1779",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160005","Health First Silver HMO 80 1778","36194FL016",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160005-05","Health First Silver AV87 HMO 80 1780","87% AV Level Silver Plan",,"0.876404739759582","No","Yes","No","100%",,"$500","$0","$800","$60","$800","$400","$100","$60","$500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1780",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190003","Florida Hospital Gold POS 80 1773","36194FL019",,"FLN002","FLS002","FLF020","New","POS","Gold","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190003-01","Florida Hospital Gold POS 80 1773","Standard Gold On Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$50","$2,000","$60","$400","$2,100","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1773",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190003","Florida Hospital Gold POS 80 1773","36194FL019",,"FLN002","FLS002","FLF020","New","POS","Gold","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190003-02","Florida Hospital Gold POS 80 1773","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1773_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190003","Florida Hospital Gold POS 80 1773","36194FL019",,"FLN002","FLS002","FLF020","New","POS","Gold","Design 4","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190003-03","Florida Hospital Gold POS 80 1773","Limited Cost Sharing Plan Variation",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$50","$2,000","$60","$400","$2,100","$100","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1773_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160004","Health First Bronze HMO 100 1774","36194FL016",,"FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160004-00","Health First Bronze HMO 100 1774","Standard Bronze Off Exchange Plan",,"0.58543686315904","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$7,200","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1774",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030031","Health First Platinum HMO 100 5513","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9859",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030031-00","Health First Platinum HMO 100 5513","Standard Platinum Off Exchange Plan",,"0.915311814310235","No","Yes","No","100%",,"$0","$400","$0","$60","$0","$1,300","$0","$60","$0","$200","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5513",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030031","Health First Platinum HMO 100 5513","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9859",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030031-01","Health First Platinum HMO 100 5513","Standard Platinum On Exchange Plan",,"0.915311814310235","No","Yes","No","100%",,"$0","$400","$0","$60","$0","$1,300","$0","$60","$0","$200","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5513",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160004","Health First Bronze HMO 100 1774","36194FL016",,"FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160004-01","Health First Bronze HMO 100 1774","Standard Bronze On Exchange Plan",,"0.58543686315904","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$7,200","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1774",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160004","Health First Bronze HMO 100 1774","36194FL016",,"FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160004-02","Health First Bronze HMO 100 1774","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1774_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070031","Florida Hospital Platinum HMO 100 5515","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9859",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070031-00","Florida Hospital Platinum HMO 100 5515","Standard Platinum Off Exchange Plan",,"0.915311814310235","No","Yes","No","100%",,"$0","$400","$0","$60","$0","$1,300","$0","$60","$0","$200","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5515",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070031","Florida Hospital Platinum HMO 100 5515","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9859",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070031-01","Florida Hospital Platinum HMO 100 5515","Standard Platinum On Exchange Plan",,"0.915311814310235","No","Yes","No","100%",,"$0","$400","$0","$60","$0","$1,300","$0","$60","$0","$200","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5515",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160004","Health First Bronze HMO 100 1774","36194FL016",,"FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160004-03","Health First Bronze HMO 100 1774","Limited Cost Sharing Plan Variation",,"0.58543686315904","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$7,200","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1774_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180004","Florida Hospital Bronze HMO 100 1776","36194FL018",,"FLN002","FLS002","FLF014","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180004-00","Florida Hospital Bronze HMO 100 1776","Standard Bronze Off Exchange Plan",,"0.58543686315904","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$7,200","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1776",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180004","Florida Hospital Bronze HMO 100 1776","36194FL018",,"FLN002","FLS002","FLF014","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180004-01","Florida Hospital Bronze HMO 100 1776","Standard Bronze On Exchange Plan",,"0.58543686315904","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$7,200","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1776",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180004","Florida Hospital Bronze HMO 100 1776","36194FL018",,"FLN002","FLS002","FLF014","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180004-02","Florida Hospital Bronze HMO 100 1776","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1776_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180004","Florida Hospital Bronze HMO 100 1776","36194FL018",,"FLN002","FLS002","FLF014","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180004-03","Florida Hospital Bronze HMO 100 1776","Limited Cost Sharing Plan Variation",,"0.58543686315904","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$7,200","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1776_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170004","Health First Bronze POS 100 1775","36194FL017",,"FLN001","FLS001","FLF001","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170004-00","Health First Bronze POS 100 1775","Standard Bronze Off Exchange Plan",,"0.58543686315904","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$7,200","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$15,700","$15700 per person","$31400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1775",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010031","Health First Platinum POS 100 5514","36194FL001",,"FLN003","FLS001","FLF009","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9868",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010031-00","Health First Platinum POS 100 5514","Standard Platinum Off Exchange Plan",,"0.915311814310235","No","Yes","No","100%",,"$0","$400","$0","$60","$0","$1,300","$0","$60","$0","$200","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5514",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010031","Health First Platinum POS 100 5514","36194FL001",,"FLN003","FLS001","FLF009","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9868",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010031-01","Health First Platinum POS 100 5514","Standard Platinum On Exchange Plan",,"0.915311814310235","No","Yes","No","100%",,"$0","$400","$0","$60","$0","$1,300","$0","$60","$0","$200","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5514",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170004","Health First Bronze POS 100 1775","36194FL017",,"FLN001","FLS001","FLF001","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170004-01","Health First Bronze POS 100 1775","Standard Bronze On Exchange Plan",,"0.58543686315904","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$7,200","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$15,700","$15700 per person","$31400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1775",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170004","Health First Bronze POS 100 1775","36194FL017",,"FLN001","FLS001","FLF001","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170004-02","Health First Bronze POS 100 1775","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1775_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050031","Florida Hospital Platinum POS 100 5516","36194FL005",,"FLN004","FLS003","FLF022","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9868",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050031-00","Florida Hospital Platinum POS 100 5516","Standard Platinum Off Exchange Plan",,"0.915311814310235","No","Yes","No","100%",,"$0","$400","$0","$60","$0","$1,300","$0","$60","$0","$200","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5516",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050031","Florida Hospital Platinum POS 100 5516","36194FL005",,"FLN004","FLS003","FLF022","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9868",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050031-01","Florida Hospital Platinum POS 100 5516","Standard Platinum On Exchange Plan",,"0.915311814310235","No","Yes","No","100%",,"$0","$400","$0","$60","$0","$1,300","$0","$60","$0","$200","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5516",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170004","Health First Bronze POS 100 1775","36194FL017",,"FLN001","FLS001","FLF001","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170004-03","Health First Bronze POS 100 1775","Limited Cost Sharing Plan Variation",,"0.58543686315904","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$7,200","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$15,700","$15700 per person","$31400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1775_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190004","Florida Hospital Bronze POS 100 1777","36194FL019",,"FLN002","FLS002","FLF014","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190004-00","Florida Hospital Bronze POS 100 1777","Standard Bronze Off Exchange Plan",,"0.58543686315904","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$7,200","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$15,700","$15700 per person","$31400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1777",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190004","Florida Hospital Bronze POS 100 1777","36194FL019",,"FLN002","FLS002","FLF014","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190004-01","Florida Hospital Bronze POS 100 1777","Standard Bronze On Exchange Plan",,"0.58543686315904","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$7,200","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$15,700","$15700 per person","$31400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1777",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190004","Florida Hospital Bronze POS 100 1777","36194FL019",,"FLN002","FLS002","FLF014","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190004-02","Florida Hospital Bronze POS 100 1777","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1777_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190004","Florida Hospital Bronze POS 100 1777","36194FL019",,"FLN002","FLS002","FLF014","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190004-03","Florida Hospital Bronze POS 100 1777","Limited Cost Sharing Plan Variation",,"0.58543686315904","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$7,200","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$15,700","$15700 per person","$31400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1777_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160005","Health First Silver HMO 80 1778","36194FL016",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160005-00","Health First Silver HMO 80 1778","Standard Silver Off Exchange Plan",,"0.689389520749388","No","Yes","No","100%",,"$2,900","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1778",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030032","Health First Platinum HMO 80 5517","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9858",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030032-00","Health First Platinum HMO 80 5517","Standard Platinum Off Exchange Plan",,"0.899196852432918","No","Yes","No","100%",,"$0","$300","$30","$60","$0","$1,600","$70","$60","$0","$1,000","$20","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5517",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030032","Health First Platinum HMO 80 5517","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9858",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030032-01","Health First Platinum HMO 80 5517","Standard Platinum On Exchange Plan",,"0.899196852432918","No","Yes","No","100%",,"$0","$300","$30","$60","$0","$1,600","$70","$60","$0","$1,000","$20","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5517",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160005","Health First Silver HMO 80 1778","36194FL016",,"FLN001","FLS001","FLF009","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160005-06","Health First Silver AV94 HMO 80 1781","94% AV Level Silver Plan",,"0.939124549641805","No","Yes","No","100%",,"$200","$0","$300","$60","$300","$200","$10","$60","$200","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1781",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180005","Florida Hospital Silver HMO 80 1786","36194FL018",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180005-00","Florida Hospital Silver HMO 80 1786","Standard Silver Off Exchange Plan",,"0.689389520749388","No","Yes","No","100%",,"$2,900","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1786",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180005","Florida Hospital Silver HMO 80 1786","36194FL018",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180005-01","Florida Hospital Silver HMO 80 1786","Standard Silver On Exchange Plan",,"0.689389520749388","No","Yes","No","100%",,"$2,900","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1786",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180005","Florida Hospital Silver HMO 80 1786","36194FL018",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180005-02","Florida Hospital Silver HMO 80 1786","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1786_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180005","Florida Hospital Silver HMO 80 1786","36194FL018",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180005-03","Florida Hospital Silver HMO 80 1786","Limited Cost Sharing Plan Variation",,"0.689389520749388","No","Yes","No","100%",,"$2,900","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1786_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180005","Florida Hospital Silver HMO 80 1786","36194FL018",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180005-04","Florida Hospital Silver AV73 HMO 80 1787","73% AV Level Silver Plan",,"0.735046514226566","No","Yes","No","100%",,"$1,900","$0","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1787",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180005","Florida Hospital Silver HMO 80 1786","36194FL018",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180005-05","Florida Hospital Silver AV87 HMO 80 1788","87% AV Level Silver Plan",,"0.876404739759582","No","Yes","No","100%",,"$500","$0","$800","$60","$800","$400","$100","$60","$500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1788",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180005","Florida Hospital Silver HMO 80 1786","36194FL018",,"FLN002","FLS002","FLF022","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180005-06","Florida Hospital Silver AV94 HMO 80 1789","94% AV Level Silver Plan",,"0.939124549641805","No","Yes","No","100%",,"$200","$0","$300","$60","$300","$200","$10","$60","$200","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1789",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170005","Health First Silver POS 80 1782","36194FL017",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170005-00","Health First Silver POS 80 1782","Standard Silver Off Exchange Plan",,"0.689389520749388","No","Yes","No","100%",,"$2,900","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1782",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010032","Health First Platinum POS 80 5518","36194FL001",,"FLN003","FLS001","FLF009","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9866",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010032-00","Health First Platinum POS 80 5518","Standard Platinum Off Exchange Plan",,"0.899196852432918","No","Yes","No","100%",,"$0","$300","$30","$60","$0","$1,600","$70","$60","$0","$1,000","$20","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5518",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030040","Health First Silver HMO 50 5531","36194FL003",,"FLN003","FLS001","FLF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9817",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030040-01","Health First Silver HMO 50 5531","Standard Silver On Exchange Plan","71.69%","0.738708311462218","No","Yes","No","100%",,"$80","$1,700","$80","$60","$700","$2,000","$200","$60","$500","$300","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5531",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160007","Health First Silver HMO 90 1798","36194FL016",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160007-01","Health First Silver HMO 90 1798","Standard Silver On Exchange Plan","70.88%","0.715804087698543","No","Yes","No","100%",,"$5,300","$100","$1,000","$60","$900","$1,800","$50","$60","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1798",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160007","Health First Silver HMO 90 1798","36194FL016",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160007-02","Health First Silver HMO 90 1798","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1798_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190005","Florida Hospital Silver POS 80 1790","36194FL019",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190005-04","Florida Hospital Silver AV73 POS 80 1791","73% AV Level Silver Plan",,"0.735046514226566","No","Yes","No","100%",,"$1,900","$0","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1791",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190005","Florida Hospital Silver POS 80 1790","36194FL019",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190005-05","Florida Hospital Silver AV87 POS 80 1792","87% AV Level Silver Plan",,"0.876404739759582","No","Yes","No","100%",,"$500","$0","$800","$60","$800","$400","$100","$60","$500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1792",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190005","Florida Hospital Silver POS 80 1790","36194FL019",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190005-06","Florida Hospital Silver AV94 POS 80 1793","94% AV Level Silver Plan",,"0.939124549641805","No","Yes","No","100%",,"$200","$0","$300","$60","$300","$200","$10","$60","$200","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1793",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010032","Health First Platinum POS 80 5518","36194FL001",,"FLN003","FLS001","FLF009","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9866",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010032-01","Health First Platinum POS 80 5518","Standard Platinum On Exchange Plan",,"0.899196852432918","No","Yes","No","100%",,"$0","$300","$30","$60","$0","$1,600","$70","$60","$0","$1,000","$20","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5518",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170005","Health First Silver POS 80 1782","36194FL017",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170005-01","Health First Silver POS 80 1782","Standard Silver On Exchange Plan",,"0.689389520749388","No","Yes","No","100%",,"$2,900","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1782",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170005","Health First Silver POS 80 1782","36194FL017",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170005-02","Health First Silver POS 80 1782","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1782_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050032","Florida Hospital Platinum POS 80 5520","36194FL005",,"FLN004","FLS003","FLF022","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9866",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050032-00","Florida Hospital Platinum POS 80 5520","Standard Platinum Off Exchange Plan",,"0.899196852432918","No","Yes","No","100%",,"$0","$300","$30","$60","$0","$1,600","$70","$60","$0","$1,000","$20","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5520",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0050032","Florida Hospital Platinum POS 80 5520","36194FL005",,"FLN004","FLS003","FLF022","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9866",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0050032-01","Florida Hospital Platinum POS 80 5520","Standard Platinum On Exchange Plan",,"0.899196852432918","No","Yes","No","100%",,"$0","$300","$30","$60","$0","$1,600","$70","$60","$0","$1,000","$20","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5520",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170005","Health First Silver POS 80 1782","36194FL017",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170005-03","Health First Silver POS 80 1782","Limited Cost Sharing Plan Variation",,"0.689389520749388","No","Yes","No","100%",,"$2,900","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1782_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170005","Health First Silver POS 80 1782","36194FL017",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170005-04","Health First Silver AV73 POS 80 1783","73% AV Level Silver Plan",,"0.735046514226566","No","Yes","No","100%",,"$1,900","$0","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1783",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170005","Health First Silver POS 80 1782","36194FL017",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170005-05","Health First Silver AV87 POS 80 1784","87% AV Level Silver Plan",,"0.876404739759582","No","Yes","No","100%",,"$500","$0","$800","$60","$800","$400","$100","$60","$500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1784",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0170005","Health First Silver POS 80 1782","36194FL017",,"FLN001","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0170005-06","Health First Silver AV94 POS 80 1785","94% AV Level Silver Plan",,"0.939124549641805","No","Yes","No","100%",,"$200","$0","$300","$60","$300","$200","$10","$60","$200","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1785",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190005","Florida Hospital Silver POS 80 1790","36194FL019",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190005-00","Florida Hospital Silver POS 80 1790","Standard Silver Off Exchange Plan",,"0.689389520749388","No","Yes","No","100%",,"$2,900","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1790",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190005","Florida Hospital Silver POS 80 1790","36194FL019",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190005-01","Florida Hospital Silver POS 80 1790","Standard Silver On Exchange Plan",,"0.689389520749388","No","Yes","No","100%",,"$2,900","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1790",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190005","Florida Hospital Silver POS 80 1790","36194FL019",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190005-02","Florida Hospital Silver POS 80 1790","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1790_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0190005","Florida Hospital Silver POS 80 1790","36194FL019",,"FLN002","FLS002","FLF022","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0190005-03","Florida Hospital Silver POS 80 1790","Limited Cost Sharing Plan Variation",,"0.689389520749388","No","Yes","No","100%",,"$2,900","$10","$2,000","$60","$1,500","$1,500","$200","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1790_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160007","Health First Silver HMO 90 1798","36194FL016",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160007-00","Health First Silver HMO 90 1798","Standard Silver Off Exchange Plan","70.88%","0.715804087698543","No","Yes","No","100%",,"$5,300","$100","$1,000","$60","$900","$1,800","$50","$60","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1798",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030040","Health First Silver HMO 50 5531","36194FL003",,"FLN003","FLS001","FLF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9817",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030040-00","Health First Silver HMO 50 5531","Standard Silver Off Exchange Plan","71.69%","0.738708311462218","No","Yes","No","100%",,"$80","$1,700","$80","$60","$700","$2,000","$200","$60","$500","$300","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5531",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160006","Health First Bronze HMO 100 HSA 1794","36194FL016",,"FLN001","FLS001","FLF001","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160006-00","Health First Bronze HMO 100 HSA 1794","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2018_sbc_1794",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030033","Health First Silver HMO 70 5521","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9816",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030033-00","Health First Silver HMO 70 5521","Standard Silver Off Exchange Plan","71.96%","0.747392679979254","No","Yes","No","100%",,"$100","$1,600","$0","$60","$1,100","$1,800","$100","$60","$700","$700","$300","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5521",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030033","Health First Silver HMO 70 5521","36194FL003",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9816",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030033-01","Health First Silver HMO 70 5521","Standard Silver On Exchange Plan","71.96%","0.747392679979254","No","Yes","No","100%",,"$100","$1,600","$0","$60","$1,100","$1,800","$100","$60","$700","$700","$300","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5521",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160006","Health First Bronze HMO 100 HSA 1794","36194FL016",,"FLN001","FLS001","FLF001","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160006-01","Health First Bronze HMO 100 HSA 1794","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2018_sbc_1794",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160006","Health First Bronze HMO 100 HSA 1794","36194FL016",,"FLN001","FLS001","FLF001","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160006-02","Health First Bronze HMO 100 1794","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1794_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070033","Florida Hospital Silver HMO 70 5522","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9816",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070033-00","Florida Hospital Silver HMO 70 5522","Standard Silver Off Exchange Plan","71.96%","0.747392679979254","No","Yes","No","100%",,"$100","$1,600","$0","$60","$1,100","$1,800","$100","$60","$700","$700","$300","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5522",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070033","Florida Hospital Silver HMO 70 5522","36194FL007",,"FLN004","FLS003","FLF022","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9816",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070033-01","Florida Hospital Silver HMO 70 5522","Standard Silver On Exchange Plan","71.96%","0.747392679979254","No","Yes","No","100%",,"$100","$1,600","$0","$60","$1,100","$1,800","$100","$60","$700","$700","$300","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5522",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160006","Health First Bronze HMO 100 HSA 1794","36194FL016",,"FLN001","FLS001","FLF001","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160006-03","Health First Bronze HMO 100 HSA 1794","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2018_sbc_1794_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180006","Florida Hospital Bronze HMO 100 HSA 1795","36194FL018",,"FLN002","FLS002","FLF014","New","HMO","Expanded Bronze","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180006-00","Florida Hospital Bronze HMO 100 HSA 1795","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2018_sbc_1795",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180006","Florida Hospital Bronze HMO 100 HSA 1795","36194FL018",,"FLN002","FLS002","FLF014","New","HMO","Expanded Bronze","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180006-01","Florida Hospital Bronze HMO 100 HSA 1795","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2018_sbc_1795",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180006","Florida Hospital Bronze HMO 100 HSA 1795","36194FL018",,"FLN002","FLS002","FLF014","New","HMO","Expanded Bronze","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180006-02","Florida Hospital Bronze HMO 100 1795","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1795_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180006","Florida Hospital Bronze HMO 100 HSA 1795","36194FL018",,"FLN002","FLS002","FLF014","New","HMO","Expanded Bronze","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180006-03","Florida Hospital Bronze HMO 100 HSA 1795","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2018_sbc_1795_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120016","Health First GYM ACCESS Bronze HMO 50 1796","36194FL012",,"FLN001","FLS001","FLF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9871",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120016-00","Health First GYM ACCESS Bronze HMO 50 1796","Standard Bronze Off Exchange Plan",,"0.614915913100037","Yes","Yes","No","100%",,"$2,100","$0","$5,000","$60","$3,800","$200","$2,200","$60","$1,000","$0","$1,000","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1796",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030034","Health First Bronze HMO 50 5523","36194FL003",,"FLN003","FLS001","FLF010","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9765",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030034-00","Health First Bronze HMO 50 5523","Standard Bronze Off Exchange Plan",,"0.599589062244111","No","Yes","No","100%",,"$2,300","$0","$5,000","$60","$900","$2,000","$200","$60","$800","$400","$800","$0",,"0","0","1",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,200","$7200 per person","$14400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5523",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030034","Health First Bronze HMO 50 5523","36194FL003",,"FLN003","FLS001","FLF010","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9765",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030034-01","Health First Bronze HMO 50 5523","Standard Bronze On Exchange Plan",,"0.599589062244111","No","Yes","No","100%",,"$2,300","$0","$5,000","$60","$900","$2,000","$200","$60","$800","$400","$800","$0",,"0","0","1",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,200","$7200 per person","$14400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5523",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120016","Health First GYM ACCESS Bronze HMO 50 1796","36194FL012",,"FLN001","FLS001","FLF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9871",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120016-01","Health First GYM ACCESS Bronze HMO 50 1796","Standard Bronze On Exchange Plan",,"0.614915913100037","Yes","Yes","No","100%",,"$2,100","$0","$5,000","$60","$3,800","$200","$2,200","$60","$1,000","$0","$1,000","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1796",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120016","Health First GYM ACCESS Bronze HMO 50 1796","36194FL012",,"FLN001","FLS001","FLF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9871",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120016-02","Health First GYM ACCESS Bronze HMO 50 1796","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1796_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070034","Florida Hospital Bronze HMO 50 5524","36194FL007",,"FLN004","FLS003","FLF023","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9765",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070034-00","Florida Hospital Bronze HMO 50 5524","Standard Bronze Off Exchange Plan",,"0.599589062244111","No","Yes","No","100%",,"$2,300","$0","$5,000","$60","$900","$2,000","$200","$60","$800","$400","$800","$0",,"0","0","1",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,200","$7200 per person","$14400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5524",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070034","Florida Hospital Bronze HMO 50 5524","36194FL007",,"FLN004","FLS003","FLF023","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9765",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070034-01","Florida Hospital Bronze HMO 50 5524","Standard Bronze On Exchange Plan",,"0.599589062244111","No","Yes","No","100%",,"$2,300","$0","$5,000","$60","$900","$2,000","$200","$60","$800","$400","$800","$0",,"0","0","1",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,200","$7200 per person","$14400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5524",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0120016","Health First GYM ACCESS Bronze HMO 50 1796","36194FL012",,"FLN001","FLS001","FLF006","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9871",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0120016-03","Health First GYM ACCESS Bronze HMO 50 1796","Limited Cost Sharing Plan Variation",,"0.614915913100037","Yes","Yes","No","100%",,"$2,100","$0","$5,000","$60","$3,800","$200","$2,200","$60","$1,000","$0","$1,000","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1796_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140016","Florida Hospital GYM ACCESS Bronze HMO 50 1797","36194FL014",,"FLN002","FLS002","FLF019","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9871",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140016-00","Florida Hospital GYM ACCESS Bronze HMO 50 1797","Standard Bronze Off Exchange Plan",,"0.614915913100037","Yes","Yes","No","100%",,"$2,100","$0","$5,000","$60","$3,800","$200","$2,200","$60","$1,000","$0","$1,000","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1797",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140016","Florida Hospital GYM ACCESS Bronze HMO 50 1797","36194FL014",,"FLN002","FLS002","FLF019","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9871",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140016-01","Florida Hospital GYM ACCESS Bronze HMO 50 1797","Standard Bronze On Exchange Plan",,"0.614915913100037","Yes","Yes","No","100%",,"$2,100","$0","$5,000","$60","$3,800","$200","$2,200","$60","$1,000","$0","$1,000","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1797",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140016","Florida Hospital GYM ACCESS Bronze HMO 50 1797","36194FL014",,"FLN002","FLS002","FLF019","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9871",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140016-02","Florida Hospital GYM ACCESS Bronze HMO 50 1797","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1797_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0140016","Florida Hospital GYM ACCESS Bronze HMO 50 1797","36194FL014",,"FLN002","FLS002","FLF019","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9871",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0140016-03","Florida Hospital GYM ACCESS Bronze HMO 50 1797","Limited Cost Sharing Plan Variation",,"0.614915913100037","Yes","Yes","No","100%",,"$2,100","$0","$5,000","$60","$3,800","$200","$2,200","$60","$1,000","$0","$1,000","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,900","$6900 per person","$13800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1797_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070040","Florida Hospital Silver HMO 50 5532","36194FL007",,"FLN004","FLS003","FLF022","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9817",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070040-00","Florida Hospital Silver HMO 50 5532","Standard Silver Off Exchange Plan","71.69%","0.738708311462218","No","Yes","No","100%",,"$80","$1,700","$80","$60","$700","$2,000","$200","$60","$500","$300","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5532",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070040","Florida Hospital Silver HMO 50 5532","36194FL007",,"FLN004","FLS003","FLF022","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9817",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070040-01","Florida Hospital Silver HMO 50 5532","Standard Silver On Exchange Plan","71.69%","0.738708311462218","No","Yes","No","100%",,"$80","$1,700","$80","$60","$700","$2,000","$200","$60","$500","$300","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5532",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160007","Health First Silver HMO 90 1798","36194FL016",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160007-03","Health First Silver HMO 90 1798","Limited Cost Sharing Plan Variation","70.88%","0.715804087698543","No","Yes","No","100%",,"$5,300","$100","$1,000","$60","$900","$1,800","$50","$60","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1798_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160007","Health First Silver HMO 90 1798","36194FL016",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160007-04","Health First Silver AV73 HMO 90 1799","73% AV Level Silver Plan","73.86%","0.744775809203438","No","Yes","No","100%",,"$4,300","$70","$1,000","$60","$900","$1,700","$50","$60","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1799",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160007","Health First Silver HMO 90 1798","36194FL016",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160007-05","Health First Silver AV87 HMO 90 1800","87% AV Level Silver Plan","87.06%","0.878649826655153","No","Yes","No","100%",,"$500","$0","$1,000","$60","$700","$700","$30","$60","$500","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1800",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160007","Health First Silver HMO 90 1798","36194FL016",,"FLN001","FLS001","FLF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160007-06","Health First Silver AV94 HMO 90 1801","94% AV Level Silver Plan","93.42%","0.935979604680952","No","Yes","No","100%",,"$0","$0","$600","$60","$300","$300","$30","$60","$0","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2018_sbc_1801",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180007","Florida Hospital Silver HMO 90 1802","36194FL018",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180007-00","Florida Hospital Silver HMO 90 1802","Standard Silver Off Exchange Plan","70.88%","0.715804087698543","No","Yes","No","100%",,"$5,300","$100","$1,000","$60","$900","$1,800","$50","$60","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1802",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180007","Florida Hospital Silver HMO 90 1802","36194FL018",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180007-01","Florida Hospital Silver HMO 90 1802","Standard Silver On Exchange Plan","70.88%","0.715804087698543","No","Yes","No","100%",,"$5,300","$100","$1,000","$60","$900","$1,800","$50","$60","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1802",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180007","Florida Hospital Silver HMO 90 1802","36194FL018",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180007-02","Florida Hospital Silver HMO 90 1802","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1802_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180007","Florida Hospital Silver HMO 90 1802","36194FL018",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180007-03","Florida Hospital Silver HMO 90 1802","Limited Cost Sharing Plan Variation","70.88%","0.715804087698543","No","Yes","No","100%",,"$5,300","$100","$1,000","$60","$900","$1,800","$50","$60","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1802_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180007","Florida Hospital Silver HMO 90 1802","36194FL018",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180007-04","Florida Hospital Silver AV73 HMO 90 1803","73% AV Level Silver Plan","73.86%","0.744775809203438","No","Yes","No","100%",,"$4,300","$70","$1,000","$60","$900","$1,700","$50","$60","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1803",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180007","Florida Hospital Silver HMO 90 1802","36194FL018",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180007-05","Florida Hospital Silver AV87 HMO 90 1804","87% AV Level Silver Plan","87.06%","0.878649826655153","No","Yes","No","100%",,"$500","$0","$1,000","$60","$700","$700","$30","$60","$500","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1804",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180007","Florida Hospital Silver HMO 90 1802","36194FL018",,"FLN002","FLS002","FLF021","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180007-06","Florida Hospital Silver AV94 HMO 90 1805","94% AV Level Silver Plan","93.42%","0.935979604680952","No","Yes","No","100%",,"$0","$0","$600","$60","$300","$300","$30","$60","$0","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2018_sbc_1805",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160008","Health First Silver HMO 65 1806","36194FL016",,"FLN001","FLS001","FLF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160008-00","Health First Silver HMO 65 1806","Standard Silver Off Exchange Plan",,"0.693720843830597","Yes","Yes","No","100%",,"$1,600","$0","$3,600","$60","$1,600","$0","$2,500","$60","$1,300","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1806",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160008","Health First Silver HMO 65 1806","36194FL016",,"FLN001","FLS001","FLF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160008-01","Health First Silver HMO 65 1806","Standard Silver On Exchange Plan",,"0.693720843830597","Yes","Yes","No","100%",,"$1,600","$0","$3,600","$60","$1,600","$0","$2,500","$60","$1,300","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1806",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160008","Health First Silver HMO 65 1806","36194FL016",,"FLN001","FLS001","FLF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160008-02","Health First Silver HMO 65 1806","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1806_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160008","Health First Silver HMO 65 1806","36194FL016",,"FLN001","FLS001","FLF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160008-03","Health First Silver HMO 65 1806","Limited Cost Sharing Plan Variation",,"0.693720843830597","Yes","Yes","No","100%",,"$1,600","$0","$3,600","$60","$1,600","$0","$2,500","$60","$1,300","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1806_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160008","Health First Silver HMO 65 1806","36194FL016",,"FLN001","FLS001","FLF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160008-04","Health First Silver AV73 HMO 65 1807","73% AV Level Silver Plan",,"0.737152660787763","Yes","Yes","No","100%",,"$1,000","$0","$3,600","$60","$1,000","$0","$2,200","$60","$1,000","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1807",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160008","Health First Silver HMO 65 1806","36194FL016",,"FLN001","FLS001","FLF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160008-05","Health First Silver AV87 HMO 65 1808","87% AV Level Silver Plan",,"0.869834329232694","Yes","Yes","No","100%",,"$500","$0","$900","$60","$500","$0","$900","$60","$500","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1808",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0160008","Health First Silver HMO 65 1806","36194FL016",,"FLN001","FLS001","FLF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayHF","http://www.myHFHP.org/MP_formulary_2018","36194FL0160008-06","Health First Silver AV94 HMO 65 1809","94% AV Level Silver Plan",,"0.939733021394784","Yes","Yes","No","100%",,"$0","$0","$700","$60","$0","$0","$700","$60","$0","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2018_sbc_1809",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180008","Florida Hospital Silver HMO 65 1810","36194FL018",,"FLN002","FLS002","FLF017","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180008-00","Florida Hospital Silver HMO 65 1810","Standard Silver Off Exchange Plan",,"0.693720843830597","Yes","Yes","No","100%",,"$1,600","$0","$3,600","$60","$1,600","$0","$2,500","$60","$1,300","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1810",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180008","Florida Hospital Silver HMO 65 1810","36194FL018",,"FLN002","FLS002","FLF017","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180008-01","Florida Hospital Silver HMO 65 1810","Standard Silver On Exchange Plan",,"0.693720843830597","Yes","Yes","No","100%",,"$1,600","$0","$3,600","$60","$1,600","$0","$2,500","$60","$1,300","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1810",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180008","Florida Hospital Silver HMO 65 1810","36194FL018",,"FLN002","FLS002","FLF017","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180008-02","Florida Hospital Silver HMO 65 1810","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1810_0",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180008","Florida Hospital Silver HMO 65 1810","36194FL018",,"FLN002","FLS002","FLF017","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180008-03","Florida Hospital Silver HMO 65 1810","Limited Cost Sharing Plan Variation",,"0.693720843830597","Yes","Yes","No","100%",,"$1,600","$0","$3,600","$60","$1,600","$0","$2,500","$60","$1,300","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1810_Lmt",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180008","Florida Hospital Silver HMO 65 1810","36194FL018",,"FLN002","FLS002","FLF017","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180008-04","Florida Hospital Silver AV73 HMO 65 1811","73% AV Level Silver Plan",,"0.737152660787763","Yes","Yes","No","100%",,"$1,000","$0","$3,600","$60","$1,000","$0","$2,200","$60","$1,000","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1811",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180008","Florida Hospital Silver HMO 65 1810","36194FL018",,"FLN002","FLS002","FLF017","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180008-05","Florida Hospital Silver AV87 HMO 65 1812","87% AV Level Silver Plan",,"0.869834329232694","Yes","Yes","No","100%",,"$500","$0","$900","$60","$500","$0","$900","$60","$500","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1812",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","Individual","No","47-2894653","36194FL0180008","Florida Hospital Silver HMO 65 1810","36194FL018",,"FLN002","FLS002","FLF017","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","1",,,"2018-01-01",,"No",,"No",,"No","https://www.HF.org/2018PayFH","http://www.myFHCA.org/FHMP_formulary_2018","36194FL0180008-06","Florida Hospital Silver AV94 HMO 65 1813","94% AV Level Silver Plan",,"0.939733021394784","Yes","Yes","No","100%",,"$0","$0","$700","$60","$0","$0","$700","$60","$0","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2018_sbc_1813",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030043","Health First Bronze HMO 50 5537","36194FL003",,"FLN003","FLS001","FLF009","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9787",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030043-00","Health First Bronze HMO 50 5537","Standard Bronze Off Exchange Plan","63.03%","0.651657711689103","No","Yes","No","100%",,"$600","$2,700","$500","$60","$1,400","$2,000","$200","$60","$500","$400","$500","$0",,"0","0","1",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5537",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030043","Health First Bronze HMO 50 5537","36194FL003",,"FLN003","FLS001","FLF009","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9787",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030043-01","Health First Bronze HMO 50 5537","Standard Bronze On Exchange Plan","63.03%","0.651657711689103","No","Yes","No","100%",,"$600","$2,700","$500","$60","$1,400","$2,000","$200","$60","$500","$400","$500","$0",,"0","0","1",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5537",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070043","Florida Hospital Bronze HMO 50 5538","36194FL007",,"FLN004","FLS003","FLF022","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9787",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070043-00","Florida Hospital Bronze HMO 50 5538","Standard Bronze Off Exchange Plan","63.03%","0.651657711689103","No","Yes","No","100%",,"$600","$2,700","$500","$60","$1,400","$2,000","$200","$30","$500","$400","$500","$0",,"0","0","1",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5538",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070043","Florida Hospital Bronze HMO 50 5538","36194FL007",,"FLN004","FLS003","FLF022","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9787",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070043-01","Florida Hospital Bronze HMO 50 5538","Standard Bronze On Exchange Plan","63.03%","0.651657711689103","No","Yes","No","100%",,"$600","$2,700","$500","$60","$1,400","$2,000","$200","$30","$500","$400","$500","$0",,"0","0","1",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2018_sbc_5538",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030044","Health First Silver HMO 80 HSA 5539","36194FL003",,"FLN003","FLS001","FLF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9801",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030044-00","Health First Silver HMO 80 HSA 5539","Standard Silver Off Exchange Plan",,"0.680037170577398","Yes","Yes","No","100%",,"$3,100","$0","$2,000","$60","$3,500","$0","$1,400","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5539",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030044","Health First Silver HMO 80 HSA 5539","36194FL003",,"FLN003","FLS001","FLF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9801",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030044-01","Health First Silver HMO 80 HSA 5539","Standard Silver On Exchange Plan",,"0.680037170577398","Yes","Yes","No","100%",,"$3,100","$0","$2,000","$60","$3,500","$0","$1,400","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5539",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070044","Florida Hospital Silver HMO 80 HSA 5540","36194FL007",,"FLN004","FLS003","FLF016","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9801",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070044-00","Florida Hospital Silver HMO 80 HSA 5540","Standard Silver Off Exchange Plan",,"0.680037170577398","Yes","Yes","No","100%",,"$3,100","$0","$2,000","$60","$3,500","$0","$1,400","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5540",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070044","Florida Hospital Silver HMO 80 HSA 5540","36194FL007",,"FLN004","FLS003","FLF016","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9801",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070044-01","Florida Hospital Silver HMO 80 HSA 5540","Standard Silver On Exchange Plan",,"0.680037170577398","Yes","Yes","No","100%",,"$3,100","$0","$2,000","$60","$3,500","$0","$1,400","$60","$1,500","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5540",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030045","Health First Silver HMO 100 HSA 5541","36194FL003",,"FLN003","FLS001","FLF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9802",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030045-00","Health First Silver HMO 100 HSA 5541","Standard Silver Off Exchange Plan",,"0.681162826616788","Yes","Yes","No","100%",,"$4,500","$0","$0","$60","$4,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5541",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0030045","Health First Silver HMO 100 HSA 5541","36194FL003",,"FLN003","FLS001","FLF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9802",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0030045-01","Health First Silver HMO 100 HSA 5541","Standard Silver On Exchange Plan",,"0.681162826616788","Yes","Yes","No","100%",,"$4,500","$0","$0","$60","$4,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5541",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070045","Florida Hospital Silver HMO 100 HSA 5542","36194FL007",,"FLN004","FLS003","FLF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9802",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070045-00","Florida Hospital Silver HMO 100 HSA 5542","Standard Silver Off Exchange Plan",,"0.681162826616788","Yes","Yes","No","100%",,"$4,500","$0","$0","$60","$4,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5542",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0070045","Florida Hospital Silver HMO 100 HSA 5542","36194FL007",,"FLN004","FLS003","FLF014","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9802",,,"2018-01-01",,"No",,"No",,"No",,"http://www.myFHCA.org/FHMP_formulary_2018","36194FL0070045-01","Florida Hospital Silver HMO 100 HSA 5542","Standard Silver On Exchange Plan",,"0.681162826616788","Yes","Yes","No","100%",,"$4,500","$0","$0","$60","$4,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2018_sbc_5542",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010040","Health First Gold Access POS 50 5543","36194FL001",,"FLN005","FLS001","FLF009","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9862",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","Yes",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010040-00","Health First Gold Access POS 50 5543","Standard Gold Off Exchange Plan","81.91%","0.8481482322847","No","Yes","No","100%",,"$500","$900","$500","$60","$400","$1,700","$200","$60","$400","$200","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5543",
"2018","FL","43274","HIOS","2017-06-20 02:20:27","Individual","Yes","14-1917982","43274FL0030002","EssentialSmile211","43274FL003",,"FLN002","FLS002",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Only for palliative care where a network provider is not available.","No","http://www.solsticecare.com/pay","","43274FL0030002-00","EssentialSmile211","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15"
"2018","FL","43274","HIOS","2017-06-20 02:20:27","Individual","Yes","14-1917982","43274FL0030002","EssentialSmile211","43274FL003",,"FLN002","FLS002",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Only for palliative care where a network provider is not available.","No","http://www.solsticecare.com/pay","","43274FL0030002-01","EssentialSmile211","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15"
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010040","Health First Gold Access POS 50 5543","36194FL001",,"FLN005","FLS001","FLF009","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9862",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","Yes",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010040-01","Health First Gold Access POS 50 5543","Standard Gold On Exchange Plan","81.91%","0.8481482322847","No","Yes","No","100%",,"$500","$900","$500","$60","$400","$1,700","$200","$60","$400","$200","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5543",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010041","Health First Silver Access POS 50 5544","36194FL001",,"FLN005","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9831",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","Yes",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010041-00","Health First Silver Access POS 50 5544","Standard Silver Off Exchange Plan",,"0.717925930471802","No","Yes","No","100%",,"$2,000","$0","$4,600","$60","$500","$1,600","$300","$60","$1,000","$0","$1,000","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group",,,,"$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5544",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010041","Health First Silver Access POS 50 5544","36194FL001",,"FLN005","FLS001","FLF009","New","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9831",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","Yes",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010041-01","Health First Silver Access POS 50 5544","Standard Silver On Exchange Plan",,"0.717925930471802","No","Yes","No","100%",,"$2,000","$0","$4,600","$60","$500","$1,600","$300","$60","$1,000","$0","$1,000","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group",,,,"$13,900","$13900 per person","$27800 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5544",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010042","Health First Gold Access POS 50 5545","36194FL001",,"FLN005","FLS001","FLF009","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9863",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","Yes",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010042-00","Health First Gold Access POS 50 5545","Standard Gold Off Exchange Plan","81.36%","0.840997106044077","No","Yes","No","100%",,"$500","$900","$500","$60","$400","$1,700","$200","$60","$400","$200","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group",,,,"$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5545",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010042","Health First Gold Access POS 50 5545","36194FL001",,"FLN005","FLS001","FLF009","New","POS","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9863",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","Yes",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010042-01","Health First Gold Access POS 50 5545","Standard Gold On Exchange Plan","81.36%","0.840997106044077","No","Yes","No","100%",,"$500","$900","$500","$60","$400","$1,700","$200","$60","$400","$200","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group",,,,"$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5545",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010043","Health First Gold Access POS 80 5546","36194FL001",,"FLN005","FLS001","FLF009","New","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9856",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","Yes",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010043-00","Health First Gold Access POS 80 5546","Standard Gold Off Exchange Plan",,"0.800479436944632","No","Yes","No","100%",,"$800","$50","$2,000","$60","$600","$1,600","$100","$60","$500","$700","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5546",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010043","Health First Gold Access POS 80 5546","36194FL001",,"FLN005","FLS001","FLF009","New","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9856",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","Yes",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010043-01","Health First Gold Access POS 80 5546","Standard Gold On Exchange Plan",,"0.800479436944632","No","Yes","No","100%",,"$800","$50","$2,000","$60","$600","$1,600","$100","$60","$500","$700","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2018_sbc_5546",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010044","Health First Silver Access POS 90 HSA 5547","36194FL001",,"FLN005","FLS001","FLF002","New","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9835",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","Yes",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010044-00","Health First Silver Access POS 90 HSA 5547","Standard Silver Off Exchange Plan",,"0.719795359849575","Yes","Yes","No","100%",,"$2,600","$0","$1,000","$60","$2,600","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","10.00%",,,,,"$5,200","per person not applicable","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5547",
"2018","FL","36194","HIOS","2017-09-07 07:26:32","SHOP (Small Group)","No","47-2894653","36194FL0010044","Health First Silver Access POS 90 HSA 5547","36194FL001",,"FLN005","FLS001","FLF002","New","POS","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9835",,,"2018-01-01",,"No",,"Yes","Medically necessary services and supplies rendered in accordance with benefit guidelines and plan rules are covered.","Yes",,"http://www.myHFHP.org/MP_formulary_2018","36194FL0010044-01","Health First Silver Access POS 90 HSA 5547","Standard Silver On Exchange Plan",,"0.719795359849575","Yes","Yes","No","100%",,"$2,600","$0","$1,000","$60","$2,600","$0","$700","$60","$1,700","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","10.00%",,,,,"$5,200","per person not applicable","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2018_sbc_5547",
"2018","FL","38897","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","38897FL0030001","TruAssure Dental Small Group Basic Plan","38897FL003",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","38897FL0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","FL","38897","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","38897FL0010001","TruAssure Basic Adult or Child Dental Plan","38897FL001",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered  Benefits","Yes","https://www.truassure.com/payment","","38897FL0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$115","$115 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=FL","https://www.truassure.com/brochure?state=FL"
"2018","FL","38897","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","38897FL0010001","TruAssure Basic Adult or Child Dental Plan","38897FL001",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered  Benefits","Yes","https://www.truassure.com/payment","","38897FL0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$115","$115 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=FL","https://www.truassure.com/brochure?state=FL"
"2018","FL","38897","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","38897FL0040001","TruAssure Dental Small Group Preferred Plan","38897FL004",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","38897FL0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","FL","43274","HIOS","2017-06-20 02:20:27","Individual","Yes","14-1917982","43274FL0010001","EssentialSmile Ped 221","43274FL001",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","National Network of providers is available and members may also receive services at out of network providers.","Yes","http://www.solsticecare.com/pay","","43274FL0010001-00","EssentialSmile Ped 221","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15"
"2018","FL","43274","HIOS","2017-06-20 02:20:27","Individual","Yes","14-1917982","43274FL0010001","EssentialSmile Ped 221","43274FL001",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","National Network of providers is available and members may also receive services at out of network providers.","Yes","http://www.solsticecare.com/pay","","43274FL0010001-01","EssentialSmile Ped 221","Standard Low On Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15"
"2018","FL","43274","HIOS","2017-06-20 02:20:27","Individual","Yes","14-1917982","43274FL0010002","EssentialSmile 221","43274FL001",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","National Network of providers is available and members may also receive services at out of network providers.","Yes","http://www.solsticecare.com/pay","","43274FL0010002-00","EssentialSmile 221","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15"
"2018","FL","43274","HIOS","2017-06-20 02:20:27","Individual","Yes","14-1917982","43274FL0010002","EssentialSmile 221","43274FL001",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","National Network of providers is available and members may also receive services at out of network providers.","Yes","http://www.solsticecare.com/pay","","43274FL0010002-01","EssentialSmile 221","Standard Low On Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0010002-02","Molina Marketplace Silver Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-silver-zero-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1380002","IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1380002-00","IND Essential Plus Bronze HMO 41","Standard Bronze Off Exchange Plan",,"0.613115433022202","Yes","Yes","No","100%",,"$1,380","$0","$5,570","$60","$4,050","$1,040","$720","$60","$670","$0","$1,160","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","60.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1380002-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL1380002-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1380002","IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1380002-01","IND Essential Plus Bronze HMO 41","Standard Bronze On Exchange Plan",,"0.613115433022202","Yes","Yes","No","100%",,"$1,380","$0","$5,570","$60","$4,050","$1,040","$720","$60","$670","$0","$1,160","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","60.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1380002-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL1380002-01.pdf"
"2018","FL","48121","HIOS","2017-06-21 02:20:35","Individual","Yes","59-1031071","48121FL0030001","Cigna Dental Pediatric","48121FL003","7730182962","FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","48121FL0030001-00","Cigna Dental Pediatric","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2018/sob/cigna-dental-pediatric-fedvip"
"2018","FL","48121","HIOS","2017-06-21 02:20:35","Individual","Yes","59-1031071","48121FL0030001","Cigna Dental Pediatric","48121FL003","7730182962","FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","48121FL0030001-01","Cigna Dental Pediatric","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2018/sob/cigna-dental-pediatric-fedvip"
"2018","FL","48121","HIOS","2017-06-21 02:20:35","Individual","Yes","59-1031071","48121FL0030002","Cigna Dental Family + Pediatric","48121FL003","7730182962","FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","48121FL0030002-01","Cigna Dental Family + Pediatric","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2018/sob/cigna-dental-family-pediatric-fedvip"
"2018","FL","48129","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","48129FL0080001","Renaissance Individual Dental PPO, EHB Certified","48129FL008",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","48129FL0080001-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0020001","Molina Marketplace Options Silver","54172FL002",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0020001-03","Molina Marketplace Options Silver LCS","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,400","$400","$60","$900","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0020001","Molina Marketplace Options Silver","54172FL002",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0020001-04","Molina Marketplace Options Silver 200","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$100","$2,500","$60","$1,500","$1,400","$400","$60","$900","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-silver-200-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0020001","Molina Marketplace Options Silver","54172FL002",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0020001-05","Molina Marketplace Options Silver 150","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,800","$60","$700","$600","$100","$60","$700","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-silver-150-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0020001","Molina Marketplace Options Silver","54172FL002",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0020001-06","Molina Marketplace Options Silver 100","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$20","$600","$60","$250","$200","$90","$60","$250","$100","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-silver-100-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1410001-05","Gym Access IND Essential Plus Silver POS 54 87%","87% AV Level Silver Plan",,"0.878246169075043","Yes","Yes","No","100%",,"$500","$700","$500","$60","$90","$1,420","$40","$60","$500","$350","$430","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1410001-05.pdf","http://www.fhcp.com/ISOB/2018/56503FL1410001-05.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1410001-06","Gym Access IND Essential Plus Silver POS 54 94%","94% AV Level Silver Plan",,"0.940372589575275","Yes","Yes","No","100%",,"$0","$490","$260","$60","$0","$750","$0","$60","$100","$250","$280","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1410001-06.pdf","http://www.fhcp.com/ISOB/2018/56503FL1410001-06.pdf"
"2018","FL","48129","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","48129FL0080002","Renaissance Individual Dental PPO, EHB Certified","48129FL008",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","48129FL0080002-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","FL","48129","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","48129FL0130001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","48129FL013",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129","","48129FL0130001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/FL_EHB_High_2018","http://www.renaissancedental.com/FL_EHB_High_2018"
"2018","FL","48129","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","48129FL0130002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","48129FL013",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129","","48129FL0130002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/FL_EHB_Low_2018","http://www.renaissancedental.com/FL_EHB_Low_2018"
"2018","FL","48129","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","48129FL0110001","Renaissance Individual Dental Pediatric-Only, EHB Certified","48129FL011",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","48129FL0110001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","FL","48129","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","48129FL0110002","Renaissance Individual Dental Pediatric-Only, EHB Certified","48129FL011",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","48129FL0110002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","FL","48129","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","48129FL0150001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","48129FL015",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129","","48129FL0150001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/FL_Ped_High_2018","http://www.renaissancedental.com/FL_Ped_High_2018"
"2018","FL","48129","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","48129FL0150002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","48129FL015",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129","","48129FL0150002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/FL_Ped_Low_2018","http://www.renaissancedental.com/FL_Ped_Low_2018"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0010001","Molina Marketplace Gold","54172FL001",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0010001-00","Molina Marketplace Gold Off-Exch","Standard Gold Off Exchange Plan",,"0.770138560314203","No","Yes","No","100%",,"$3,800","$300","$2,300","$60","$1,400","$1,200","$300","$60","$60","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-gold-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0010001","Molina Marketplace Gold","54172FL001",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0010001-01","Molina Marketplace Gold","Standard Gold On Exchange Plan",,"0.770138560314203","No","Yes","No","100%",,"$3,800","$300","$2,300","$60","$1,400","$1,200","$300","$60","$60","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-gold-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0010001","Molina Marketplace Gold","54172FL001",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0010001-02","Molina Marketplace Gold Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-gold-zero-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0010001","Molina Marketplace Gold","54172FL001",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0010001-03","Molina Marketplace Gold LCS","Limited Cost Sharing Plan Variation",,"0.770138560314203","No","Yes","No","100%",,"$3,800","$300","$2,300","$60","$1,400","$1,200","$300","$60","$60","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-gold-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0010002-00","Molina Marketplace Silver Off-Exch","Standard Silver Off Exchange Plan",,"0.678048193152746","No","Yes","No","100%",,"$2,100","$400","$4,500","$60","$1,000","$1,700","$700","$60","$40","$700","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,950","$4950 per person","$9900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,950","$4950 per person","$9900 per group","$400","$400 per person","$800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0010002-01","Molina Marketplace Silver 250","Standard Silver On Exchange Plan",,"0.678048193152746","No","Yes","No","100%",,"$2,100","$400","$4,500","$60","$1,000","$1,700","$700","$60","$40","$700","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,950","$4950 per person","$9900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,950","$4950 per person","$9900 per group","$400","$400 per person","$800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0010002-03","Molina Marketplace Silver LCS","Limited Cost Sharing Plan Variation",,"0.678048193152746","No","Yes","No","100%",,"$2,100","$400","$4,500","$60","$1,000","$1,700","$700","$60","$40","$700","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,950","$4950 per person","$9900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,950","$4950 per person","$9900 per group","$400","$400 per person","$800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0010002-04","Molina Marketplace Silver 200","73% AV Level Silver Plan",,"0.739709064127067","No","Yes","No","100%",,"$1,400","$400","$3,700","$60","$1,000","$1,500","$700","$60","$40","$600","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$2,500","$2500 per person","$5000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$400","$400 per person","$800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-silver-200-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0010002-05","Molina Marketplace Silver 150","87% AV Level Silver Plan",,"0.879609893257353","No","Yes","No","100%",,"$500","$200","$1,700","$60","$500","$800","$300","$60","$60","$300","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$525","$525 per person","$1050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$525","$525 per person","$1050 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-silver-150-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0010002-06","Molina Marketplace Silver 100","94% AV Level Silver Plan",,"0.949265703364465","No","Yes","No","100%",,"$0","$200","$1,100","$60","$0","$400","$200","$60","$0","$100","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-silver-100-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0010003","Molina Marketplace Bronze","54172FL001",,"FLN001","FLS001","FLF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0010003-00","Molina Marketplace Bronze Off-Exch","Standard Bronze Off Exchange Plan",,"0.625077353580658","Yes","Yes","No","100%",,"$2,100","$400","$4,500","$60","$4,000","$1,800","$700","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-bronze-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0010003","Molina Marketplace Bronze","54172FL001",,"FLN001","FLS001","FLF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0010003-01","Molina Marketplace Bronze","Standard Bronze On Exchange Plan",,"0.625077353580658","Yes","Yes","No","100%",,"$2,100","$400","$4,500","$60","$4,000","$1,800","$700","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-bronze-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0010003","Molina Marketplace Bronze","54172FL001",,"FLN001","FLS001","FLF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0010003-02","Molina Marketplace Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-bronze-zero-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0010003","Molina Marketplace Bronze","54172FL001",,"FLN001","FLS001","FLF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0010003-03","Molina Marketplace Bronze LCS","Limited Cost Sharing Plan Variation",,"0.625077353580658","Yes","Yes","No","100%",,"$2,100","$400","$4,500","$60","$4,000","$1,800","$700","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-bronze-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0020001","Molina Marketplace Options Silver","54172FL002",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0020001-00","Molina Marketplace Options Silver Off-Exch","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,400","$400","$60","$900","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0020001","Molina Marketplace Options Silver","54172FL002",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0020001-01","Molina Marketplace Options Silver 250","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,400","$400","$60","$900","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0020001","Molina Marketplace Options Silver","54172FL002",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0020001-02","Molina Marketplace Options Silver Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-silver-zero-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0020002","Molina Marketplace Options Bronze","54172FL002",,"FLN001","FLS001","FLF005","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0020002-00","Molina Marketplace Options Bronze Off-Exch","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,400","$0","$5,000","$60","$3,400","$900","$2,000","$60","$600","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0020002","Molina Marketplace Options Bronze","54172FL002",,"FLN001","FLS001","FLF005","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0020002-01","Molina Marketplace Options Bronze","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,400","$0","$5,000","$60","$3,400","$900","$2,000","$60","$600","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0020002","Molina Marketplace Options Bronze","54172FL002",,"FLN001","FLS001","FLF005","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0020002-02","Molina Marketplace Options Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-zero-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","54172","HIOS","2017-09-04 02:20:51","Individual","No","26-0155137","54172FL0020002","Molina Marketplace Options Bronze","54172FL002",,"FLN001","FLS001","FLF005","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All Specialties except Podiatry, Chiropractic, Dermatology (first 5 visits), Obstetrician and Gynecologist (OB/GYN)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/formulary-2018.pdf","54172FL0020002-03","Molina Marketplace Options Bronze LCS","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$2,400","$0","$5,000","$60","$3,400","$900","$2,000","$60","$600","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2018.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1300001","Gym Access IND Essential Plus Catastrophic HMO 36","56503FL130","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1300001-00","Gym Access IND Essential Plus Catastrophic HMO 36","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,180","$0","$0","$60","$1,920","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","100.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1300001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL1300001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1300001","Gym Access IND Essential Plus Catastrophic HMO 36","56503FL130","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1300001-01","Gym Access IND Essential Plus Catastrophic HMO 36","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,180","$0","$0","$60","$1,920","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","100.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1300001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL1300001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1320001","Gym Access IND Essential Plus Catastrophic POS 37","56503FL132","7265435496","FLN001","FLS001","FLF001","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1320001-00","Gym Access IND Essential Plus Catastrophic POS 37","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,180","$0","$0","$60","$1,920","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","100.00%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1320001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL1320001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1320001","Gym Access IND Essential Plus Catastrophic POS 37","56503FL132","7265435496","FLN001","FLS001","FLF001","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1320001-01","Gym Access IND Essential Plus Catastrophic POS 37","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,180","$0","$0","$60","$1,920","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","100.00%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1320001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL1320001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1380002","IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1380002-02","IND Essential Plus Bronze HMO 41 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1380002-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL1380002-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1380002","IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1380002-03","IND Essential Plus Bronze HMO 41 - Limited","Limited Cost Sharing Plan Variation",,"0.613115433022202","Yes","Yes","No","100%",,"$1,380","$0","$5,570","$60","$4,050","$1,040","$720","$60","$670","$0","$1,160","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","60.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1380002-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL1380002-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1460001","Gym Access IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1460001-00","Gym Access IND Essential Plus Bronze POS 42","Standard Bronze Off Exchange Plan",,"0.613912224795081","Yes","Yes","No","100%",,"$1,550","$0","$5,550","$60","$4,110","$1,040","$660","$60","$750","$0","$1,060","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","55.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1460001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL1460001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1460001","Gym Access IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1460001-01","Gym Access IND Essential Plus Bronze POS 42","Standard Bronze On Exchange Plan",,"0.613912224795081","Yes","Yes","No","100%",,"$1,550","$0","$5,550","$60","$4,110","$1,040","$660","$60","$750","$0","$1,060","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","55.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1460001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL1460001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1460001","Gym Access IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1460001-02","Gym Access IND Essential Plus Bronze POS 42 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1460001-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL1460001-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1330001-03","Gym Access IND Essential Plus Silver HMO 53 - Limited","Limited Cost Sharing Plan Variation",,"0.718665585418336","Yes","Yes","No","100%",,"$2,500","$1,230","$3,000","$60","$2,500","$1,490","$40","$60","$970","$460","$430","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1330001-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL1330001-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1330001-04","Gym Access IND Essential Plus Silver HMO 53 73%","73% AV Level Silver Plan",,"0.739247440381934","Yes","Yes","No","100%",,"$1,790","$910","$3,000","$60","$2,300","$1,490","$40","$60","$970","$460","$430","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1330001-04.pdf","http://www.fhcp.com/ISOB/2018/56503FL1330001-04.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1330001-05","Gym Access IND Essential Plus Silver HMO 53 87%","87% AV Level Silver Plan",,"0.878246169075043","Yes","Yes","No","100%",,"$500","$700","$500","$60","$90","$1,420","$40","$60","$500","$350","$430","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1330001-05.pdf","http://www.fhcp.com/ISOB/2018/56503FL1330001-05.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1330001-06","Gym Access IND Essential Plus Silver HMO 53 94%","94% AV Level Silver Plan",,"0.940372589575275","Yes","Yes","No","100%",,"$0","$490","$260","$60","$0","$750","$0","$60","$100","$250","$280","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1330001-06.pdf","http://www.fhcp.com/ISOB/2018/56503FL1330001-06.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1410001-00","Gym Access IND Essential Plus Silver POS 54","Standard Silver Off Exchange Plan",,"0.718665585418336","Yes","Yes","No","100%",,"$2,500","$1,230","$3,000","$60","$2,500","$1,490","$40","$60","$970","$460","$430","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1410001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL1410001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1460001","Gym Access IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1460001-03","Gym Access IND Essential Plus Bronze POS 42 - Limited","Limited Cost Sharing Plan Variation",,"0.613912224795081","Yes","Yes","No","100%",,"$1,550","$0","$5,550","$60","$4,110","$1,040","$660","$60","$750","$0","$1,060","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","55.00%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1460001-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL1460001-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2240001","Gym Access IND Bronze HMO HSA 5000/6550","56503FL224","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2240001-00","Gym Access IND Bronze HMO HSA 5000/6550","Standard Bronze Off Exchange Plan",,"0.616939231443325","Yes","Yes","No","100%",,"$2,830","$0","$3,720","$60","$4,410","$1,040","$360","$60","$1,240","$0","$690","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2018/56503FL2240001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2240001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2240001","Gym Access IND Bronze HMO HSA 5000/6550","56503FL224","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2240001-01","Gym Access IND Bronze HMO HSA 5000/6550","Standard Bronze On Exchange Plan",,"0.616939231443325","Yes","Yes","No","100%",,"$2,830","$0","$3,720","$60","$4,410","$1,040","$360","$60","$1,240","$0","$690","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2018/56503FL2240001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2240001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2240001","Gym Access IND Bronze HMO HSA 5000/6550","56503FL224","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2240001-02","Gym Access IND Bronze HMO HSA 5000/6550","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2240001-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2240001-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2240001","Gym Access IND Bronze HMO HSA 5000/6550","56503FL224","7265435496","FLN001","FLS001","FLF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2240001-03","Gym Access IND Bronze HMO HSA 5000/6550","Limited Cost Sharing Plan Variation",,"0.616939231443325","Yes","Yes","No","100%",,"$2,830","$0","$3,720","$60","$4,410","$1,040","$360","$60","$1,240","$0","$690","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2018/56503FL2240001-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2240001-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1330001-00","Gym Access IND Essential Plus Silver HMO 53","Standard Silver Off Exchange Plan",,"0.718665585418336","Yes","Yes","No","100%",,"$2,500","$1,230","$3,000","$60","$2,500","$1,490","$40","$60","$970","$460","$430","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1330001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL1330001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1330001-01","Gym Access IND Essential Plus Silver HMO 53","Standard Silver On Exchange Plan",,"0.718665585418336","Yes","Yes","No","100%",,"$2,500","$1,230","$3,000","$60","$2,500","$1,490","$40","$60","$970","$460","$430","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1330001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL1330001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1330001-02","Gym Access IND Essential Plus Silver HMO 53 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1330001-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL1330001-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1410001-01","Gym Access IND Essential Plus Silver POS 54","Standard Silver On Exchange Plan",,"0.718665585418336","Yes","Yes","No","100%",,"$2,500","$1,230","$3,000","$60","$2,500","$1,490","$40","$60","$970","$460","$430","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1410001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL1410001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1410001-02","Gym Access IND Essential Plus Silver POS 54 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1410001-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL1410001-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1410001-03","Gym Access IND Essential Plus Silver POS 54 - Limited","Limited Cost Sharing Plan Variation",,"0.718665585418336","Yes","Yes","No","100%",,"$2,500","$1,230","$3,000","$60","$2,500","$1,490","$40","$60","$970","$460","$430","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1410001-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL1410001-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1410001-04","Gym Access IND Essential Plus Silver POS 54 73%","73% AV Level Silver Plan",,"0.739247440381934","Yes","Yes","No","100%",,"$1,790","$910","$3,000","$60","$2,300","$1,490","$40","$60","$970","$460","$430","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","30.00%",,,,,"$3,400","$3400 per person","$6800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1410001-04.pdf","http://www.fhcp.com/ISOB/2018/56503FL1410001-04.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF009","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2040001-00","Gym Access IND Silver HMO 6400","Standard Silver Off Exchange Plan",,"0.716850217567413","No","Yes","No","100%",,"$4,460","$1,940","$0","$60","$0","$1,750","$0","$60","$60","$1,030","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2040001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2040001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF009","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2040001-01","Gym Access IND Silver HMO 6400","Standard Silver On Exchange Plan",,"0.716850217567413","No","Yes","No","100%",,"$4,460","$1,940","$0","$60","$0","$1,750","$0","$60","$60","$1,030","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2040001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2040001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF009","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2040001-02","Gym Access IND Silver HMO 6400 - Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2040001-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2040001-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF009","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2040001-03","Gym Access IND Silver HMO 6400 - Limited","Limited Cost Sharing Plan Variation",,"0.716850217567413","No","Yes","No","100%",,"$4,460","$1,940","$0","$60","$0","$1,750","$0","$60","$60","$1,030","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2040001-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2040001-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF009","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2040001-04","Gym Access IND Silver HMO 6400 73%","73% AV Level Silver Plan",,"0.738445190841045","No","Yes","No","100%",,"$3,730","$1,770","$0","$60","$0","$1,590","$0","$60","$60","$1,030","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2040001-04.pdf","http://www.fhcp.com/ISOB/2018/56503FL2040001-04.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1400001","Gym Access IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1400001-03","Gym Access IND Essential Plus Platinum HMO 65 - Limited","Limited Cost Sharing Plan Variation",,"0.899166820436073","No","No","No","100%",,"$0","$1,190","$0","$60","$0","$1,270","$0","$60","$0","$560","$10","$0",,"5","0","0","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL1400001-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL1400001-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1980001","Gym Access IND Platinum HMO 4000","56503FL198","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1980001-00","Gym Access IND Platinum HMO 4000","Standard Platinum Off Exchange Plan",,"0.870965896606918","Yes","Yes","No","100%",,"$0","$1,260","$0","$60","$0","$1,280","$0","$60","$0","$730","$20","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1980001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL1980001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF009","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2040001-05","Gym Access IND Silver HMO 6400 87%","87% AV Level Silver Plan",,"0.878983176861841","No","Yes","No","100%",,"$0","$1,480","$0","$60","$0","$1,440","$0","$60","$60","$780","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2040001-05.pdf","http://www.fhcp.com/ISOB/2018/56503FL2040001-05.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF009","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2040001-06","Gym Access IND Silver HMO 6400 94%","94% AV Level Silver Plan",,"0.94032627944372","No","Yes","No","100%",,"$0","$700","$0","$60","$0","$700","$0","$60","$60","$630","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2040001-06.pdf","http://www.fhcp.com/ISOB/2018/56503FL2040001-06.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2060001-00","Gym Access IND Silver HMO 6600","Standard Silver Off Exchange Plan",,"0.712637305018253","No","Yes","No","100%",,"$4,220","$560","$1,830","$60","$3,190","$1,280","$0","$60","$1,310","$120","$330","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2060001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2060001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2060001-01","Gym Access IND Silver HMO 6600","Standard Silver On Exchange Plan",,"0.712637305018253","No","Yes","No","100%",,"$4,220","$560","$1,830","$60","$3,190","$1,280","$0","$60","$1,310","$120","$330","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2060001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2060001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2060001-02","Gym Access IND Silver HMO 6600 - Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2060001-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2060001-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2060001-03","Gym Access IND Silver HMO 6600 - Limited","Limited Cost Sharing Plan Variation",,"0.712637305018253","No","Yes","No","100%",,"$4,220","$560","$1,830","$60","$3,190","$1,280","$0","$60","$1,310","$120","$330","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2060001-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2060001-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2060001-04","Gym Access IND Silver HMO 6600 73%","73% AV Level Silver Plan",,"0.739563853578282","No","Yes","No","100%",,"$3,470","$560","$1,830","$60","$3,190","$1,280","$0","$60","$1,310","$120","$330","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2060001-04.pdf","http://www.fhcp.com/ISOB/2018/56503FL2060001-04.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2060001-05","Gym Access IND Silver HMO 6600 87%","87% AV Level Silver Plan",,"0.879199087292712","No","Yes","No","100%",,"$130","$560","$1,210","$60","$0","$1,280","$0","$60","$850","$120","$330","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2060001-05.pdf","http://www.fhcp.com/ISOB/2018/56503FL2060001-05.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2060001-06","Gym Access IND Silver HMO 6600 94%","94% AV Level Silver Plan",,"0.945237483305282","No","Yes","No","100%",,"$130","$440","$30","$60","$0","$600","$0","$60","$150","$120","$330","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2060001-06.pdf","http://www.fhcp.com/ISOB/2018/56503FL2060001-06.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1400001","Gym Access IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1400001-00","Gym Access IND Essential Plus Platinum HMO 65","Standard Platinum Off Exchange Plan",,"0.899166820436073","No","No","No","100%",,"$0","$1,190","$0","$60","$0","$1,270","$0","$60","$0","$560","$10","$0",,"5","0","0","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL1400001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL1400001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1400001","Gym Access IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1400001-01","Gym Access IND Essential Plus Platinum HMO 65","Standard Platinum On Exchange Plan",,"0.899166820436073","No","No","No","100%",,"$0","$1,190","$0","$60","$0","$1,270","$0","$60","$0","$560","$10","$0",,"5","0","0","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL1400001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL1400001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1400001","Gym Access IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1400001-02","Gym Access IND Essential Plus Platinum HMO 65 - Zero","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL1400001-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL1400001-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1980001","Gym Access IND Platinum HMO 4000","56503FL198","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1980001-01","Gym Access IND Platinum HMO 4000","Standard Platinum On Exchange Plan",,"0.870965896606918","Yes","Yes","No","100%",,"$0","$1,260","$0","$60","$0","$1,280","$0","$60","$0","$730","$20","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1980001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL1980001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1980001","Gym Access IND Platinum HMO 4000","56503FL198","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1980001-02","Gym Access IND Platinum HMO 4000 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1980001-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL1980001-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1980001","Gym Access IND Platinum HMO 4000","56503FL198","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1980001-03","Gym Access IND Platinum HMO 4000 - Limited","Limited Cost Sharing Plan Variation",,"0.870965896606918","Yes","Yes","No","100%",,"$0","$1,260","$0","$60","$0","$1,280","$0","$60","$0","$730","$20","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1980001-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL1980001-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1990001","Gym Access IND Platinum POS 4000","56503FL199","7265435496","FLN001","FLS001","FLF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1990001-00","Gym Access IND Platinum POS 4000","Standard Platinum Off Exchange Plan",,"0.870965896606918","Yes","Yes","No","100%",,"$0","$1,260","$0","$60","$0","$1,280","$0","$60","$0","$730","$20","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1990001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL1990001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1990001","Gym Access IND Platinum POS 4000","56503FL199","7265435496","FLN001","FLS001","FLF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1990001-01","Gym Access IND Platinum POS 4000","Standard Platinum On Exchange Plan",,"0.870965896606918","Yes","Yes","No","100%",,"$0","$1,260","$0","$60","$0","$1,280","$0","$60","$0","$730","$20","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1990001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL1990001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1990001","Gym Access IND Platinum POS 4000","56503FL199","7265435496","FLN001","FLS001","FLF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1990001-02","Gym Access IND Platinum POS 4000 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1990001-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL1990001-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1990001","Gym Access IND Platinum POS 4000","56503FL199","7265435496","FLN001","FLS001","FLF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1990001-03","Gym Access IND Platinum POS 4000 - Limited","Limited Cost Sharing Plan Variation",,"0.870965896606918","Yes","Yes","No","100%",,"$0","$1,260","$0","$60","$0","$1,280","$0","$60","$0","$730","$20","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL1990001-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL1990001-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2630002","Gym Access IND Platinum HMO BC 1941","56503FL263","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2630002-00","Gym Access IND Platinum HMO BC 1941","Standard Platinum Off Exchange Plan",,"0.906884009588819","Yes","Yes","No","100%",,"$0","$1,180","$0","$60","$0","$1,160","$0","$60","$0","$1,270","$10","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2630002-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2630002-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2630002","Gym Access IND Platinum HMO BC 1941","56503FL263","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2630002-01","Gym Access IND Platinum HMO BC 1941","Standard Platinum On Exchange Plan",,"0.906884009588819","Yes","Yes","No","100%",,"$0","$1,180","$0","$60","$0","$1,160","$0","$60","$0","$1,270","$10","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2630002-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2630002-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2630002","Gym Access IND Platinum HMO BC 1941","56503FL263","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2630002-02","Gym Access IND Platinum HMO BC 1941 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2630002-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2630002-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2630002","Gym Access IND Platinum HMO BC 1941","56503FL263","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2630002-03","Gym Access IND Platinum HMO BC 1941 - Limited","Limited Cost Sharing Plan Variation",,"0.906884009588819","Yes","Yes","No","100%",,"$0","$1,180","$0","$60","$0","$1,160","$0","$60","$0","$1,270","$10","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2630002-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2630002-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2640002","Gym Access IND Platinum POS BC 1941","56503FL264","7265435496","FLN001","FLS001","FLF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2640002-00","Gym Access IND Platinum POS BC 1941","Standard Platinum Off Exchange Plan",,"0.906884009588819","Yes","Yes","No","100%",,"$0","$1,180","$0","$60","$0","$1,160","$0","$60","$0","$1,270","$10","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2640002-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2640002-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2640002","Gym Access IND Platinum POS BC 1941","56503FL264","7265435496","FLN001","FLS001","FLF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2640002-01","Gym Access IND Platinum POS BC 1941","Standard Platinum On Exchange Plan",,"0.906884009588819","Yes","Yes","No","100%",,"$0","$1,180","$0","$60","$0","$1,160","$0","$60","$0","$1,270","$10","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2640002-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2640002-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2640002","Gym Access IND Platinum POS BC 1941","56503FL264","7265435496","FLN001","FLS001","FLF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2640002-02","Gym Access IND Platinum POS BC 1941 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2640002-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2640002-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2640002","Gym Access IND Platinum POS BC 1941","56503FL264","7265435496","FLN001","FLS001","FLF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2640002-03","Gym Access IND Platinum POS BC 1941 - Limited","Limited Cost Sharing Plan Variation",,"0.906884009588819","Yes","Yes","No","100%",,"$0","$1,180","$0","$60","$0","$1,160","$0","$60","$0","$1,270","$10","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2640002-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2640002-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2650002","Gym Access IND Platinum HMO 91","56503FL265","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2650002-00","Gym Access IND Platinum HMO 91","Standard Platinum Off Exchange Plan",,"0.898788722927064","No","Yes","No","100%",,"$0","$1,120","$0","$60","$0","$1,220","$0","$60","$250","$250","$80","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2650002-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2650002-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2590002","Gym Access IND Gold HMO BC 5651","56503FL259","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2590002-00","Gym Access IND Gold HMO BC 5651","Standard Gold Off Exchange Plan",,"0.818876937771753","Yes","Yes","No","100%",,"$0","$2,750","$0","$60","$0","$1,680","$0","$60","$0","$1,570","$20","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2590002-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2590002-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2590002","Gym Access IND Gold HMO BC 5651","56503FL259","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2590002-01","Gym Access IND Gold HMO BC 5651","Standard Gold On Exchange Plan",,"0.818876937771753","Yes","Yes","No","100%",,"$0","$2,750","$0","$60","$0","$1,680","$0","$60","$0","$1,570","$20","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2590002-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2590002-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2650002","Gym Access IND Platinum HMO 91","56503FL265","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2650002-01","Gym Access IND Platinum HMO 91","Standard Platinum On Exchange Plan",,"0.898788722927064","No","Yes","No","100%",,"$0","$1,120","$0","$60","$0","$1,220","$0","$60","$250","$250","$80","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2650002-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2650002-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2650002","Gym Access IND Platinum HMO 91","56503FL265","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2650002-02","Gym Access IND Platinum HMO 91 - Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2650002-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2650002-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2650002","Gym Access IND Platinum HMO 91","56503FL265","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2650002-03","Gym Access IND Platinum HMO 91 - Limited","Limited Cost Sharing Plan Variation",,"0.898788722927064","No","Yes","No","100%",,"$0","$1,120","$0","$60","$0","$1,220","$0","$60","$250","$250","$80","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2650002-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2650002-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2660002","Gym Acccess IND Platinum HMO 92","56503FL266","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2660002-00","Gym Acccess IND Platinum HMO 92","Standard Platinum Off Exchange Plan",,"0.89682756999707","No","Yes","No","100%",,"$0","$1,200","$0","$60","$0","$1,220","$0","$60","$500","$190","$80","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2660002-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2660002-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2660002","Gym Acccess IND Platinum HMO 92","56503FL266","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2660002-01","Gym Acccess IND Platinum HMO 92","Standard Platinum On Exchange Plan",,"0.89682756999707","No","Yes","No","100%",,"$0","$1,200","$0","$60","$0","$1,220","$0","$60","$500","$190","$80","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2660002-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2660002-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2660002","Gym Acccess IND Platinum HMO 92","56503FL266","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2660002-02","Gym Acccess IND Platinum HMO 92 - Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2660002-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2660002-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2660002","Gym Acccess IND Platinum HMO 92","56503FL266","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2660002-03","Gym Acccess IND Platinum HMO 92 - Limited","Limited Cost Sharing Plan Variation",,"0.89682756999707","No","Yes","No","100%",,"$0","$1,200","$0","$60","$0","$1,220","$0","$60","$500","$190","$80","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2660002-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2660002-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2090002","IND Gold HMO 4500","56503FL209","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2090002-00","IND Gold HMO 4500","Standard Gold Off Exchange Plan",,"0.818662782011831","Yes","Yes","No","100%",,"$150","$1,360","$20","$60","$0","$1,470","$0","$60","$1,240","$250","$140","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2090002-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2090002-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2090002","IND Gold HMO 4500","56503FL209","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2090002-01","IND Gold HMO 4500","Standard Gold On Exchange Plan",,"0.818662782011831","Yes","Yes","No","100%",,"$150","$1,360","$20","$60","$0","$1,470","$0","$60","$1,240","$250","$140","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2090002-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2090002-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2090002","IND Gold HMO 4500","56503FL209","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2090002-02","IND Gold HMO 4500 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2090002-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2090002-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2090002","IND Gold HMO 4500","56503FL209","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2090002-03","IND Gold HMO 4500 - Limited","Limited Cost Sharing Plan Variation",,"0.818662782011831","Yes","Yes","No","100%",,"$150","$1,360","$20","$60","$0","$1,470","$0","$60","$1,240","$250","$140","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2090002-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2090002-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2000001","Gym Access IND Gold HMO 5500","56503FL200","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2000001-00","Gym Access IND Gold HMO 5500","Standard Gold Off Exchange Plan",,"0.819321307528016","No","Yes","No","100%",,"$0","$1,380","$0","$60","$0","$1,430","$0","$60","$30","$730","$20","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2000001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2000001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2610001","IND Platinum HMO BC 5841","56503FL261","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2610001-00","IND Platinum HMO BC 5841","Standard Platinum Off Exchange Plan",,"0.889157688398698","No","Yes","No","100%",,"$800","$410","$910","$60","$0","$1,200","$0","$60","$800","$60","$160","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2610001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2610001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2610001","IND Platinum HMO BC 5841","56503FL261","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2610001-01","IND Platinum HMO BC 5841","Standard Platinum On Exchange Plan",,"0.889157688398698","No","Yes","No","100%",,"$800","$410","$910","$60","$0","$1,200","$0","$60","$800","$60","$160","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2610001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2610001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2610001","IND Platinum HMO BC 5841","56503FL261","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2610001-02","IND Platinum HMO BC 5841 - Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2610001-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2610001-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2000001","Gym Access IND Gold HMO 5500","56503FL200","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2000001-01","Gym Access IND Gold HMO 5500","Standard Gold On Exchange Plan",,"0.819321307528016","No","Yes","No","100%",,"$0","$1,380","$0","$60","$0","$1,430","$0","$60","$30","$730","$20","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2000001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2000001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2000001","Gym Access IND Gold HMO 5500","56503FL200","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2000001-02","Gym Access IND Gold HMO 5500 - Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2000001-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2000001-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2000001","Gym Access IND Gold HMO 5500","56503FL200","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2000001-03","Gym Access IND Gold HMO 5500 - Limited","Limited Cost Sharing Plan Variation",,"0.819321307528016","No","Yes","No","100%",,"$0","$1,380","$0","$60","$0","$1,430","$0","$60","$30","$730","$20","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2000001-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2000001-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2010001","Gym Access IND Gold POS 5500","56503FL201","7265435496","FLN001","FLS001","FLF005","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2010001-00","Gym Access IND Gold POS 5500","Standard Gold Off Exchange Plan",,"0.819321307528016","No","Yes","No","100%",,"$0","$1,380","$0","$60","$0","$1,430","$0","$60","$30","$730","$20","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","20.00%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2010001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2010001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2010001","Gym Access IND Gold POS 5500","56503FL201","7265435496","FLN001","FLS001","FLF005","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2010001-01","Gym Access IND Gold POS 5500","Standard Gold On Exchange Plan",,"0.819321307528016","No","Yes","No","100%",,"$0","$1,380","$0","$60","$0","$1,430","$0","$60","$30","$730","$20","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","20.00%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2010001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2010001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2010001","Gym Access IND Gold POS 5500","56503FL201","7265435496","FLN001","FLS001","FLF005","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2010001-02","Gym Access IND Gold POS 5500 - Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2010001-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2010001-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2010001","Gym Access IND Gold POS 5500","56503FL201","7265435496","FLN001","FLS001","FLF005","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2010001-03","Gym Access IND Gold POS 5500 - Limited","Limited Cost Sharing Plan Variation",,"0.819321307528016","No","Yes","No","100%",,"$0","$1,380","$0","$60","$0","$1,430","$0","$60","$30","$730","$20","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","20.00%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2010001-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2010001-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2590002","Gym Access IND Gold HMO BC 5651","56503FL259","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2590002-02","Gym Access IND Gold HMO BC 5651 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2590002-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2590002-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2590002","Gym Access IND Gold HMO BC 5651","56503FL259","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2590002-03","Gym Access IND Gold HMO BC 5651 - Limited","Limited Cost Sharing Plan Variation",,"0.818876937771753","Yes","Yes","No","100%",,"$0","$2,750","$0","$60","$0","$1,680","$0","$60","$0","$1,570","$20","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2590002-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2590002-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2600002","Gym Access IND Gold POS BC 5651","56503FL260","7265435496","FLN001","FLS001","FLF005","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2600002-00","Gym Access IND Gold POS BC 5651","Standard Gold Off Exchange Plan",,"0.818876937771753","Yes","Yes","No","100%",,"$0","$2,750","$0","$60","$0","$1,680","$0","$60","$0","$1,570","$20","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2600002-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2600002-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2600002","Gym Access IND Gold POS BC 5651","56503FL260","7265435496","FLN001","FLS001","FLF005","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2600002-01","Gym Access IND Gold POS BC 5651","Standard Gold On Exchange Plan",,"0.818876937771753","Yes","Yes","No","100%",,"$0","$2,750","$0","$60","$0","$1,680","$0","$60","$0","$1,570","$20","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2600002-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2600002-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2600002","Gym Access IND Gold POS BC 5651","56503FL260","7265435496","FLN001","FLS001","FLF005","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2600002-02","Gym Access IND Gold POS BC 5651 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2600002-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2600002-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2600002","Gym Access IND Gold POS BC 5651","56503FL260","7265435496","FLN001","FLS001","FLF005","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2600002-03","Gym Access IND Gold POS BC 5651 - Limited","Limited Cost Sharing Plan Variation",,"0.818876937771753","Yes","Yes","No","100%",,"$0","$2,750","$0","$60","$0","$1,680","$0","$60","$0","$1,570","$20","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2600002-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2600002-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF007","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2570001-03","IND Silver HMO BC 7741 - Limited","Limited Cost Sharing Plan Variation",,"0.660046899320775","Yes","Yes","No","100%",,"$2,300","$1,410","$3,580","$60","$2,930","$2,100","$0","$60","$480","$710","$320","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2570001-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2570001-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF007","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2570001-04","IND Silver HMO BC 7741 73%","73% AV Level Silver Plan",,"0.738782215122303","Yes","Yes","No","100%",,"$510","$1,410","$3,580","$60","$0","$1,900","$0","$60","$480","$650","$320","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2570001-04.pdf","http://www.fhcp.com/ISOB/2018/56503FL2570001-04.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2610001","IND Platinum HMO BC 5841","56503FL261","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2610001-03","IND Platinum HMO BC 5841 - Limited","Limited Cost Sharing Plan Variation",,"0.889157688398698","No","Yes","No","100%",,"$800","$410","$910","$60","$0","$1,200","$0","$60","$800","$60","$160","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2610001-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2610001-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2620002","Gym Access IND Platinum POS BC 5841","56503FL262","7265435496","FLN001","FLS001","FLF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2620002-00","Gym Access IND Platinum POS BC 5841","Standard Platinum Off Exchange Plan",,"0.889157688398698","No","Yes","No","100%",,"$800","$410","$910","$60","$0","$1,200","$0","$60","$800","$60","$160","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2620002-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2620002-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2620002","Gym Access IND Platinum POS BC 5841","56503FL262","7265435496","FLN001","FLS001","FLF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2620002-01","Gym Access IND Platinum POS BC 5841","Standard Platinum On Exchange Plan",,"0.889157688398698","No","Yes","No","100%",,"$800","$410","$910","$60","$0","$1,200","$0","$60","$800","$60","$160","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2620002-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2620002-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2620002","Gym Access IND Platinum POS BC 5841","56503FL262","7265435496","FLN001","FLS001","FLF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2620002-02","Gym Access IND Platinum POS BC 5841 - Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2620002-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2620002-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF007","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2570001-02","IND Silver HMO BC 7741 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2570001-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2570001-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2620002","Gym Access IND Platinum POS BC 5841","56503FL262","7265435496","FLN001","FLS001","FLF005","Existing","POS","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2620002-03","Gym Access IND Platinum POS BC 5841 - Limited","Limited Cost Sharing Plan Variation",,"0.889157688398698","No","Yes","No","100%",,"$800","$410","$910","$60","$0","$1,200","$0","$60","$800","$60","$160","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2620002-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2620002-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2550002-00","Gym Access IND Silver HMO BC 0941","Standard Silver Off Exchange Plan",,"0.661334447086824","No","Yes","No","100%",,"$4,760","$2,390","$0","$60","$3,000","$1,960","$0","$60","$20","$1,950","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,600","$5600 per person","$11200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2550002-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2550002-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2550002-01","Gym Access IND Silver HMO BC 0941","Standard Silver On Exchange Plan",,"0.661334447086824","No","Yes","No","100%",,"$4,760","$2,390","$0","$60","$3,000","$1,960","$0","$60","$20","$1,950","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,600","$5600 per person","$11200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2550002-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2550002-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2550002-02","Gym Access IND Silver HMO BC 0941 - Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2550002-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2550002-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2550002-03","Gym Access IND Silver HMO BC 0941 - Limited","Limited Cost Sharing Plan Variation",,"0.661334447086824","No","Yes","No","100%",,"$4,760","$2,390","$0","$60","$3,000","$1,960","$0","$60","$20","$1,950","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,600","$5600 per person","$11200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2550002-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2550002-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2550002-04","Gym Access IND Silver HMO BC 0941 73%","73% AV Level Silver Plan",,"0.727950936367383","No","Yes","No","100%",,"$2,900","$1,570","$0","$60","$3,000","$1,540","$0","$60","$20","$1,540","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2550002-04.pdf","http://www.fhcp.com/ISOB/2018/56503FL2550002-04.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2550002-05","Gym Access IND Silver HMO BC 0941 87%","87% AV Level Silver Plan",,"0.877708381792288","No","Yes","No","100%",,"$500","$1,080","$0","$60","$0","$1,330","$0","$60","$20","$1,250","$20","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2550002-05.pdf","http://www.fhcp.com/ISOB/2018/56503FL2550002-05.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2550002-06","Gym Access IND Silver HMO BC 0941 94%","94% AV Level Silver Plan",,"0.94523592226774","No","Yes","No","100%",,"$0","$550","$0","$60","$0","$1,000","$0","$60","$0","$990","$10","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2550002-06.pdf","http://www.fhcp.com/ISOB/2018/56503FL2550002-06.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2560002-00","Gym Access IND Silver POS BC 0941","Standard Silver Off Exchange Plan",,"0.661334447086824","No","Yes","No","100%",,"$4,760","$2,390","$0","$60","$3,000","$1,960","$0","$60","$20","$1,950","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,600","$5600 per person","$11200 per group","40.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2560002-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2560002-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2560002-01","Gym Access IND Silver POS BC 0941","Standard Silver On Exchange Plan",,"0.661334447086824","No","Yes","No","100%",,"$4,760","$2,390","$0","$60","$3,000","$1,960","$0","$60","$20","$1,950","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,600","$5600 per person","$11200 per group","40.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2560002-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2560002-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2560002-02","Gym Access IND Silver POS BC 0941 - Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2560002-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2560002-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2560002-03","Gym Access IND Silver POS BC 0941 - Limited","Limited Cost Sharing Plan Variation",,"0.661334447086824","No","Yes","No","100%",,"$4,760","$2,390","$0","$60","$3,000","$1,960","$0","$60","$20","$1,950","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,600","$5600 per person","$11200 per group","40.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2560002-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2560002-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2560002-04","Gym Access IND Silver POS BC 0941 73%","73% AV Level Silver Plan",,"0.727950936367383","No","Yes","No","100%",,"$2,900","$1,570","$0","$60","$3,000","$1,540","$0","$60","$20","$1,540","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","40.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2560002-04.pdf","http://www.fhcp.com/ISOB/2018/56503FL2560002-04.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2560002-05","Gym Access IND Silver POS BC 0941 87%","87% AV Level Silver Plan",,"0.877708381792288","No","Yes","No","100%",,"$500","$1,080","$0","$60","$0","$1,330","$0","$60","$20","$1,250","$20","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2560002-05.pdf","http://www.fhcp.com/ISOB/2018/56503FL2560002-05.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2560002-06","Gym Access IND Silver POS BC 0941 94%","94% AV Level Silver Plan",,"0.94523592226774","No","Yes","No","100%",,"$0","$550","$0","$60","$0","$1,000","$0","$60","$0","$990","$10","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2560002-06.pdf","http://www.fhcp.com/ISOB/2018/56503FL2560002-06.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF007","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2570001-00","IND Silver HMO BC 7741","Standard Silver Off Exchange Plan",,"0.660046899320775","Yes","Yes","No","100%",,"$2,300","$1,410","$3,580","$60","$2,930","$2,100","$0","$60","$480","$710","$320","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2570001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2570001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF007","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2570001-01","IND Silver HMO BC 7741","Standard Silver On Exchange Plan",,"0.660046899320775","Yes","Yes","No","100%",,"$2,300","$1,410","$3,580","$60","$2,930","$2,100","$0","$60","$480","$710","$320","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2570001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2570001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF007","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2570001-05","IND Silver HMO BC 7741 87%","87% AV Level Silver Plan",,"0.878766075016431","Yes","Yes","No","100%",,"$0","$500","$1,950","$60","$0","$1,190","$0","$60","$0","$260","$320","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2570001-05.pdf","http://www.fhcp.com/ISOB/2018/56503FL2570001-05.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF007","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2570001-06","IND Silver HMO BC 7741 94%","94% AV Level Silver Plan",,"0.947537652153442","Yes","Yes","No","100%",,"$0","$140","$1,110","$60","$0","$530","$0","$60","$0","$70","$200","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2570001-06.pdf","http://www.fhcp.com/ISOB/2018/56503FL2570001-06.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2580002-00","Gym Access IND Silver POS BC 7741","Standard Silver Off Exchange Plan",,"0.660046899320775","Yes","Yes","No","100%",,"$2,300","$1,410","$3,580","$60","$2,930","$2,100","$0","$60","$480","$710","$320","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2580002-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2580002-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2580002-01","Gym Access IND Silver POS BC 7741","Standard Silver On Exchange Plan",,"0.660046899320775","Yes","Yes","No","100%",,"$2,300","$1,410","$3,580","$60","$2,930","$2,100","$0","$60","$480","$710","$320","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2580002-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2580002-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2580002-02","Gym Access IND Silver POS BC 7741 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2580002-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2580002-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2580002-03","Gym Access IND Silver POS BC 7741 - Limited","Limited Cost Sharing Plan Variation",,"0.660046899320775","Yes","Yes","No","100%",,"$2,300","$1,410","$3,580","$60","$2,930","$2,100","$0","$60","$480","$710","$320","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2580002-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2580002-03.pdf"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410053","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS021","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410053-05","BCBSHP Silver Pathway X Guided Access HMO 10 S05","87% AV Level Silver Plan","86.02%","0.861447593742684","Yes","Yes","Yes","60%","40%","$1,150","$0","$0","$60","$1,130","$0","$220","$55","$1,150","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","$1,350","$1350 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0.00%","$1,150","$1150 per person","$2300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J35","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410053","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS021","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410053-06","BCBSHP Silver Pathway X Guided Access HMO 10 S06","94% AV Level Silver Plan","93.12%","0.934979393751568","Yes","Yes","Yes","60%","40%","$400","$0","$0","$60","$400","$0","$300","$55","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","0.00%","$400","$400 per person","$800 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J36","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2580002-04","Gym Access IND Silver POS BC 7741 73%","73% AV Level Silver Plan",,"0.738782215122303","Yes","Yes","No","100%",,"$510","$1,410","$3,580","$60","$0","$1,900","$0","$60","$480","$650","$320","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2580002-04.pdf","http://www.fhcp.com/ISOB/2018/56503FL2580002-04.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2580002-05","Gym Access IND Silver POS BC 7741 87%","87% AV Level Silver Plan",,"0.878766075016431","Yes","Yes","No","100%",,"$0","$500","$1,950","$60","$0","$1,190","$0","$60","$0","$260","$320","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2580002-05.pdf","http://www.fhcp.com/ISOB/2018/56503FL2580002-05.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2260001","Gym Access IND Bronze HMO HSA 6000/6000","56503FL226","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2260001-02","Gym Access IND Bronze HMO 6000/6000 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2260001-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2260001-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2260001","Gym Access IND Bronze HMO HSA 6000/6000","56503FL226","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2260001-03","Gym Access IND Bronze HMO HSA 6000/6000 - Limited","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$5,460","$340","$0","$60","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2018/56503FL2260001-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2260001-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2670001","IND Bronze Standardized HMO","56503FL267","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2670001-00","IND Bronze Standardized HMO","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,300","$1,050","$4,000","$60","$2,410","$1,860","$1,310","$60","$960","$230","$650","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2670001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2670001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2670001","IND Bronze Standardized HMO","56503FL267","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2670001-01","IND Bronze Standardized HMO","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,300","$1,050","$4,000","$60","$2,410","$1,860","$1,310","$60","$960","$230","$650","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2670001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2670001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2670001","IND Bronze Standardized HMO","56503FL267","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2670001-02","IND Bronze Standardized HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2670001-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2670001-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF007","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2580002-06","Gym Access IND Silver POS BC 7741 94%","94% AV Level Silver Plan",,"0.947537652153442","Yes","Yes","No","100%",,"$0","$140","$1,110","$60","$0","$530","$0","$60","$0","$70","$200","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2580002-06.pdf","http://www.fhcp.com/ISOB/2018/56503FL2580002-06.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2530002","Gym Access IND Bronze HMO BC 3841","56503FL253","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2530002-00","Gym Access IND Bronze HMO BC 3841","Standard Bronze Off Exchange Plan",,"0.649436371926993","Yes","Yes","No","100%",,"$5,470","$1,010","$520","$60","$2,800","$2,150","$70","$60","$690","$460","$690","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2530002-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2530002-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2530002","Gym Access IND Bronze HMO BC 3841","56503FL253","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2530002-01","Gym Access IND Bronze HMO BC 3841","Standard Bronze On Exchange Plan",,"0.649436371926993","Yes","Yes","No","100%",,"$5,470","$1,010","$520","$60","$2,800","$2,150","$70","$60","$690","$460","$690","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2530002-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2530002-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2530002","Gym Access IND Bronze HMO BC 3841","56503FL253","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2530002-02","Gym Access IND Bronze HMO BC 3841 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2530002-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2530002-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2530002","Gym Access IND Bronze HMO BC 3841","56503FL253","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2530002-03","Gym Access IND Bronze HMO BC 3841 - Limited","Limited Cost Sharing Plan Variation",,"0.649436371926993","Yes","Yes","No","100%",,"$5,470","$1,010","$520","$60","$2,800","$2,150","$70","$60","$690","$460","$690","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2530002-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2530002-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2540002","Gym Access IND Bronze POS BC 3841","56503FL254","7265435496","FLN001","FLS001","FLF003","Existing","POS","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2540002-00","Gym Access IND Bronze POS BC 3841","Standard Bronze Off Exchange Plan",,"0.649436371926993","Yes","Yes","No","100%",,"$5,470","$1,010","$520","$60","$2,800","$2,150","$70","$60","$690","$460","$690","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2540002-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2540002-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2540002","Gym Access IND Bronze POS BC 3841","56503FL254","7265435496","FLN001","FLS001","FLF003","Existing","POS","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2540002-01","Gym Access IND Bronze POS BC 3841","Standard Bronze On Exchange Plan",,"0.649436371926993","Yes","Yes","No","100%",,"$5,470","$1,010","$520","$60","$2,800","$2,150","$70","$60","$690","$460","$690","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2540002-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2540002-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2540002","Gym Access IND Bronze POS BC 3841","56503FL254","7265435496","FLN001","FLS001","FLF003","Existing","POS","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2540002-02","Gym Access IND Bronze POS BC 3841 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2540002-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2540002-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2540002","Gym Access IND Bronze POS BC 3841","56503FL254","7265435496","FLN001","FLS001","FLF003","Existing","POS","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2540002-03","Gym Access IND Bronze POS BC 3841 - Limited","Limited Cost Sharing Plan Variation",,"0.649436371926993","Yes","Yes","No","100%",,"$5,470","$1,010","$520","$60","$2,800","$2,150","$70","$60","$690","$460","$690","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2540002-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2540002-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2260001","Gym Access IND Bronze HMO HSA 6000/6000","56503FL226","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2260001-00","Gym Access IND Bronze HMO HSA 6000/6000","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$5,460","$340","$0","$60","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2018/56503FL2260001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2260001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2260001","Gym Access IND Bronze HMO HSA 6000/6000","56503FL226","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2260001-01","Gym Access IND Bronze HMO HSA 6000/6000","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$5,460","$340","$0","$60","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2018/56503FL2260001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2260001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2670001","IND Bronze Standardized HMO","56503FL267","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2670001-03","IND Bronze Standardized HMO","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$2,300","$1,050","$4,000","$60","$2,410","$1,860","$1,310","$60","$960","$230","$650","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2670001-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2670001-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2680001","IND Silver Standardized HMO 1","56503FL268","7265435496","FLN001","FLS001","FLF012","Existing","HMO","Silver","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2680001-00","IND Silver Standardized HMO 1","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$1,230","$2,000","$60","$110","$1,830","$30","$60","$1,280","$200","$330","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2680001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2680001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2680001","IND Silver Standardized HMO 1","56503FL268","7265435496","FLN001","FLS001","FLF012","Existing","HMO","Silver","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2680001-01","IND Silver Standardized HMO 1","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$1,230","$2,000","$60","$110","$1,830","$30","$60","$1,280","$200","$330","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2680001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2680001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2680001","IND Silver Standardized HMO 1","56503FL268","7265435496","FLN001","FLS001","FLF012","Existing","HMO","Silver","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2680001-02","IND Silver Standardized HMO 1 - Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2680001-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2680001-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2680001","IND Silver Standardized HMO 1","56503FL268","7265435496","FLN001","FLS001","FLF012","Existing","HMO","Silver","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2680001-03","IND Silver Standardized HMO 1 - Limited","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$1,230","$2,000","$60","$110","$1,830","$30","$60","$1,280","$200","$330","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2680001-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2680001-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2680001","IND Silver Standardized HMO 1","56503FL268","7265435496","FLN001","FLS001","FLF012","Existing","HMO","Silver","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2680001-04","IND Silver Standardized HMO 1 73%","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$2,940","$910","$2,000","$60","$110","$1,830","$30","$60","$1,280","$200","$330","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2680001-04.pdf","http://www.fhcp.com/ISOB/2018/56503FL2680001-04.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2680001","IND Silver Standardized HMO 1","56503FL268","7265435496","FLN001","FLS001","FLF012","Existing","HMO","Silver","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2680001-05","IND Silver Standardized HMO 1 87%","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$350","$1,400","$60","$110","$950","$30","$60","$700","$80","$330","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2680001-05.pdf","http://www.fhcp.com/ISOB/2018/56503FL2680001-05.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2680001","IND Silver Standardized HMO 1","56503FL268","7265435496","FLN001","FLS001","FLF012","Existing","HMO","Silver","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2680001-06","IND Silver Standardized HMO 1 94%","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$190","$500","$60","$130","$560","$10","$60","$250","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL2680001-06.pdf","http://www.fhcp.com/ISOB/2018/56503FL2680001-06.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2730001","IND Bronze HMO 1340","56503FL273","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2730001-00","IND Bronze HMO 1340","Standard Bronze Off Exchange Plan",,"0.608297190977618","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,180","$0","$0","$60","$1,920","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2730001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL2730001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2730001","IND Bronze HMO 1340","56503FL273","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2730001-01","IND Bronze HMO 1340","Standard Bronze On Exchange Plan",,"0.608297190977618","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,180","$0","$0","$60","$1,920","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2730001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL2730001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2730001","IND Bronze HMO 1340","56503FL273","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2730001-02","IND Bronze HMO 1340 - Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,180","$0","$0","$60","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2730001-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL2730001-02.pdf"
"2018","FL","59667","HIOS","2017-08-17 02:20:39","Individual","Yes","65-0743731","59667FL0010001","DentaQuest EPO Pediatric High","59667FL001","7891798028","FLN001","FLS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","59667FL0010001-01","DentaQuest EPO Pediatric High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/"
"2018","FL","59667","HIOS","2017-08-17 02:20:39","Individual","Yes","65-0743731","59667FL0010003","DentaQuest EPO Family High","59667FL001","7891798028","FLN001","FLS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","59667FL0010003-00","DentaQuest EPO Family High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/"
"2018","FL","59667","HIOS","2017-08-17 02:20:39","Individual","Yes","65-0743731","59667FL0010003","DentaQuest EPO Family High","59667FL001","7891798028","FLN001","FLS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","59667FL0010003-01","DentaQuest EPO Family High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/"
"2018","FL","59667","HIOS","2017-08-17 02:20:39","Individual","Yes","65-0743731","59667FL0010004","DentaQuest EPO Family Low","59667FL001","7891798028","FLN001","FLS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","59667FL0010004-00","DentaQuest EPO Family Low","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/"
"2018","FL","59667","HIOS","2017-08-17 02:20:39","Individual","Yes","65-0743731","59667FL0010004","DentaQuest EPO Family Low","59667FL001","7891798028","FLN001","FLS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","59667FL0010004-01","DentaQuest EPO Family Low","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/"
"2018","FL","85019","HIOS","2017-09-23 02:26:22","Individual","Yes","27-0963551","85019FL0020001","LIBERTY FL Family Value Dental Plan","85019FL002",,"FLN001","FLS001",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No",,"No","https://www.libertydentalplan.com/ExchangePayment","","85019FL0020001-01","LIBERTY FL Family Value Dental Plan","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.libertydentalplan.com/Resources/Documents/2018-LDP-FL-IND-Exchange.pdf"
"2018","FL","93299","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","45-2548158","93299FL0020001","FL Affordable Smiles","93299FL002",,"FLN001","FLS001",,"Existing","EPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.0833","Guaranteed Rate","2018-01-01",,"No",,"No",,"No",,"","93299FL0020001-01","FL Affordable Smiles","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/FLAFFORDABLESMILES_BENEFITS","http://www.healthplex.com/doc/no/FLAFFORDABLESMILES_BROCHURE"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL2730001","IND Bronze HMO 1340","56503FL273","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL2730001-03","IND Bronze HMO 1340 - Limited","Limited Cost Sharing Plan Variation",,"0.608297190977618","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,180","$0","$0","$60","$1,920","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2018/56503FL2730001-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL2730001-03.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1390001","Gym Access IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF011","Existing","HMO","Gold","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1390001-00","Gym Access IND Essential Plus Gold HMO 63","Standard Gold Off Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$930","$2,000","$60","$110","$1,430","$30","$60","$1,100","$150","$330","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL1390001-00.pdf","http://www.fhcp.com/ISOB/2018/56503FL1390001-00.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1390001","Gym Access IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF011","Existing","HMO","Gold","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1390001-01","Gym Access IND Essential Plus Gold HMO 63","Standard Gold On Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$930","$2,000","$60","$110","$1,430","$30","$60","$1,100","$150","$330","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL1390001-01.pdf","http://www.fhcp.com/ISOB/2018/56503FL1390001-01.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1390001","Gym Access IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF011","Existing","HMO","Gold","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1390001-02","Gym Access IND Essential Plus Gold HMO 63 - Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL1390001-02.pdf","http://www.fhcp.com/ISOB/2018/56503FL1390001-02.pdf"
"2018","FL","56503","HIOS","2017-09-22 02:20:26","Individual","No","26-3238817","56503FL1390001","Gym Access IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF011","Existing","HMO","Gold","Design 1","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9815",,,"2018-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://fm.formularynavigator.com/MemberPages/pdf/2018QHPFormulary_12170_Full_3833.pdf","56503FL1390001-03","Gym Access IND Essential Plus Gold HMO 63 - Limited","Limited Cost Sharing Plan Variation",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$930","$2,000","$60","$110","$1,430","$30","$60","$1,100","$150","$330","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2018/56503FL1390001-03.pdf","http://www.fhcp.com/ISOB/2018/56503FL1390001-03.pdf"
"2018","FL","59667","HIOS","2017-08-17 02:20:39","Individual","Yes","65-0743731","59667FL0010001","DentaQuest EPO Pediatric High","59667FL001","7891798028","FLN001","FLS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","59667FL0010001-00","DentaQuest EPO Pediatric High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/"
"2018","FL","93299","HIOS","2017-08-15 02:20:31","Individual","Yes","45-2548158","93299FL0010001","FL Young Smiles","93299FL001",,"FLN001","FLS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No",,"","93299FL0010001-00","FL Young Smiles","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/FLFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/FLFAMILYSMILES_BROCHURE"
"2018","FL","93299","HIOS","2017-08-15 02:20:31","Individual","Yes","45-2548158","93299FL0010001","FL Young Smiles","93299FL001",,"FLN001","FLS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No",,"","93299FL0010001-01","FL Young Smiles","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/FLFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/FLFAMILYSMILES_BROCHURE"
"2018","FL","93299","HIOS","2017-08-15 02:20:31","Individual","Yes","45-2548158","93299FL0010002","FL Family Smiles","93299FL001",,"FLN001","FLS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.0833","Guaranteed Rate","2018-01-01",,"No",,"No",,"No",,"","93299FL0010002-00","FL Family Smiles","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/FLFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/FLFAMILYSMILES_BROCHURE"
"2018","FL","93299","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","45-2548158","93299FL0020002","FL Affordable Smiles","93299FL002",,"FLN001","FLS001",,"Existing","EPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.0833","Guaranteed Rate","2018-01-01",,"No",,"No",,"No",,"","93299FL0020002-00","FL Affordable Smiles","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/FLAFFORDABLESMILES_BENEFITS","http://www.healthplex.com/doc/no/FLAFFORDABLESMILES_BROCHURE"
"2018","FL","93299","HIOS","2017-08-15 02:20:31","Individual","Yes","45-2548158","93299FL0010002","FL Family Smiles","93299FL001",,"FLN001","FLS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.0833","Guaranteed Rate","2018-01-01",,"No",,"No",,"No",,"","93299FL0010002-01","FL Family Smiles","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/FLFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/FLFAMILYSMILES_BROCHURE"
"2018","FL","97725","HIOS","2017-08-17 02:20:39","SHOP (Small Group)","Yes","94-2761537","97725FL0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","97725FL002",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0020001-00","Delta Dental PPO Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0020001-18"
"2018","FL","97725","HIOS","2017-08-17 02:20:39","Individual","Yes","94-2761537","97725FL0010001","Delta Dental PPO Pediatric Basic Plan","97725FL001",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0010001-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0010001-18"
"2018","FL","97725","HIOS","2017-08-17 02:20:39","Individual","Yes","94-2761537","97725FL0010002","Delta Dental PPO Pediatric Preferred Plan","97725FL001",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0010002-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","$45 per person","per group not applicable",,,,,,"$45","$45 per person","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0010002-18"
"2018","FL","97725","HIOS","2017-08-17 02:20:39","SHOP (Small Group)","Yes","94-2761537","97725FL0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","97725FL002",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0020002-00","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","$45 per person","per group not applicable",,,,,,"$45","$45 per person","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0020002-18"
"2018","FL","97725","HIOS","2017-08-17 02:20:39","SHOP (Small Group)","Yes","94-2761537","97725FL0040001","DeltaCare USA Pediatric Basic Plan for Small Businesses","97725FL004",,"FLN002","FLS002",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","97725FL0040001-00","DeltaCare USA Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0040001-18"
"2018","FL","97725","HIOS","2017-08-17 02:20:39","Individual","Yes","94-2761537","97725FL0010006","Delta Dental PPO Basic Plan for Families","97725FL001",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0010006-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0010006-18"
"2018","FL","97725","HIOS","2017-08-17 02:20:39","SHOP (Small Group)","Yes","94-2761537","97725FL0040002","DeltaCare USA Pediatric Preferred Plan for Small Businesses","97725FL004",,"FLN002","FLS002",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","97725FL0040002-00","DeltaCare USA Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0040002-18"
"2018","FL","97725","HIOS","2017-08-17 02:20:39","Individual","Yes","94-2761537","97725FL0010004","Delta Dental PPO Preferred Plan for Families","97725FL001",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0010004-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","$45 per person","per group not applicable",,,,,,"$45","$45 per person","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0010004-18"
"2018","FL","97725","HIOS","2017-08-17 02:20:39","Individual","Yes","94-2761537","97725FL0030001","DeltaCare USA Pediatric Basic Plan","97725FL003",,"FLN002","FLS002",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","97725FL0030001-00","DeltaCare USA Pediatric Basic Plan","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0030001-18"
"2018","FL","97725","HIOS","2017-08-17 02:20:39","Individual","Yes","94-2761537","97725FL0030002","DeltaCare USA Pediatric Preferred Plan","97725FL003",,"FLN002","FLS002",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","97725FL0030002-00","DeltaCare USA Pediatric Preferred Plan","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0030002-18"
"2018","FL","97725","HIOS","2017-08-17 02:20:39","Individual","Yes","94-2761537","97725FL0030006","DeltaCare USA Basic Plan for Families","97725FL003",,"FLN002","FLS002",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","97725FL0030006-01","DeltaCare USA Basic Plan for Families","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0030006-18"
"2018","FL","97725","HIOS","2017-08-17 02:20:39","Individual","Yes","94-2761537","97725FL0030004","DeltaCare USA Preferred Plan for Families","97725FL003",,"FLN002","FLS002",,"Existing","HMO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","97725FL0030004-01","DeltaCare USA Preferred Plan for Families","Standard High On Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0030004-18"
"2018","FL","98534","HIOS","2017-06-20 02:20:27","SHOP (Small Group)","Yes","13-5581829","98534FL0240001","Family Basic Dental Plan (Low)","98534FL024",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.91","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98534FL0240001-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","FL","98869","HIOS","2017-06-16 02:20:26","Individual","Yes","20-4023720","98869FL0010001","EMI Health Choice PPO (High)","98869FL001",,"FLN001","FLS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9651","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","98869FL0010001-01","EMI Health Choice PPO (High)","Standard High On Exchange Plan","86.44%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$15","$15 per person","$45 per group",,"$15","$15 per person","$45 per group",,"$15","$15 per person","$45 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/fl-federal-marketplace-dental.aspx"
"2018","FL","98869","HIOS","2017-06-16 02:20:26","Individual","Yes","20-4023720","98869FL0010002","EMI Health Choice PPO (Low)","98869FL001",,"FLN001","FLS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","98869FL0010002-01","EMI Health Choice PPO (Low)","Standard Low On Exchange Plan","70.71%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,"$100","$100 per person","$300 per group",,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/fl-federal-marketplace-dental.aspx"
"2018","GA","22500","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","22500GA0020001","TruAssure Preferred Adult or Child Dental Plan","22500GA002",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/plan-information2?state=GA","","22500GA0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","83.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$35","$35 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=GA","https://www.truassure.com/brochure?state=GA"
"2018","GA","28167","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","28167GA0010001","Dentegra Dental PPO Pediatric Basic Plan","28167GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","28167GA0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ga/28167ga0010001-18"
"2018","GA","28167","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","28167GA0010008","Dentegra Dental PPO Family Preferred Plan","28167GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","28167GA0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ga/28167ga0010008-18"
"2018","GA","28167","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","28167GA0010007","Dentegra Dental PPO Family Basic Plan","28167GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","28167GA0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ga/28167ga0010007-18"
"2018","GA","37001","HIOS","2017-08-08 02:20:26","Individual","Yes","39-1263473","37001GA0540001","Humana Dental Smart Choice","37001GA054",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9909","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","37001GA0540001-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110276"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410053","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS021","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410053-04","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA S04","73% AV Level Silver Plan","72.38%","0.727103417565281","Yes","Yes","Yes","60%","40%","$2,700","$0","$1,154","$60","$2,700","$0","$1,150","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group","$3,850","$3850 per person","$7700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%","$2,700","$2700 per person","$5400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J34","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","FL","98869","HIOS","2017-06-16 02:20:26","Individual","Yes","20-4023720","98869FL0010003","EMI Health Advantage Co-Pay","98869FL001",,"FLN002","FLS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","98869FL0010003-01","EMI Health Advantage Co-Pay","Standard Low On Exchange Plan","70.38%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/fl-federal-marketplace-dental.aspx"
"2018","FL","99787","HIOS","2017-08-12 02:21:25","Individual","Yes","75-1233841","99787FL0010001","Dentegra Dental PPO Pediatric Basic Plan","99787FL001",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","99787FL0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/fl/99787fl0010001-18"
"2018","FL","99787","HIOS","2017-08-12 02:21:25","Individual","Yes","75-1233841","99787FL0010008","Dentegra Dental PPO Family Preferred Plan","99787FL001",,"FLN001","FLS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","99787FL0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","$45 per person","per group not applicable",,,,,,"$45","$45 per person","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/fl/99787fl0010008-18"
"2018","FL","99787","HIOS","2017-08-12 02:21:25","Individual","Yes","75-1233841","99787FL0010007","Dentegra Dental PPO Family Basic Plan","99787FL001",,"FLN001","FLS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","99787FL0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/fl/99787fl0010007-18"
"2018","GA","20744","HIOS","2017-11-02 02:20:21","Individual","Yes","81-3569969","20744GA0010003","Choice PPO Basic Kids","20744GA001","7962405180","GAN001","GAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","20744GA0010003-00","Choice PPO Basic Kids","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBLINDPEDEHB.PDF"
"2018","GA","20744","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","Yes","81-3569969","20744GA0020001","Choice PPO Basic","20744GA002","7962405180","GAN001","GAS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","20744GA0020001-00","Choice PPO Basic","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBLSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBLSMGFAMEHB.PDF"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410043","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS019","GAF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410043-01","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","Standard Bronze On Exchange Plan","60.22%","0.602242886076114","Yes","Yes","Yes","60%","40%","$6,650","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%","$6,650","$6650 per person","$13300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J30","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410043","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS019","GAF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410043-02","BCBSHP Bronze Pathway X Guided Access HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J31","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410043","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS019","GAF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410043-03","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","Limited Cost Sharing Plan Variation","60.22%","0.602242886076114","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%","$6,650","$6650 per person","$13300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J30","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410045","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS021","GAF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410045-00","BCBSHP Bronze Pathway Guided Access HMO 0 for HSA","Standard Bronze Off Exchange Plan","60.22%","0.602242886076114","Yes","Yes","Yes","60%","40%","$6,650","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%","$6,650","$6650 per person","$13300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J32","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410077","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS021","GAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410077-01","BCBSHP Bronze Pathway X Guided Access HMO 5850","Standard Bronze On Exchange Plan","58.93%","0.590547716494683","Yes","Yes","Yes","60%","40%","$2,236","$0","$5,114","$60","$4,490","$0","$2,693","$55","$1,251","$0","$674","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3G","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","20744","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","Yes","81-3569969","20744GA0020001","Choice PPO Basic","20744GA002","7962405180","GAN001","GAS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","20744GA0020001-01","Choice PPO Basic","Standard High On Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBLSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBLSMGFAMEHB.PDF"
"2018","GA","20744","HIOS","2017-11-02 02:20:21","Individual","Yes","81-3569969","20744GA0010003","Choice PPO Basic Kids","20744GA001","7962405180","GAN001","GAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","20744GA0010003-01","Choice PPO Basic Kids","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBLINDPEDEHB.PDF"
"2018","GA","20744","HIOS","2017-11-02 02:20:21","Individual","Yes","81-3569969","20744GA0010004","Choice PPO Premium Kids","20744GA001","7962405180","GAN001","GAS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","20744GA0010004-00","Choice PPO Premium Kids","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBHINDPEDEHB.PDF"
"2018","GA","20744","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","Yes","81-3569969","20744GA0020002","Choice PPO Premium","20744GA002","7962405180","GAN001","GAS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","20744GA0020002-00","Choice PPO Premium","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBHSMGFAMEHB.PDF"
"2018","GA","20744","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","Yes","81-3569969","20744GA0020002","Choice PPO Premium","20744GA002","7962405180","GAN001","GAS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","20744GA0020002-01","Choice PPO Premium","Standard High On Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBHSMGFAMEHB.PDF"
"2018","GA","20744","HIOS","2017-11-02 02:20:21","Individual","Yes","81-3569969","20744GA0010004","Choice PPO Premium Kids","20744GA001","7962405180","GAN001","GAS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","20744GA0010004-01","Choice PPO Premium Kids","Standard High On Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBHINDPEDEHB.PDF"
"2018","GA","20744","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","Yes","81-3569969","20744GA0020003","Choice PPO Plus","20744GA002","7962405180","GAN001","GAS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","20744GA0020003-00","Choice PPO Plus","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SB2SMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SB2SMGFAMEHB.PDF"
"2018","GA","20744","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","Yes","81-3569969","20744GA0020003","Choice PPO Plus","20744GA002","7962405180","GAN001","GAS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","20744GA0020003-01","Choice PPO Plus","Standard High On Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SB2SMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SB2SMGFAMEHB.PDF"
"2018","GA","20744","HIOS","2017-11-02 02:20:21","Individual","Yes","81-3569969","20744GA0010001","Choice PPO Basic","20744GA001","7962405180","GAN001","GAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","20744GA0010001-00","Choice PPO Basic","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBLINDFAMEHB.PDF"
"2018","GA","20744","HIOS","2017-11-02 02:20:21","Individual","Yes","81-3569969","20744GA0010001","Choice PPO Basic","20744GA001","7962405180","GAN001","GAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","20744GA0010001-01","Choice PPO Basic","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBLINDFAMEHB.PDF"
"2018","GA","20744","HIOS","2017-11-02 02:20:21","Individual","Yes","81-3569969","20744GA0010002","Choice PPO Premium","20744GA001","7962405180","GAN001","GAS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","20744GA0010002-00","Choice PPO Premium","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBHINDFAMEHB.PDF"
"2018","GA","20744","HIOS","2017-11-02 02:20:21","Individual","Yes","81-3569969","20744GA0010002","Choice PPO Premium","20744GA001","7962405180","GAN001","GAS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","20744GA0010002-01","Choice PPO Premium","Standard High On Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SBHINDFAMEHB.PDF"
"2018","GA","20744","HIOS","2017-11-02 02:20:21","Individual","Yes","81-3569969","20744GA0010005","Choice PPO Plus","20744GA001","7962405180","GAN001","GAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","20744GA0010005-00","Choice PPO Plus","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SB2INDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SB2INDFAMEHB.PDF"
"2018","GA","20744","HIOS","2017-11-02 02:20:21","Individual","Yes","81-3569969","20744GA0010005","Choice PPO Plus","20744GA001","7962405180","GAN001","GAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","20744GA0010005-01","Choice PPO Plus","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SB2INDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNGA18SB2INDFAMEHB.PDF"
"2018","GA","22500","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","22500GA0010001","TruAssure Basic Adult or Child Dental Plan","22500GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","22500GA0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$115","$115 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=GA","https://www.truassure.com/brochure?state=GA"
"2018","GA","22500","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","22500GA0030001","TruAssure Dental Small Group Basic Plan","22500GA003",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","22500GA0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","GA","22500","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","22500GA0040001","TruAssure Dental Small Group Preferred Plan","22500GA004",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","22500GA0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","GA","22500","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","22500GA0010001","TruAssure Basic Adult or Child Dental Plan","22500GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","22500GA0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$115","$115 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=GA","https://www.truassure.com/brochure?state=GA"
"2018","GA","22500","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","22500GA0020001","TruAssure Preferred Adult or Child Dental Plan","22500GA002",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/plan-information2?state=GA","","22500GA0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$35","$35 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=GA","https://www.truassure.com/brochure?state=GA"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410015","BCBSHP Bronze Pathway X HMO 0 for HSA","49046GA041",,"GAN001","GAS023","GAF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410015-00","BCBSHP Bronze Pathway HMO 0 for HSA","Standard Bronze Off Exchange Plan","60.22%","0.602242886076114","Yes","Yes","Yes","60%","40%","$6,650","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%","$6,650","$6650 per person","$13300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5D","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410015","BCBSHP Bronze Pathway X HMO 0 for HSA","49046GA041",,"GAN001","GAS023","GAF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410015-01","BCBSHP Bronze Pathway X HMO 0 for HSA","Standard Bronze On Exchange Plan","60.22%","0.602242886076114","Yes","Yes","Yes","60%","40%","$6,650","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%","$6,650","$6650 per person","$13300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5B","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410015","BCBSHP Bronze Pathway X HMO 0 for HSA","49046GA041",,"GAN001","GAS023","GAF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410015-02","BCBSHP Bronze Pathway X HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G5C","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410015","BCBSHP Bronze Pathway X HMO 0 for HSA","49046GA041",,"GAN001","GAS023","GAF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410015-03","BCBSHP Bronze Pathway X HMO 0 for HSA","Limited Cost Sharing Plan Variation","60.22%","0.602242886076114","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%","$6,650","$6650 per person","$13300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5B","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS023","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-00","BCBSHP Silver Pathway HMO 10 for HSA","Standard Silver Off Exchange Plan","68.92%","0.692632847734193","Yes","Yes","Yes","60%","40%","$3,096","$0","$1,904","$60","$3,200","$0","$1,793","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5X","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS023","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-01","BCBSHP Silver Pathway X HMO 10 for HSA","Standard Silver On Exchange Plan","68.92%","0.692632847734193","Yes","Yes","Yes","60%","40%","$3,096","$0","$1,904","$60","$3,200","$0","$1,793","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5S","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS023","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-02","BCBSHP Silver Pathway X HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G5W","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS023","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-03","BCBSHP Silver Pathway X HMO 10 for HSA","Limited Cost Sharing Plan Variation","68.92%","0.692632847734193","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5S","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS023","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-04","BCBSHP Silver Pathway X HMO 10 for HSA S04","73% AV Level Silver Plan","72.38%","0.727103417565281","Yes","Yes","Yes","60%","40%","$2,700","$0","$1,150","$60","$2,700","$0","$1,150","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group","$3,850","$3850 per person","$7700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%","$2,700","$2700 per person","$5400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5T","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS023","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-05","BCBSHP Silver Pathway X HMO 10 S05","87% AV Level Silver Plan","86.02%","0.861447593742684","Yes","Yes","Yes","60%","40%","$1,150","$0","$0","$60","$1,130","$0","$220","$55","$1,150","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","$1,350","$1350 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0.00%","$1,150","$1150 per person","$2300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5U","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS023","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-06","BCBSHP Silver Pathway X HMO 10 S06","94% AV Level Silver Plan","93.12%","0.932027331102622","Yes","Yes","Yes","60%","40%","$400","$0","$0","$60","$400","$0","$300","$55","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","0.00%","$400","$400 per person","$800 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5V","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410043","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS019","GAF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410043-00","BCBSHP Bronze Pathway Guided Access HMO 0 for HSA","Standard Bronze Off Exchange Plan","60.22%","0.602242886076114","Yes","Yes","Yes","60%","40%","$6,650","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%","$6,650","$6650 per person","$13300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J32","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410045","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS021","GAF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410045-01","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","Standard Bronze On Exchange Plan","60.22%","0.602242886076114","Yes","Yes","Yes","60%","40%","$6,650","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%","$6,650","$6650 per person","$13300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J30","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410045","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS021","GAF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410045-02","BCBSHP Bronze Pathway X Guided Access HMO 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J31","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410045","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","49046GA041",,"GAN002","GAS021","GAF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410045-03","BCBSHP Bronze Pathway X Guided Access HMO 0 for HSA","Limited Cost Sharing Plan Variation","60.22%","0.602242886076114","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%","$6,650","$6650 per person","$13300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J30","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410051","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS019","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410051-00","BCBSHP Silver Pathway Guided Access HMO 10 for HSA","Standard Silver Off Exchange Plan","68.92%","0.692632847734193","Yes","Yes","Yes","60%","40%","$3,096","$0","$1,904","$60","$3,200","$0","$1,793","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J38","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410051","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS019","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410051-01","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","Standard Silver On Exchange Plan","68.92%","0.692632847734193","Yes","Yes","Yes","60%","40%","$3,096","$0","$1,904","$60","$3,200","$0","$1,793","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J33","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410051","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS019","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410051-02","BCBSHP Silver Pathway X Guided Access HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J37","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410051","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS019","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410051-03","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","Limited Cost Sharing Plan Variation","68.92%","0.692632847734193","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J33","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410051","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS019","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410051-04","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA S04","73% AV Level Silver Plan","72.38%","0.727103417565281","Yes","Yes","Yes","60%","40%","$2,700","$0","$1,150","$60","$2,700","$0","$1,150","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group","$3,850","$3850 per person","$7700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%","$2,700","$2700 per person","$5400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J34","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410051","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS019","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410051-05","BCBSHP Silver Pathway X Guided Access HMO 10 S05","87% AV Level Silver Plan","86.02%","0.861447593742684","Yes","Yes","Yes","60%","40%","$1,150","$0","$0","$60","$1,130","$0","$220","$55","$1,150","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","$1,350","$1350 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0.00%","$1,150","$1150 per person","$2300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J35","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410051","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS019","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410051-06","BCBSHP Silver Pathway X Guided Access HMO 10 S06","94% AV Level Silver Plan","93.12%","0.934979393751568","Yes","Yes","Yes","60%","40%","$400","$0","$0","$60","$400","$0","$300","$55","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","0.00%","$400","$400 per person","$800 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J36","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410053","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS021","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410053-00","BCBSHP Silver Pathway Guided Access HMO 10 for HSA","Standard Silver Off Exchange Plan","68.92%","0.692632847734193","Yes","Yes","Yes","60%","40%","$3,096","$0","$1,904","$60","$3,200","$0","$1,793","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J38","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410053","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS021","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410053-01","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","Standard Silver On Exchange Plan","68.92%","0.692632847734193","Yes","Yes","Yes","60%","40%","$3,096","$0","$1,904","$60","$3,200","$0","$1,793","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J33","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410053","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS021","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410053-02","BCBSHP Silver Pathway X Guided Access HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J37","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410053","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","49046GA041",,"GAN002","GAS021","GAF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410053-03","BCBSHP Silver Pathway X Guided Access HMO 10 for HSA","Limited Cost Sharing Plan Variation","68.92%","0.692632847734193","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","10.00%","$3,200","$3200 per person","$6400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2J33","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410029","BCBSHP Bronze Pathway X HMO 5850","49046GA041",,"GAN001","GAS023","GAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410029-00","BCBSHP Bronze Pathway HMO 5850","Standard Bronze Off Exchange Plan","58.93%","0.590547716494683","Yes","Yes","Yes","60%","40%","$2,236","$0","$5,114","$60","$4,490","$0","$2,693","$55","$1,251","$0","$674","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3C","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410029","BCBSHP Bronze Pathway X HMO 5850","49046GA041",,"GAN001","GAS023","GAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410029-01","BCBSHP Bronze Pathway X HMO 5850","Standard Bronze On Exchange Plan","58.93%","0.590547716494683","Yes","Yes","Yes","60%","40%","$2,236","$0","$5,114","$60","$4,490","$0","$2,693","$55","$1,251","$0","$674","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3D","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410029","BCBSHP Bronze Pathway X HMO 5850","49046GA041",,"GAN001","GAS023","GAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410029-02","BCBSHP Bronze Pathway X HMO 5850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J3E","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410029","BCBSHP Bronze Pathway X HMO 5850","49046GA041",,"GAN001","GAS023","GAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410029-03","BCBSHP Bronze Pathway X HMO 5850","Limited Cost Sharing Plan Variation","58.93%","0.590547716494683","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3D","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410083","BCBSHP Bronze Pathway X HMO 6750","49046GA041",,"GAN001","GAS023","GAF005","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410083-00","BCBSHP Bronze Pathway HMO 6750","Standard Bronze Off Exchange Plan","58.62%","0.586206714207272","Yes","Yes","Yes","60%","40%","$2,064","$0","$5,286","$60","$4,233","$0","$2,951","$55","$1,155","$0","$770","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","40.00%","$6,750","$6750 per person","$13500 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VXX","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410083","BCBSHP Bronze Pathway X HMO 6750","49046GA041",,"GAN001","GAS023","GAF005","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410083-01","BCBSHP Bronze Pathway X HMO 6750","Standard Bronze On Exchange Plan","58.62%","0.586206714207272","Yes","Yes","Yes","60%","40%","$2,064","$0","$5,286","$60","$4,233","$0","$2,951","$55","$1,155","$0","$770","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","40.00%","$6,750","$6750 per person","$13500 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VXY","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410083","BCBSHP Bronze Pathway X HMO 6750","49046GA041",,"GAN001","GAS023","GAF005","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410083-02","BCBSHP Bronze Pathway X HMO 6750 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VXZ","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410083","BCBSHP Bronze Pathway X HMO 6750","49046GA041",,"GAN001","GAS023","GAF005","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410083-03","BCBSHP Bronze Pathway X HMO 6750","Limited Cost Sharing Plan Variation","58.62%","0.586206714207272","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","40.00%","$6,750","$6750 per person","$13500 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VXY","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410075","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS019","GAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410075-00","BCBSHP Bronze Pathway Guided Access HMO 5850","Standard Bronze Off Exchange Plan","58.93%","0.590547716494683","Yes","Yes","Yes","60%","40%","$2,236","$0","$5,114","$60","$4,490","$0","$2,693","$55","$1,251","$0","$674","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3F","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410075","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS019","GAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410075-01","BCBSHP Bronze Pathway X Guided Access HMO 5850","Standard Bronze On Exchange Plan","58.93%","0.590547716494683","Yes","Yes","Yes","60%","40%","$2,236","$0","$5,114","$60","$4,490","$0","$2,693","$55","$1,251","$0","$674","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3G","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410075","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS019","GAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410075-02","BCBSHP Bronze Pathway X Guided Access HMO 5850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J3H","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410075","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS019","GAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410075-03","BCBSHP Bronze Pathway X Guided Access HMO 5850","Limited Cost Sharing Plan Variation","58.93%","0.590547716494683","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3G","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410077","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS021","GAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410077-00","BCBSHP Bronze Pathway Guided Access HMO 5850","Standard Bronze Off Exchange Plan","58.93%","0.590547716494683","Yes","Yes","Yes","60%","40%","$2,236","$0","$5,114","$60","$4,490","$0","$2,693","$55","$1,251","$0","$674","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3F","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000","49046GA041",,"GAN001","GAS023","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-04","BCBSHP Silver Pathway X HMO 2000 S04","73% AV Level Silver Plan","72.82%","0.733799333970384","Yes","Yes","Yes","60%","40%","$1,750","$0","$3,850","$60","$1,750","$420","$2,067","$55","$1,224","$210","$408","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","25.00%","$1,750","$1750 per person","$3500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6L","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000","49046GA041",,"GAN001","GAS023","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-05","BCBSHP Silver Pathway X HMO 2000 S05","87% AV Level Silver Plan","86.05%","0.863467970606582","Yes","Yes","Yes","60%","40%","$750","$0","$1,000","$60","$750","$100","$900","$55","$750","$90","$408","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6M","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000","49046GA041",,"GAN001","GAS023","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-06","BCBSHP Silver Pathway X HMO 2000 S06","94% AV Level Silver Plan","93.16%","0.933096878328566","Yes","Yes","Yes","60%","40%","$134","$0","$566","$60","$250","$90","$360","$55","$250","$90","$360","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6N","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410077","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS021","GAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410077-02","BCBSHP Bronze Pathway X Guided Access HMO 5850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J3H","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410077","BCBSHP Bronze Pathway X Guided Access HMO 5850","49046GA041",,"GAN002","GAS021","GAF006","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410077-03","BCBSHP Bronze Pathway X Guided Access HMO 5850","Limited Cost Sharing Plan Variation","58.93%","0.590547716494683","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35.00%","$5,850","$5850 per person","$11700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3G","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410100","BCBSHP Bronze Pathway X Guided Access HMO 6750","49046GA041",,"GAN002","GAS019","GAF005","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410100-00","BCBSHP Bronze Pathway Guided Access HMO 6750","Standard Bronze Off Exchange Plan","58.62%","0.586206714207272","Yes","Yes","Yes","60%","40%","$2,064","$0","$5,286","$60","$4,233","$0","$2,951","$55","$1,155","$0","$770","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","40.00%","$6,750","$6750 per person","$13500 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VY0","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410100","BCBSHP Bronze Pathway X Guided Access HMO 6750","49046GA041",,"GAN002","GAS019","GAF005","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410100-01","BCBSHP Bronze Pathway X Guided Access HMO 6750","Standard Bronze On Exchange Plan","58.62%","0.586206714207272","Yes","Yes","Yes","60%","40%","$2,064","$0","$5,286","$60","$4,233","$0","$2,951","$55","$1,155","$0","$770","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","40.00%","$6,750","$6750 per person","$13500 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VY1","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410100","BCBSHP Bronze Pathway X Guided Access HMO 6750","49046GA041",,"GAN002","GAS019","GAF005","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410100-02","BCBSHP Bronze Pathway X Guided Access HMO 6750 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VY2","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410100","BCBSHP Bronze Pathway X Guided Access HMO 6750","49046GA041",,"GAN002","GAS019","GAF005","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410100-03","BCBSHP Bronze Pathway X Guided Access HMO 6750","Limited Cost Sharing Plan Variation","58.62%","0.586206714207272","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","40.00%","$6,750","$6750 per person","$13500 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VY1","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410102","BCBSHP Bronze Pathway X Guided Access HMO 6750","49046GA041",,"GAN002","GAS021","GAF005","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410102-00","BCBSHP Bronze Pathway Guided Access HMO 6750","Standard Bronze Off Exchange Plan","58.62%","0.586206714207272","Yes","Yes","Yes","60%","40%","$2,064","$0","$5,286","$60","$4,233","$0","$2,951","$55","$1,155","$0","$770","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","40.00%","$6,750","$6750 per person","$13500 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VY0","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410102","BCBSHP Bronze Pathway X Guided Access HMO 6750","49046GA041",,"GAN002","GAS021","GAF005","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410102-01","BCBSHP Bronze Pathway X Guided Access HMO 6750","Standard Bronze On Exchange Plan","58.62%","0.586206714207272","Yes","Yes","Yes","60%","40%","$2,064","$0","$5,286","$60","$4,233","$0","$2,951","$55","$1,155","$0","$770","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","40.00%","$6,750","$6750 per person","$13500 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VY1","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410102","BCBSHP Bronze Pathway X Guided Access HMO 6750","49046GA041",,"GAN002","GAS021","GAF005","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410102-02","BCBSHP Bronze Pathway X Guided Access HMO 6750 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VY2","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410102","BCBSHP Bronze Pathway X Guided Access HMO 6750","49046GA041",,"GAN002","GAS021","GAF005","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410102-03","BCBSHP Bronze Pathway X Guided Access HMO 6750","Limited Cost Sharing Plan Variation","58.62%","0.586206714207272","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","40.00%","$6,750","$6750 per person","$13500 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VY1","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000","49046GA041",,"GAN001","GAS023","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-00","BCBSHP Silver Pathway HMO 2000","Standard Silver Off Exchange Plan","69.81%","0.704614697473701","Yes","Yes","Yes","60%","40%","$2,000","$10","$5,340","$60","$2,000","$420","$2,067","$55","$1,224","$210","$408","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6Q","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000","49046GA041",,"GAN001","GAS023","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-01","BCBSHP Silver Pathway X HMO 2000","Standard Silver On Exchange Plan","69.81%","0.704614697473701","Yes","Yes","Yes","60%","40%","$2,000","$10","$5,340","$60","$2,000","$420","$2,067","$55","$1,224","$210","$408","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6K","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000","49046GA041",,"GAN001","GAS023","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-02","BCBSHP Silver Pathway X HMO 2000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G6P","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000","49046GA041",,"GAN001","GAS023","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-03","BCBSHP Silver Pathway X HMO 2000","Limited Cost Sharing Plan Variation","69.81%","0.704614697473701","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6K","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410067","BCBSHP Silver Pathway X Guided Access HMO 2000","49046GA041",,"GAN002","GAS019","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410067-00","BCBSHP Silver Pathway Guided Access HMO 2000","Standard Silver Off Exchange Plan","69.81%","0.704280100368153","Yes","Yes","Yes","60%","40%","$2,000","$10","$5,340","$60","$2,000","$420","$2,067","$55","$1,224","$210","$408","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3P","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410067","BCBSHP Silver Pathway X Guided Access HMO 2000","49046GA041",,"GAN002","GAS019","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410067-01","BCBSHP Silver Pathway X Guided Access HMO 2000","Standard Silver On Exchange Plan","69.81%","0.704280100368153","Yes","Yes","Yes","60%","40%","$2,000","$10","$5,340","$60","$2,000","$420","$2,067","$55","$1,224","$210","$408","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3J","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410067","BCBSHP Silver Pathway X Guided Access HMO 2000","49046GA041",,"GAN002","GAS019","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410067-02","BCBSHP Silver Pathway X Guided Access HMO 2000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J3N","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410067","BCBSHP Silver Pathway X Guided Access HMO 2000","49046GA041",,"GAN002","GAS019","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410067-03","BCBSHP Silver Pathway X Guided Access HMO 2000","Limited Cost Sharing Plan Variation","69.81%","0.704280100368153","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3J","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410067","BCBSHP Silver Pathway X Guided Access HMO 2000","49046GA041",,"GAN002","GAS019","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410067-04","BCBSHP Silver Pathway X Guided Access HMO 2000 S04","73% AV Level Silver Plan","72.82%","0.733515741882527","Yes","Yes","Yes","60%","40%","$1,750","$0","$3,850","$60","$1,750","$420","$2,067","$55","$1,224","$210","$408","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","25.00%","$1,750","$1750 per person","$3500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3K","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410067","BCBSHP Silver Pathway X Guided Access HMO 2000","49046GA041",,"GAN002","GAS019","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410067-05","BCBSHP Silver Pathway X Guided Access HMO 2000 S05","87% AV Level Silver Plan","86.05%","0.863205189147762","Yes","Yes","Yes","60%","40%","$750","$0","$1,000","$60","$750","$100","$900","$55","$750","$90","$408","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3L","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410069","BCBSHP Silver Pathway X Guided Access HMO 2000","49046GA041",,"GAN002","GAS021","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410069-05","BCBSHP Silver Pathway X Guided Access HMO 2000 S05","87% AV Level Silver Plan","86.05%","0.863205189147762","Yes","Yes","Yes","60%","40%","$750","$0","$1,000","$60","$750","$100","$900","$55","$750","$90","$408","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3L","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410069","BCBSHP Silver Pathway X Guided Access HMO 2000","49046GA041",,"GAN002","GAS021","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410069-06","BCBSHP Silver Pathway X Guided Access HMO 2000 S06","94% AV Level Silver Plan","93.16%","0.932900586319277","Yes","Yes","Yes","60%","40%","$134","$0","$566","$60","$250","$90","$360","$55","$250","$90","$360","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3M","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410032","BCBSHP Silver Pathway X HMO 5300","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410032-00","BCBSHP Silver Pathway HMO 5300","Standard Silver Off Exchange Plan","68.05%","0.681053443484059","Yes","Yes","Yes","60%","40%","$2,580","$0","$3,920","$60","$3,750","$590","$1,966","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3V","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410032","BCBSHP Silver Pathway X HMO 5300","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410032-01","BCBSHP Silver Pathway X HMO 5300","Standard Silver On Exchange Plan","68.05%","0.681053443484059","Yes","Yes","Yes","60%","40%","$2,580","$0","$3,920","$60","$3,750","$590","$1,966","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3Q","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410067","BCBSHP Silver Pathway X Guided Access HMO 2000","49046GA041",,"GAN002","GAS019","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410067-06","BCBSHP Silver Pathway X Guided Access HMO 2000 S06","94% AV Level Silver Plan","93.16%","0.932900586319277","Yes","Yes","Yes","60%","40%","$134","$0","$566","$60","$250","$90","$360","$55","$250","$90","$360","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3M","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410088","BCBSHP Silver Pathway X HMO 6000","49046GA041",,"GAN001","GAS023","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410088-02","BCBSHP Silver Pathway X HMO 6000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VYP","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410069","BCBSHP Silver Pathway X Guided Access HMO 2000","49046GA041",,"GAN002","GAS021","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410069-00","BCBSHP Silver Pathway Guided Access HMO 2000","Standard Silver Off Exchange Plan","69.81%","0.704280100368153","Yes","Yes","Yes","60%","40%","$2,000","$10","$5,340","$60","$2,000","$420","$2,067","$55","$1,224","$210","$408","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3P","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410069","BCBSHP Silver Pathway X Guided Access HMO 2000","49046GA041",,"GAN002","GAS021","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410069-01","BCBSHP Silver Pathway X Guided Access HMO 2000","Standard Silver On Exchange Plan","69.81%","0.704280100368153","Yes","Yes","Yes","60%","40%","$2,000","$10","$5,340","$60","$2,000","$420","$2,067","$55","$1,224","$210","$408","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3J","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410069","BCBSHP Silver Pathway X Guided Access HMO 2000","49046GA041",,"GAN002","GAS021","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410069-02","BCBSHP Silver Pathway X Guided Access HMO 2000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J3N","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410069","BCBSHP Silver Pathway X Guided Access HMO 2000","49046GA041",,"GAN002","GAS021","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410069-03","BCBSHP Silver Pathway X Guided Access HMO 2000","Limited Cost Sharing Plan Variation","69.81%","0.704280100368153","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%","$2,000","$2000 per person","$4000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3J","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410069","BCBSHP Silver Pathway X Guided Access HMO 2000","49046GA041",,"GAN002","GAS021","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410069-04","BCBSHP Silver Pathway X Guided Access HMO 2000 S04","73% AV Level Silver Plan","72.82%","0.733515741882527","Yes","Yes","Yes","60%","40%","$1,750","$0","$3,850","$60","$1,750","$420","$2,067","$55","$1,224","$210","$408","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","25.00%","$1,750","$1750 per person","$3500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3K","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410032","BCBSHP Silver Pathway X HMO 5300","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410032-02","BCBSHP Silver Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J3U","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410032","BCBSHP Silver Pathway X HMO 5300","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410032-03","BCBSHP Silver Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.05%","0.681053443484059","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3Q","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410032","BCBSHP Silver Pathway X HMO 5300","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410032-04","BCBSHP Silver Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.06%","0.72138353856223","Yes","Yes","Yes","60%","40%","$2,580","$0","$2,320","$60","$2,882","$465","$1,553","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","25.00%","$3,800","$3800 per person","$7600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3R","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410032","BCBSHP Silver Pathway X HMO 5300","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410032-05","BCBSHP Silver Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.07%","0.86122863395874","Yes","Yes","Yes","60%","40%","$900","$0","$700","$60","$900","$165","$535","$55","$900","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","25.00%","$900","$900 per person","$1800 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3S","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410032","BCBSHP Silver Pathway X HMO 5300","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410032-06","BCBSHP Silver Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.01%","0.930635411813134","Yes","Yes","Yes","60%","40%","$134","$0","$566","$60","$250","$85","$365","$55","$250","$0","$450","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J3T","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410085","BCBSHP Silver Pathway X HMO 4950","49046GA041",,"GAN001","GAS023","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410085-00","BCBSHP Silver Pathway HMO 4950","Standard Silver Off Exchange Plan","68.33%","0.684453072990548","Yes","Yes","Yes","60%","40%","$2,236","$0","$4,264","$60","$3,537","$590","$2,180","$55","$1,251","$0","$674","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","35.00%","$4,950","$4950 per person","$9900 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VY3","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410085","BCBSHP Silver Pathway X HMO 4950","49046GA041",,"GAN001","GAS023","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410085-01","BCBSHP Silver Pathway X HMO 4950","Standard Silver On Exchange Plan","68.33%","0.684453072990548","Yes","Yes","Yes","60%","40%","$2,236","$0","$4,264","$60","$3,537","$590","$2,180","$55","$1,251","$0","$674","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","35.00%","$4,950","$4950 per person","$9900 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VY4","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410085","BCBSHP Silver Pathway X HMO 4950","49046GA041",,"GAN001","GAS023","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410085-02","BCBSHP Silver Pathway X HMO 4950 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VY5","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410085","BCBSHP Silver Pathway X HMO 4950","49046GA041",,"GAN001","GAS023","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410085-03","BCBSHP Silver Pathway X HMO 4950","Limited Cost Sharing Plan Variation","68.33%","0.684453072990548","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","35.00%","$4,950","$4950 per person","$9900 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VY4","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410085","BCBSHP Silver Pathway X HMO 4950","49046GA041",,"GAN001","GAS023","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410085-04","BCBSHP Silver Pathway X HMO 4950 S04","73% AV Level Silver Plan","72.03%","0.721351421695498","Yes","Yes","Yes","60%","40%","$2,236","$0","$2,764","$60","$2,802","$465","$1,733","$55","$1,251","$0","$674","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group","35.00%","$3,650","$3650 per person","$7300 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VY6","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410085","BCBSHP Silver Pathway X HMO 4950","49046GA041",,"GAN001","GAS023","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410085-05","BCBSHP Silver Pathway X HMO 4950 S05","87% AV Level Silver Plan","86.05%","0.862109597042889","Yes","Yes","Yes","60%","40%","$700","$0","$900","$60","$860","$135","$605","$55","$900","$0","$674","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","35.00%","$900","$900 per person","$1800 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VY7","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410085","BCBSHP Silver Pathway X HMO 4950","49046GA041",,"GAN001","GAS023","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410085-06","BCBSHP Silver Pathway X HMO 4950 S06","94% AV Level Silver Plan","93.15%","0.932259745850352","Yes","Yes","Yes","60%","40%","$116","$0","$534","$60","$250","$115","$285","$55","$250","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","$650","$650 per person","$1300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","35.00%","$250","$250 per person","$500 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VY8","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410088","BCBSHP Silver Pathway X HMO 6000","49046GA041",,"GAN001","GAS023","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410088-00","BCBSHP Silver Pathway HMO 6000","Standard Silver Off Exchange Plan","66.10%","0.661783823260697","Yes","Yes","Yes","60%","40%","$2,408","$0","$4,942","$60","$3,643","$630","$2,073","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%","$6,000","$6000 per person","$12000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VYM","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410088","BCBSHP Silver Pathway X HMO 6000","49046GA041",,"GAN001","GAS023","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410088-01","BCBSHP Silver Pathway X HMO 6000","Standard Silver On Exchange Plan","66.10%","0.661783823260697","Yes","Yes","Yes","60%","40%","$2,408","$0","$4,942","$60","$3,643","$630","$2,073","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%","$6,000","$6000 per person","$12000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VYN","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410088","BCBSHP Silver Pathway X HMO 6000","49046GA041",,"GAN001","GAS023","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410088-03","BCBSHP Silver Pathway X HMO 6000","Limited Cost Sharing Plan Variation","66.10%","0.661783823260697","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%","$6,000","$6000 per person","$12000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VYN","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410088","BCBSHP Silver Pathway X HMO 6000","49046GA041",,"GAN001","GAS023","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410088-04","BCBSHP Silver Pathway X HMO 6000 S04","73% AV Level Silver Plan","72.03%","0.723012049546562","Yes","Yes","Yes","60%","40%","$2,408","$0","$2,592","$60","$2,857","$500","$1,643","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","30.00%","$3,400","$3400 per person","$6800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VYQ","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410088","BCBSHP Silver Pathway X HMO 6000","49046GA041",,"GAN001","GAS023","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410088-05","BCBSHP Silver Pathway X HMO 6000 S05","87% AV Level Silver Plan","86.05%","0.861784003401523","Yes","Yes","Yes","60%","40%","$828","$0","$772","$60","$929","$105","$566","$55","$1,000","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30.00%","$1,000","$1000 per person","$2000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VYR","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410088","BCBSHP Silver Pathway X HMO 6000","49046GA041",,"GAN001","GAS023","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410088-06","BCBSHP Silver Pathway X HMO 6000 S06","94% AV Level Silver Plan","93.03%","0.93138720744803","Yes","Yes","Yes","60%","40%","$125","$0","$575","$60","$200","$85","$415","$55","$200","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VYS","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410071","BCBSHP Silver Pathway X Guided Access HMO 3150","49046GA041",,"GAN002","GAS019","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410071-00","BCBSHP Silver Pathway Guided Access HMO 3150","Standard Silver Off Exchange Plan","70.25%","0.710142452593873","No","Yes","Yes","60%","40%","$2,580","$0","$3,170","$60","$2,601","$315","$1,966","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,150","$3150 per person","$6300 per group","25.00%","$3,150","$3150 per person","$6300 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J40","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410071","BCBSHP Silver Pathway X Guided Access HMO 3150","49046GA041",,"GAN002","GAS019","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410071-01","BCBSHP Silver Pathway X Guided Access HMO 3150","Standard Silver On Exchange Plan","70.25%","0.710142452593873","No","Yes","Yes","60%","40%","$2,580","$0","$3,170","$60","$2,601","$315","$1,966","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,150","$3150 per person","$6300 per group","25.00%","$3,150","$3150 per person","$6300 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3W","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410071","BCBSHP Silver Pathway X Guided Access HMO 3150","49046GA041",,"GAN002","GAS019","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410071-02","BCBSHP Silver Pathway X Guided Access HMO 3150 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J41","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410073","BCBSHP Silver Pathway X Guided Access HMO 3150","49046GA041",,"GAN002","GAS021","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410073-03","BCBSHP Silver Pathway X Guided Access HMO 3150","Limited Cost Sharing Plan Variation","70.25%","0.710142452593873","No","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,150","$3150 per person","$6300 per group","25.00%","$3,150","$3150 per person","$6300 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3W","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410073","BCBSHP Silver Pathway X Guided Access HMO 3150","49046GA041",,"GAN002","GAS021","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410073-04","BCBSHP Silver Pathway X Guided Access HMO 3150 S04","73% AV Level Silver Plan","73.62%","0.741868526869928","No","Yes","Yes","60%","40%","$2,250","$0","$2,500","$60","$2,491","$305","$1,954","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3X","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410073","BCBSHP Silver Pathway X Guided Access HMO 3150","49046GA041",,"GAN002","GAS021","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410073-05","BCBSHP Silver Pathway X Guided Access HMO 3150 S05","87% AV Level Silver Plan","86.33%","0.865353345281902","No","Yes","Yes","60%","40%","$750","$0","$900","$60","$920","$80","$650","$55","$750","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3Y","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410071","BCBSHP Silver Pathway X Guided Access HMO 3150","49046GA041",,"GAN002","GAS019","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410071-03","BCBSHP Silver Pathway X Guided Access HMO 3150","Limited Cost Sharing Plan Variation","70.25%","0.710142452593873","No","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,150","$3150 per person","$6300 per group","25.00%","$3,150","$3150 per person","$6300 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3W","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410071","BCBSHP Silver Pathway X Guided Access HMO 3150","49046GA041",,"GAN002","GAS019","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410071-04","BCBSHP Silver Pathway X Guided Access HMO 3150 S04","73% AV Level Silver Plan","73.62%","0.741868526869928","No","Yes","Yes","60%","40%","$2,250","$0","$2,500","$60","$2,491","$305","$1,954","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25.00%","$2,250","$2250 per person","$4500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3X","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410071","BCBSHP Silver Pathway X Guided Access HMO 3150","49046GA041",,"GAN002","GAS019","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410071-05","BCBSHP Silver Pathway X Guided Access HMO 3150 S05","87% AV Level Silver Plan","86.33%","0.865353345281902","No","Yes","Yes","60%","40%","$750","$0","$900","$60","$920","$80","$650","$55","$750","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3Y","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410071","BCBSHP Silver Pathway X Guided Access HMO 3150","49046GA041",,"GAN002","GAS019","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410071-06","BCBSHP Silver Pathway X Guided Access HMO 3150 S06","94% AV Level Silver Plan","93.75%","0.937845632145673","No","Yes","Yes","60%","40%","$134","$0","$466","$60","$350","$50","$200","$55","$250","$0","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3Z","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410073","BCBSHP Silver Pathway X Guided Access HMO 3150","49046GA041",,"GAN002","GAS021","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410073-00","BCBSHP Silver Pathway Guided Access HMO 3150","Standard Silver Off Exchange Plan","70.25%","0.710142452593873","No","Yes","Yes","60%","40%","$2,580","$0","$3,170","$60","$2,601","$315","$1,966","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,150","$3150 per person","$6300 per group","25.00%","$3,150","$3150 per person","$6300 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J40","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410073","BCBSHP Silver Pathway X Guided Access HMO 3150","49046GA041",,"GAN002","GAS021","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410073-01","BCBSHP Silver Pathway X Guided Access HMO 3150","Standard Silver On Exchange Plan","70.25%","0.710142452593873","No","Yes","Yes","60%","40%","$2,580","$0","$3,170","$60","$2,601","$315","$1,966","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,150","$3150 per person","$6300 per group","25.00%","$3,150","$3150 per person","$6300 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3W","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410073","BCBSHP Silver Pathway X Guided Access HMO 3150","49046GA041",,"GAN002","GAS021","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410073-02","BCBSHP Silver Pathway X Guided Access HMO 3150 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J41","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410073","BCBSHP Silver Pathway X Guided Access HMO 3150","49046GA041",,"GAN002","GAS021","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410073-06","BCBSHP Silver Pathway X Guided Access HMO 3150 S06","94% AV Level Silver Plan","93.75%","0.937845632145673","No","Yes","Yes","60%","40%","$134","$0","$466","$60","$350","$50","$200","$55","$250","$0","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2J3Z","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410104","BCBSHP Silver Pathway X Guided Access HMO 4950","49046GA041",,"GAN002","GAS019","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410104-00","BCBSHP Silver Pathway Guided Access HMO 4950","Standard Silver Off Exchange Plan","68.33%","0.684453072990548","Yes","Yes","Yes","60%","40%","$2,236","$0","$4,264","$60","$3,537","$590","$2,180","$55","$1,251","$0","$674","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","35.00%","$4,950","$4950 per person","$9900 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VY9","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410104","BCBSHP Silver Pathway X Guided Access HMO 4950","49046GA041",,"GAN002","GAS019","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410104-01","BCBSHP Silver Pathway X Guided Access HMO 4950","Standard Silver On Exchange Plan","68.33%","0.684453072990548","Yes","Yes","Yes","60%","40%","$2,236","$0","$4,264","$60","$3,537","$590","$2,180","$55","$1,251","$0","$674","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","35.00%","$4,950","$4950 per person","$9900 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VYA","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410104","BCBSHP Silver Pathway X Guided Access HMO 4950","49046GA041",,"GAN002","GAS019","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410104-02","BCBSHP Silver Pathway X Guided Access HMO 4950 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VYB","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410104","BCBSHP Silver Pathway X Guided Access HMO 4950","49046GA041",,"GAN002","GAS019","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410104-03","BCBSHP Silver Pathway X Guided Access HMO 4950","Limited Cost Sharing Plan Variation","68.33%","0.684453072990548","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","35.00%","$4,950","$4950 per person","$9900 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VYA","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410104","BCBSHP Silver Pathway X Guided Access HMO 4950","49046GA041",,"GAN002","GAS019","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410104-04","BCBSHP Silver Pathway X Guided Access HMO 4950 S04","73% AV Level Silver Plan","72.03%","0.721351421695498","Yes","Yes","Yes","60%","40%","$2,236","$0","$2,764","$60","$2,802","$465","$1,733","$55","$1,251","$0","$674","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group","35.00%","$3,650","$3650 per person","$7300 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VYC","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410104","BCBSHP Silver Pathway X Guided Access HMO 4950","49046GA041",,"GAN002","GAS019","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410104-05","BCBSHP Silver Pathway X Guided Access HMO 4950 S05","87% AV Level Silver Plan","86.05%","0.862109597042889","Yes","Yes","Yes","60%","40%","$700","$0","$900","$60","$860","$135","$605","$55","$900","$0","$674","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","35.00%","$900","$900 per person","$1800 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VYD","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410104","BCBSHP Silver Pathway X Guided Access HMO 4950","49046GA041",,"GAN002","GAS019","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410104-06","BCBSHP Silver Pathway X Guided Access HMO 4950 S06","94% AV Level Silver Plan","93.15%","0.932259745850352","Yes","Yes","Yes","60%","40%","$116","$0","$534","$60","$250","$115","$285","$55","$250","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","$650","$650 per person","$1300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","35.00%","$250","$250 per person","$500 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VYE","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410106","BCBSHP Silver Pathway X Guided Access HMO 4950","49046GA041",,"GAN002","GAS021","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410106-00","BCBSHP Silver Pathway Guided Access HMO 4950","Standard Silver Off Exchange Plan","68.33%","0.684453072990548","Yes","Yes","Yes","60%","40%","$2,236","$0","$4,264","$60","$3,537","$590","$2,180","$55","$1,251","$0","$674","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","35.00%","$4,950","$4950 per person","$9900 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VY9","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410106","BCBSHP Silver Pathway X Guided Access HMO 4950","49046GA041",,"GAN002","GAS021","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410106-01","BCBSHP Silver Pathway X Guided Access HMO 4950","Standard Silver On Exchange Plan","68.33%","0.684453072990548","Yes","Yes","Yes","60%","40%","$2,236","$0","$4,264","$60","$3,537","$590","$2,180","$55","$1,251","$0","$674","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","35.00%","$4,950","$4950 per person","$9900 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VYA","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410106","BCBSHP Silver Pathway X Guided Access HMO 4950","49046GA041",,"GAN002","GAS021","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410106-02","BCBSHP Silver Pathway X Guided Access HMO 4950 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VYB","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410106","BCBSHP Silver Pathway X Guided Access HMO 4950","49046GA041",,"GAN002","GAS021","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410106-03","BCBSHP Silver Pathway X Guided Access HMO 4950","Limited Cost Sharing Plan Variation","68.33%","0.684453072990548","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","35.00%","$4,950","$4950 per person","$9900 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VYA","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410106","BCBSHP Silver Pathway X Guided Access HMO 4950","49046GA041",,"GAN002","GAS021","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410106-04","BCBSHP Silver Pathway X Guided Access HMO 4950 S04","73% AV Level Silver Plan","72.03%","0.721351421695498","Yes","Yes","Yes","60%","40%","$2,236","$0","$2,764","$60","$2,802","$465","$1,733","$55","$1,251","$0","$674","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group","35.00%","$3,650","$3650 per person","$7300 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VYC","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410106","BCBSHP Silver Pathway X Guided Access HMO 4950","49046GA041",,"GAN002","GAS021","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410106-05","BCBSHP Silver Pathway X Guided Access HMO 4950 S05","87% AV Level Silver Plan","86.05%","0.862109597042889","Yes","Yes","Yes","60%","40%","$700","$0","$900","$60","$860","$135","$605","$55","$900","$0","$674","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","35.00%","$900","$900 per person","$1800 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VYD","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410106","BCBSHP Silver Pathway X Guided Access HMO 4950","49046GA041",,"GAN002","GAS021","GAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410106-06","BCBSHP Silver Pathway X Guided Access HMO 4950 S06","94% AV Level Silver Plan","93.15%","0.932259745850352","Yes","Yes","Yes","60%","40%","$116","$0","$534","$60","$250","$115","$285","$55","$250","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","$650","$650 per person","$1300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","35.00%","$250","$250 per person","$500 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VYE","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410109","BCBSHP Silver Pathway X Guided Access HMO 6000","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410109-00","BCBSHP Silver Pathway Guided Access HMO 6000","Standard Silver Off Exchange Plan","66.10%","0.661783823260697","Yes","Yes","Yes","60%","40%","$2,408","$0","$4,942","$0","$3,643","$630","$2,073","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%","$6,000","$6000 per person","$12000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZJ","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410109","BCBSHP Silver Pathway X Guided Access HMO 6000","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410109-01","BCBSHP Silver Pathway X Guided Access HMO 6000","Standard Silver On Exchange Plan","66.10%","0.661783823260697","Yes","Yes","Yes","60%","40%","$2,408","$0","$4,942","$0","$3,643","$630","$2,073","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%","$6,000","$6000 per person","$12000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZK","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410109","BCBSHP Silver Pathway X Guided Access HMO 6000","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410109-02","BCBSHP Silver Pathway X Guided Access HMO 6000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VZL","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410109","BCBSHP Silver Pathway X Guided Access HMO 6000","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410109-03","BCBSHP Silver Pathway X Guided Access HMO 6000","Limited Cost Sharing Plan Variation","66.10%","0.661783823260697","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%","$6,000","$6000 per person","$12000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZK","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410109","BCBSHP Silver Pathway X Guided Access HMO 6000","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410109-04","BCBSHP Silver Pathway X Guided Access HMO 6000 S04","73% AV Level Silver Plan","72.03%","0.723012049546562","Yes","Yes","Yes","60%","40%","$2,408","$0","$2,592","$0","$2,857","$500","$1,643","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","30.00%","$3,400","$3400 per person","$6800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZM","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410109","BCBSHP Silver Pathway X Guided Access HMO 6000","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410109-05","BCBSHP Silver Pathway X Guided Access HMO 6000 S05","87% AV Level Silver Plan","86.05%","0.861784003401523","Yes","Yes","Yes","60%","40%","$828","$0","$772","$0","$929","$105","$566","$55","$1,000","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30.00%","$1,000","$1000 per person","$2000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZN","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410109","BCBSHP Silver Pathway X Guided Access HMO 6000","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410109-06","BCBSHP Silver Pathway X Guided Access HMO 6000 S06","94% AV Level Silver Plan","93.03%","0.93138720744803","Yes","Yes","Yes","60%","40%","$125","$0","$575","$0","$200","$85","$415","$55","$200","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZP","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410111","BCBSHP Silver Pathway X Guided Access HMO 6000","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410111-00","BCBSHP Silver Pathway Guided Access HMO 6000","Standard Silver Off Exchange Plan","66.10%","0.661783823260697","Yes","Yes","Yes","60%","40%","$2,408","$0","$4,942","$0","$3,643","$630","$2,073","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%","$6,000","$6000 per person","$12000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZJ","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410111","BCBSHP Silver Pathway X Guided Access HMO 6000","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410111-01","BCBSHP Silver Pathway X Guided Access HMO 6000","Standard Silver On Exchange Plan","66.10%","0.661783823260697","Yes","Yes","Yes","60%","40%","$2,408","$0","$4,942","$0","$3,643","$630","$2,073","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%","$6,000","$6000 per person","$12000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZK","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410111","BCBSHP Silver Pathway X Guided Access HMO 6000","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410111-02","BCBSHP Silver Pathway X Guided Access HMO 6000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VZL","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410111","BCBSHP Silver Pathway X Guided Access HMO 6000","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410111-03","BCBSHP Silver Pathway X Guided Access HMO 6000","Limited Cost Sharing Plan Variation","66.10%","0.661783823260697","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%","$6,000","$6000 per person","$12000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZK","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410111","BCBSHP Silver Pathway X Guided Access HMO 6000","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410111-04","BCBSHP Silver Pathway X Guided Access HMO 6000 S04","73% AV Level Silver Plan","72.03%","0.723012049546562","Yes","Yes","Yes","60%","40%","$2,408","$0","$2,592","$0","$2,857","$500","$1,643","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","30.00%","$3,400","$3400 per person","$6800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZM","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410111","BCBSHP Silver Pathway X Guided Access HMO 6000","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410111-05","BCBSHP Silver Pathway X Guided Access HMO 6000 S05","87% AV Level Silver Plan","86.05%","0.861784003401523","Yes","Yes","Yes","60%","40%","$828","$0","$772","$0","$929","$105","$566","$55","$1,000","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30.00%","$1,000","$1000 per person","$2000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZN","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410111","BCBSHP Silver Pathway X Guided Access HMO 6000","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410111-06","BCBSHP Silver Pathway X Guided Access HMO 6000 S06","94% AV Level Silver Plan","93.03%","0.93138720744803","Yes","Yes","Yes","60%","40%","$125","$0","$575","$0","$200","$85","$415","$55","$200","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZP","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410079","BCBSHP Silver Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS019","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410079-00","BCBSHP Silver Pathway Guided Access HMO 5300","Standard Silver Off Exchange Plan","68.05%","0.681053443484059","Yes","Yes","Yes","60%","40%","$2,580","$0","$3,920","$60","$3,750","$590","$1,966","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J47","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410079","BCBSHP Silver Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS019","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410079-01","BCBSHP Silver Pathway X Guided Access HMO 5300","Standard Silver On Exchange Plan","68.05%","0.681053443484059","Yes","Yes","Yes","60%","40%","$2,580","$0","$3,920","$60","$3,750","$590","$1,966","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J42","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410079","BCBSHP Silver Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS019","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410079-02","BCBSHP Silver Pathway X Guided Access HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J46","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410079","BCBSHP Silver Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS019","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410079-03","BCBSHP Silver Pathway X Guided Access HMO 5300","Limited Cost Sharing Plan Variation","68.05%","0.681053443484059","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J42","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410079","BCBSHP Silver Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS019","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410079-04","BCBSHP Silver Pathway X Guided Access HMO 5300 S04","73% AV Level Silver Plan","72.06%","0.72138353856223","Yes","Yes","Yes","60%","40%","$2,580","$0","$2,320","$60","$2,882","$465","$1,553","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","25.00%","$3,800","$3800 per person","$7600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J43","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410079","BCBSHP Silver Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS019","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410079-05","BCBSHP Silver Pathway X Guided Access HMO 5300 S05","87% AV Level Silver Plan","86.07%","0.86122863395874","Yes","Yes","Yes","60%","40%","$900","$0","$700","$60","$900","$165","$535","$55","$900","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","25.00%","$900","$900 per person","$1800 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J44","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410079","BCBSHP Silver Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS019","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410079-06","BCBSHP Silver Pathway X Guided Access HMO 5300 S06","94% AV Level Silver Plan","93.01%","0.930635411813134","Yes","Yes","Yes","60%","40%","$134","$0","$566","$60","$250","$85","$365","$55","$250","$0","$450","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J45","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410081","BCBSHP Silver Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS021","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410081-00","BCBSHP Silver Pathway Guided Access HMO 5300","Standard Silver Off Exchange Plan","68.05%","0.681053443484059","Yes","Yes","Yes","60%","40%","$2,580","$0","$3,920","$60","$3,750","$590","$1,966","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J47","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410081","BCBSHP Silver Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS021","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410081-01","BCBSHP Silver Pathway X Guided Access HMO 5300","Standard Silver On Exchange Plan","68.05%","0.681053443484059","Yes","Yes","Yes","60%","40%","$2,580","$0","$3,920","$60","$3,750","$590","$1,966","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J42","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410081","BCBSHP Silver Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS021","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410081-02","BCBSHP Silver Pathway X Guided Access HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J46","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410081","BCBSHP Silver Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS021","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410081-03","BCBSHP Silver Pathway X Guided Access HMO 5300","Limited Cost Sharing Plan Variation","68.05%","0.681053443484059","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J42","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410047","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS019","GAF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410047-00","BCBSHP Bronze Pathway Guided Access HMO 5200","Standard Bronze Off Exchange Plan","59.97%","0.61110828665638","Yes","Yes","Yes","60%","40%","$2,752","$0","$4,598","$60","$5,031","$0","$2,153","$55","$1,540","$0","$385","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4A","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410047","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS019","GAF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410047-01","BCBSHP Bronze Pathway X Guided Access HMO 5200","Standard Bronze On Exchange Plan","59.97%","0.61110828665638","Yes","Yes","Yes","60%","40%","$2,752","$0","$4,598","$60","$5,031","$0","$2,153","$55","$1,540","$0","$385","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J48","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410047","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS019","GAF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410047-02","BCBSHP Bronze Pathway X Guided Access HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J49","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410047","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS019","GAF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410047-03","BCBSHP Bronze Pathway X Guided Access HMO 5200","Limited Cost Sharing Plan Variation","59.97%","0.61110828665638","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J48","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410049","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS021","GAF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410049-00","BCBSHP Bronze Pathway Guided Access HMO 5200","Standard Bronze Off Exchange Plan","59.97%","0.61110828665638","Yes","Yes","Yes","60%","40%","$2,752","$0","$4,598","$60","$5,031","$0","$2,153","$55","$1,540","$0","$385","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4A","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410049","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS021","GAF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410049-01","BCBSHP Bronze Pathway X Guided Access HMO 5200","Standard Bronze On Exchange Plan","59.97%","0.61110828665638","Yes","Yes","Yes","60%","40%","$2,752","$0","$4,598","$60","$5,031","$0","$2,153","$55","$1,540","$0","$385","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J48","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410049","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS021","GAF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410049-02","BCBSHP Bronze Pathway X Guided Access HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J49","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410081","BCBSHP Silver Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS021","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410081-04","BCBSHP Silver Pathway X Guided Access HMO 5300 S04","73% AV Level Silver Plan","72.06%","0.72138353856223","Yes","Yes","Yes","60%","40%","$2,580","$0","$2,320","$60","$2,882","$465","$1,553","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","25.00%","$3,800","$3800 per person","$7600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J43","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410041","BCBSHP Catastrophic Pathway X Guided Access HMO 7350","49046GA041",,"GAN002","GAS021","GAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410041-00","BCBSHP Catastrophic Pathway Guided Access HMO 7350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","60%","40%","$7,350","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%","$7,350","$7350 per person","$14700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4F","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410041","BCBSHP Catastrophic Pathway X Guided Access HMO 7350","49046GA041",,"GAN002","GAS021","GAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410041-01","BCBSHP Catastrophic Pathway X Guided Access HMO 7350","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","60%","40%","$7,350","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%","$7,350","$7350 per person","$14700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4E","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 2900","49046GA041",,"GAN001","GAS023","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-00","BCBSHP Silver Pathway HMO 2900","Standard Silver Off Exchange Plan","69.72%","0.717751560204746","No","Yes","Yes","60%","40%","$3,000","$0","$4,350","$60","$3,000","$310","$1,725","$55","$1,733","$0","$193","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","25.00%","$2,900","$2900 per person","$5800 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6V","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 2900","49046GA041",,"GAN001","GAS023","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-01","BCBSHP Silver Pathway X HMO 2900","Standard Silver On Exchange Plan","69.72%","0.717751560204746","No","Yes","Yes","60%","40%","$3,000","$0","$4,350","$60","$3,000","$310","$1,725","$55","$1,733","$0","$193","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","25.00%","$2,900","$2900 per person","$5800 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6R","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410081","BCBSHP Silver Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS021","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410081-05","BCBSHP Silver Pathway X Guided Access HMO 5300 S05","87% AV Level Silver Plan","86.07%","0.86122863395874","Yes","Yes","Yes","60%","40%","$900","$0","$700","$60","$900","$165","$535","$55","$900","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","25.00%","$900","$900 per person","$1800 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J44","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410081","BCBSHP Silver Pathway X Guided Access HMO 5300","49046GA041",,"GAN002","GAS021","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410081-06","BCBSHP Silver Pathway X Guided Access HMO 5300 S06","94% AV Level Silver Plan","93.01%","0.930635411813134","Yes","Yes","Yes","60%","40%","$134","$0","$566","$60","$250","$85","$365","$55","$250","$0","$450","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J45","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410017","BCBSHP Bronze Pathway X HMO 5200","49046GA041",,"GAN001","GAS023","GAF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410017-00","BCBSHP Bronze Pathway HMO 5200","Standard Bronze Off Exchange Plan","59.97%","0.61110828665638","Yes","Yes","Yes","60%","40%","$2,752","$0","$4,598","$60","$5,031","$0","$2,153","$55","$1,540","$0","$385","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5K","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410017","BCBSHP Bronze Pathway X HMO 5200","49046GA041",,"GAN001","GAS023","GAF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410017-01","BCBSHP Bronze Pathway X HMO 5200","Standard Bronze On Exchange Plan","59.97%","0.61110828665638","Yes","Yes","Yes","60%","40%","$2,752","$0","$4,598","$60","$5,031","$0","$2,153","$55","$1,540","$0","$385","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5H","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410017","BCBSHP Bronze Pathway X HMO 5200","49046GA041",,"GAN001","GAS023","GAF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410017-02","BCBSHP Bronze Pathway X HMO 5200 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G5J","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410017","BCBSHP Bronze Pathway X HMO 5200","49046GA041",,"GAN001","GAS023","GAF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410017-03","BCBSHP Bronze Pathway X HMO 5200","Limited Cost Sharing Plan Variation","59.97%","0.61110828665638","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5H","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410022","BCBSHP Bronze Pathway X HMO 5500","49046GA041",,"GAN001","GAS023","GAF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410022-00","BCBSHP Bronze Pathway HMO 5500","Standard Bronze Off Exchange Plan","59.10%","0.601274662814457","Yes","Yes","Yes","60%","40%","$2,064","$0","$5,286","$60","$4,310","$0","$2,874","$55","$1,155","$0","$770","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6J","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410022","BCBSHP Bronze Pathway X HMO 5500","49046GA041",,"GAN001","GAS023","GAF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410022-01","BCBSHP Bronze Pathway X HMO 5500","Standard Bronze On Exchange Plan","59.10%","0.601274662814457","Yes","Yes","Yes","60%","40%","$2,064","$0","$5,286","$60","$4,310","$0","$2,874","$55","$1,155","$0","$770","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6G","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410022","BCBSHP Bronze Pathway X HMO 5500","49046GA041",,"GAN001","GAS023","GAF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410022-02","BCBSHP Bronze Pathway X HMO 5500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G6H","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410022","BCBSHP Bronze Pathway X HMO 5500","49046GA041",,"GAN001","GAS023","GAF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410022-03","BCBSHP Bronze Pathway X HMO 5500","Limited Cost Sharing Plan Variation","59.10%","0.601274662814457","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6G","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410049","BCBSHP Bronze Pathway X Guided Access HMO 5200","49046GA041",,"GAN002","GAS021","GAF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410049-03","BCBSHP Bronze Pathway X Guided Access HMO 5200","Limited Cost Sharing Plan Variation","59.97%","0.61110828665638","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20.00%","$5,200","$5200 per person","$10400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J48","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410063","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS019","GAF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410063-00","BCBSHP Bronze Pathway Guided Access HMO 5500","Standard Bronze Off Exchange Plan","59.10%","0.601274662814457","Yes","Yes","Yes","60%","40%","$2,064","$0","$5,286","$60","$4,310","$0","$2,874","$55","$1,155","$0","$770","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4D","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410063","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS019","GAF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410063-01","BCBSHP Bronze Pathway X Guided Access HMO 5500","Standard Bronze On Exchange Plan","59.10%","0.601274662814457","Yes","Yes","Yes","60%","40%","$2,064","$0","$5,286","$60","$4,310","$0","$2,874","$55","$1,155","$0","$770","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4B","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410063","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS019","GAF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410063-02","BCBSHP Bronze Pathway X Guided Access HMO 5500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4C","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410063","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS019","GAF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410063-03","BCBSHP Bronze Pathway X Guided Access HMO 5500","Limited Cost Sharing Plan Variation","59.10%","0.601274662814457","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4B","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410065","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS021","GAF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410065-00","BCBSHP Bronze Pathway Guided Access HMO 5500","Standard Bronze Off Exchange Plan","59.10%","0.601274662814457","Yes","Yes","Yes","60%","40%","$2,064","$0","$5,286","$60","$4,310","$0","$2,874","$55","$1,155","$0","$770","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4D","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410055","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS019","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410055-04","BCBSHP Silver Pathway X Guided Access HMO 3000 S04","73% AV Level Silver Plan","72.08%","0.736922610304511","Yes","Yes","Yes","60%","40%","$2,500","$0","$2,600","$60","$2,500","$310","$1,725","$55","$1,733","$0","$193","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4H","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410055","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS019","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410055-05","BCBSHP Silver Pathway X Guided Access HMO 3000 S05","87% AV Level Silver Plan","86.13%","0.874084789839342","Yes","Yes","Yes","60%","40%","$700","$0","$900","$60","$700","$130","$770","$55","$700","$0","$193","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","10.00%","$700","$700 per person","$1400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4J","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410065","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS021","GAF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410065-01","BCBSHP Bronze Pathway X Guided Access HMO 5500","Standard Bronze On Exchange Plan","59.10%","0.601274662814457","Yes","Yes","Yes","60%","40%","$2,064","$0","$5,286","$60","$4,310","$0","$2,874","$55","$1,155","$0","$770","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4B","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410065","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS021","GAF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410065-02","BCBSHP Bronze Pathway X Guided Access HMO 5500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4C","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410065","BCBSHP Bronze Pathway X Guided Access HMO 5500","49046GA041",,"GAN002","GAS021","GAF007","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410065-03","BCBSHP Bronze Pathway X Guided Access HMO 5500","Limited Cost Sharing Plan Variation","59.10%","0.601274662814457","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%","$5,500","$5500 per person","$11000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4B","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410014","BCBSHP Catastrophic Pathway X HMO 7350","49046GA041",,"GAN001","GAS023","GAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410014-00","BCBSHP Catastrophic Pathway HMO 7350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","60%","40%","$7,350","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%","$7,350","$7350 per person","$14700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5A","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410014","BCBSHP Catastrophic Pathway X HMO 7350","49046GA041",,"GAN001","GAS023","GAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410014-01","BCBSHP Catastrophic Pathway X HMO 7350","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","60%","40%","$7,350","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%","$7,350","$7350 per person","$14700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G59","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410039","BCBSHP Catastrophic Pathway X Guided Access HMO 7350","49046GA041",,"GAN002","GAS019","GAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410039-00","BCBSHP Catastrophic Pathway Guided Access HMO 7350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","60%","40%","$7,350","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%","$7,350","$7350 per person","$14700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4F","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410039","BCBSHP Catastrophic Pathway X Guided Access HMO 7350","49046GA041",,"GAN002","GAS019","GAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410039-01","BCBSHP Catastrophic Pathway X Guided Access HMO 7350","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","60%","40%","$7,350","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%","$7,350","$7350 per person","$14700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4E","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 2900","49046GA041",,"GAN001","GAS023","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-02","BCBSHP Silver Pathway X HMO 2900 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6W","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 2900","49046GA041",,"GAN001","GAS023","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-03","BCBSHP Silver Pathway X HMO 2900","Limited Cost Sharing Plan Variation","69.72%","0.717751560204746","No","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","$4,850","$4850 per person","$9700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","25.00%","$2,900","$2900 per person","$5800 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6R","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 2900","49046GA041",,"GAN001","GAS023","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-04","BCBSHP Silver Pathway X HMO 2900 S04","73% AV Level Silver Plan","72.81%","0.746574094941992","No","Yes","Yes","60%","40%","$2,500","$0","$2,600","$60","$2,500","$310","$1,725","$55","$1,733","$0","$193","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","$4,600","$4600 per person","$9200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","25.00%","$1,700","$1700 per person","$3400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6S","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 2900","49046GA041",,"GAN001","GAS023","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-05","BCBSHP Silver Pathway X HMO 2900 S05","87% AV Level Silver Plan","86.24%","0.872354627495494","No","Yes","Yes","60%","40%","$700","$0","$900","$60","$700","$130","$770","$55","$700","$0","$193","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$1,400","$1400 per person","$2800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6T","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 2900","49046GA041",,"GAN001","GAS023","GAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-06","BCBSHP Silver Pathway X HMO 2900 S06","94% AV Level Silver Plan","93.38%","0.936198151891089","No","Yes","Yes","60%","40%","$250","$0","$400","$60","$250","$60","$340","$55","$250","$0","$193","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6U","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-00","BCBSHP Silver Pathway HMO 3000","Standard Silver Off Exchange Plan","68.08%","0.697396819433989","Yes","Yes","Yes","60%","40%","$2,580","$0","$2,270","$60","$2,977","$112","$1,761","$55","$1,444","$0","$481","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G63","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-01","BCBSHP Silver Pathway X HMO 3000","Standard Silver On Exchange Plan","68.08%","0.697396819433989","Yes","Yes","Yes","60%","40%","$2,580","$0","$2,270","$60","$2,977","$112","$1,761","$55","$1,444","$0","$481","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5Y","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-02","BCBSHP Silver Pathway X HMO 3000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G62","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-03","BCBSHP Silver Pathway X HMO 3000","Limited Cost Sharing Plan Variation","68.08%","0.697396819433989","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5Y","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-04","BCBSHP Silver Pathway X HMO 3000 S04","73% AV Level Silver Plan","72.08%","0.736922610304511","Yes","Yes","Yes","60%","40%","$1,700","$0","$2,900","$60","$2,700","$125","$1,775","$55","$1,444","$0","$481","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5Z","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-05","BCBSHP Silver Pathway X HMO 3000 S05","87% AV Level Silver Plan","86.13%","0.874084789839342","Yes","Yes","Yes","60%","40%","$750","$0","$650","$60","$936","$20","$444","$55","$750","$0","$481","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","10.00%","$700","$700 per person","$1400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G60","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000","49046GA041",,"GAN001","GAS023","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-06","BCBSHP Silver Pathway X HMO 3000 S06","94% AV Level Silver Plan","93.22%","0.936280171487932","Yes","Yes","Yes","60%","40%","$134","$0","$466","$60","$350","$20","$230","$55","$250","$0","$350","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","$650","$650 per person","$1300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%","$250","$250 per person","$500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G61","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410055","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS019","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410055-00","BCBSHP Silver Pathway Guided Access HMO 3000","Standard Silver Off Exchange Plan","68.08%","0.697396819433989","Yes","Yes","Yes","60%","40%","$3,000","$0","$4,350","$60","$3,000","$310","$1,725","$55","$1,733","$0","$193","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4M","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410055","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS019","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410055-01","BCBSHP Silver Pathway X Guided Access HMO 3000","Standard Silver On Exchange Plan","68.08%","0.697396819433989","Yes","Yes","Yes","60%","40%","$3,000","$0","$4,350","$60","$3,000","$310","$1,725","$55","$1,733","$0","$193","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4G","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410055","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS019","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410055-02","BCBSHP Silver Pathway X Guided Access HMO 3000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4L","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410055","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS019","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410055-03","BCBSHP Silver Pathway X Guided Access HMO 3000","Limited Cost Sharing Plan Variation","68.08%","0.697396819433989","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4G","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410055","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS019","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410055-06","BCBSHP Silver Pathway X Guided Access HMO 3000 S06","94% AV Level Silver Plan","93.22%","0.936280171487932","Yes","Yes","Yes","60%","40%","$250","$0","$400","$60","$250","$60","$340","$55","$250","$0","$193","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","$650","$650 per person","$1300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%","$250","$250 per person","$500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4K","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410057","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS021","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410057-00","BCBSHP Silver Pathway Guided Access HMO 3000","Standard Silver Off Exchange Plan","68.08%","0.697396819433989","Yes","Yes","Yes","60%","40%","$3,000","$0","$4,350","$60","$3,000","$310","$1,725","$55","$1,733","$0","$193","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4M","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410057","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS021","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410057-01","BCBSHP Silver Pathway X Guided Access HMO 3000","Standard Silver On Exchange Plan","68.08%","0.697396819433989","Yes","Yes","Yes","60%","40%","$3,000","$0","$4,350","$60","$3,000","$310","$1,725","$55","$1,733","$0","$193","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4G","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410057","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS021","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410057-02","BCBSHP Silver Pathway X Guided Access HMO 3000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2J4L","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410057","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS021","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410057-03","BCBSHP Silver Pathway X Guided Access HMO 3000","Limited Cost Sharing Plan Variation","68.08%","0.697396819433989","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4G","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410057","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS021","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410057-04","BCBSHP Silver Pathway X Guided Access HMO 3000 S04","73% AV Level Silver Plan","72.08%","0.736922610304511","Yes","Yes","Yes","60%","40%","$2,500","$0","$2,600","$60","$2,500","$310","$1,725","$55","$1,733","$0","$193","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4H","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410057","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS021","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410057-05","BCBSHP Silver Pathway X Guided Access HMO 3000 S05","87% AV Level Silver Plan","86.13%","0.874084789839342","Yes","Yes","Yes","60%","40%","$700","$0","$900","$60","$700","$130","$770","$55","$700","$0","$193","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","10.00%","$700","$700 per person","$1400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4J","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","63940","HIOS","2017-08-05 02:21:19","Individual","Yes","13-5123390","63940GA0210002","Guardian Basics for Families and Individuals","63940GA021",,"GAN002","GAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","63940GA0210002-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/georgia/","https://dentalexchange.guardianlife.com/our-plans/georgia/"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410057","BCBSHP Silver Pathway X Guided Access HMO 3000","49046GA041",,"GAN002","GAS021","GAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410057-06","BCBSHP Silver Pathway X Guided Access HMO 3000 S06","94% AV Level Silver Plan","93.22%","0.936280171487932","Yes","Yes","Yes","60%","40%","$250","$0","$400","$60","$250","$60","$340","$55","$250","$0","$193","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","$650","$650 per person","$1300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%","$250","$250 per person","$500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2J4K","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410097","BCBSHP Gold Pathway X HMO 1300","49046GA041",,"GAN001","GAS023","GAF010","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410097-00","BCBSHP Gold Pathway HMO 1300","Standard Gold Off Exchange Plan","76.00%","0.768203667730601","Yes","Yes","Yes","60%","40%","$1,300","$100","$4,824","$60","$1,300","$670","$1,619","$55","$1,300","$180","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$3900 per group","10.00%","$1,300","$1300 per person","$3900 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZA","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410097","BCBSHP Gold Pathway X HMO 1300","49046GA041",,"GAN001","GAS023","GAF010","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410097-01","BCBSHP Gold Pathway X HMO 1300","Standard Gold On Exchange Plan","76.00%","0.768203667730601","Yes","Yes","Yes","60%","40%","$1,300","$100","$4,824","$60","$1,300","$670","$1,619","$55","$1,300","$180","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$3900 per group","10.00%","$1,300","$1300 per person","$3900 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZB","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410097","BCBSHP Gold Pathway X HMO 1300","49046GA041",,"GAN001","GAS023","GAF010","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410097-02","BCBSHP Gold Pathway X HMO 1300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VZC","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410097","BCBSHP Gold Pathway X HMO 1300","49046GA041",,"GAN001","GAS023","GAF010","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410097-03","BCBSHP Gold Pathway X HMO 1300","Limited Cost Sharing Plan Variation","76.00%","0.768203667730601","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$3900 per group","10.00%","$1,300","$1300 per person","$3900 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZB","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2018)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010002-04","Ambetter Balanced Care 1 (2018)","73% AV Level Silver Plan",,"0.739812128349422","Yes","Yes","No","100%",,"$3,000","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010002-04.pdf","https://api.centene.com/Brochures/2018/70893GA0010002-04.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2018)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010002-05","Ambetter Balanced Care 1 (2018)","87% AV Level Silver Plan",,"0.87931537568396","Yes","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$300","$400","$60","$750","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010002-05.pdf","https://api.centene.com/Brochures/2018/70893GA0010002-05.pdf"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410093","BCBSHP Gold Pathway X Guided Access HMO 1300","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410093-00","BCBSHP Gold Pathway Guided Access HMO 1300","Standard Gold Off Exchange Plan","76.00%","0.768203667730601","Yes","Yes","Yes","60%","40%","$1,300","$100","$4,824","$600","$1,300","$670","$1,619","$55","$1,300","$180","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$3900 per group","10.00%","$1,300","$1300 per person","$3900 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZ6","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410093","BCBSHP Gold Pathway X Guided Access HMO 1300","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410093-01","BCBSHP Gold Pathway X Guided Access HMO 1300","Standard Gold On Exchange Plan","76.00%","0.768203667730601","Yes","Yes","Yes","60%","40%","$1,300","$100","$4,824","$600","$1,300","$670","$1,619","$55","$1,300","$180","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$3900 per group","10.00%","$1,300","$1300 per person","$3900 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZ7","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410093","BCBSHP Gold Pathway X Guided Access HMO 1300","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410093-02","BCBSHP Gold Pathway X Guided Access HMO 1300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VZ8","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410093","BCBSHP Gold Pathway X Guided Access HMO 1300","49046GA041",,"GAN002","GAS019","GAF010","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410093-03","BCBSHP Gold Pathway X Guided Access HMO 1300","Limited Cost Sharing Plan Variation","76.00%","0.768203667730601","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$3900 per group","10.00%","$1,300","$1300 per person","$3900 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZ7","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410095","BCBSHP Gold Pathway X Guided Access HMO 1300","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410095-00","BCBSHP Gold Pathway Guided Access HMO 1300","Standard Gold Off Exchange Plan","76.00%","0.768203667730601","Yes","Yes","Yes","60%","40%","$1,300","$100","$4,824","$600","$1,300","$670","$1,619","$55","$1,300","$180","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$3900 per group","10.00%","$1,300","$1300 per person","$3900 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZ6","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410095","BCBSHP Gold Pathway X Guided Access HMO 1300","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410095-01","BCBSHP Gold Pathway X Guided Access HMO 1300","Standard Gold On Exchange Plan","76.00%","0.768203667730601","Yes","Yes","Yes","60%","40%","$1,300","$100","$4,824","$600","$1,300","$670","$1,619","$55","$1,300","$180","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$3900 per group","10.00%","$1,300","$1300 per person","$3900 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZ7","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410095","BCBSHP Gold Pathway X Guided Access HMO 1300","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410095-02","BCBSHP Gold Pathway X Guided Access HMO 1300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VZ8","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","49046","HIOS","2017-11-01 02:20:20","Individual","No","58-1638390","49046GA0410095","BCBSHP Gold Pathway X Guided Access HMO 1300","49046GA041",,"GAN002","GAS021","GAF010","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists require referral with the exception of Gynecologists, Dermatologists, and Ophthalmologists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410095-03","BCBSHP Gold Pathway X Guided Access HMO 1300","Limited Cost Sharing Plan Variation","76.00%","0.768203667730601","Yes","Yes","Yes","60%","40%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$3900 per group","10.00%","$1,300","$1300 per person","$3900 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VZ7","http://editiondigital.net/view/IU65/2018/ON_HIX_GA_KIT_2018"
"2018","GA","55612","HIOS","2017-08-04 02:20:25","SHOP (Small Group)","Yes","13-5581829","55612GA0160001","EHB Basic Dental Plan (Low)","55612GA016",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","55612GA0160001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","GA","63411","HIOS","2017-08-04 02:20:25","Individual","Yes","58-0469845","63411GA0510005","BCBSGA Dental Family Value","63411GA051",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","63411GA0510005-01","BCBSGA Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e215737.pdf",
"2018","GA","63411","HIOS","2017-08-04 02:20:25","SHOP (Small Group)","Yes","58-0469845","63411GA0540003","BCBSGA Dental Family","63411GA054",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","63411GA0540003-00","BCBSGA Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e215735.pdf",
"2018","GA","63411","HIOS","2017-08-04 02:20:25","Individual","Yes","58-0469845","63411GA0570005","BCBSGA Dental Family Value","63411GA057",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","63411GA0570005-00","BCBSGA Dental Family Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e215737.pdf",
"2018","GA","63411","HIOS","2017-08-04 02:20:25","Individual","Yes","58-0469845","63411GA0510003","BCBSGA Dental Family","63411GA051",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","63411GA0510003-01","BCBSGA Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e215735.pdf",
"2018","GA","63411","HIOS","2017-08-04 02:20:25","SHOP (Small Group)","Yes","58-0469845","63411GA0540004","BCBSGA Dental Family Enhanced","63411GA054",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.836","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","63411GA0540004-00","BCBSGA Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e215736.pdf",
"2018","GA","63411","HIOS","2017-08-04 02:20:25","Individual","Yes","58-0469845","63411GA0570003","BCBSGA Dental Family","63411GA057",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","63411GA0570003-00","BCBSGA Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e215735.pdf",
"2018","GA","63411","HIOS","2017-08-04 02:20:25","Individual","Yes","58-0469845","63411GA0510004","BCBSGA Dental Family Enhanced","63411GA051",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.836","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","63411GA0510004-01","BCBSGA Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e215736.pdf",
"2018","GA","63411","HIOS","2017-08-04 02:20:25","Individual","Yes","58-0469845","63411GA0570004","BCBSGA Dental Family Enhanced","63411GA057",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.836","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","63411GA0570004-00","BCBSGA Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e215736.pdf",
"2018","GA","63940","HIOS","2017-08-05 02:21:19","Individual","Yes","13-5123390","63940GA0200003","Guardian Essentials for Families and Individuals","63940GA020",,"GAN002","GAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","63940GA0200003-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/georgia/","https://dentalexchange.guardianlife.com/our-plans/georgia/"
"2018","GA","63940","HIOS","2017-08-05 02:21:19","SHOP (Small Group)","Yes","13-5123390","63940GA0140005","Guardian Pediatric Advantage","63940GA014",,"GAN001","GAS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is allowed outside of the Service Area.","Yes",,"","63940GA0140005-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","GA","63940","HIOS","2017-08-05 02:21:19","SHOP (Small Group)","Yes","13-5123390","63940GA0150005","Guardian Pediatric Essentials","63940GA015",,"GAN001","GAS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is allowed outside of the Service Area.","Yes",,"","63940GA0150005-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","GA","63940","HIOS","2017-08-05 02:21:19","Individual","Yes","13-5123390","63940GA0200003","Guardian Essentials for Families and Individuals","63940GA020",,"GAN002","GAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","63940GA0200003-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/georgia/","https://dentalexchange.guardianlife.com/our-plans/georgia/"
"2018","GA","63940","HIOS","2017-08-05 02:21:19","Individual","Yes","13-5123390","63940GA0210002","Guardian Basics for Families and Individuals","63940GA021",,"GAN002","GAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","63940GA0210002-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/georgia/","https://dentalexchange.guardianlife.com/our-plans/georgia/"
"2018","GA","68806","HIOS","2017-08-10 02:20:26","Individual","Yes","59-0397210","68806GA0010001","DentaQuest PPO  Pediatric High","68806GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68806GA0010001-00","DentaQuest PPO  Pediatric High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/"
"2018","GA","68806","HIOS","2017-08-10 02:20:26","Individual","Yes","59-0397210","68806GA0010001","DentaQuest PPO  Pediatric High","68806GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68806GA0010001-01","DentaQuest PPO  Pediatric High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/"
"2018","GA","68806","HIOS","2017-08-10 02:20:26","Individual","Yes","59-0397210","68806GA0010003","DentaQuest PPO Family High","68806GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68806GA0010003-00","DentaQuest PPO Family High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/"
"2018","GA","68806","HIOS","2017-08-10 02:20:26","Individual","Yes","59-0397210","68806GA0010003","DentaQuest PPO Family High","68806GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68806GA0010003-01","DentaQuest PPO Family High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/"
"2018","GA","68806","HIOS","2017-08-10 02:20:26","Individual","Yes","59-0397210","68806GA0010004","DentaQuest PPO Family Low","68806GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68806GA0010004-00","DentaQuest PPO Family Low","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/"
"2018","GA","68806","HIOS","2017-08-10 02:20:26","Individual","Yes","59-0397210","68806GA0010004","DentaQuest PPO Family Low","68806GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68806GA0010004-01","DentaQuest PPO Family Low","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","70893GA001",,"GAN001","GAS001","GAF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010001-00","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/70893GA0010001-00.pdf","https://api.centene.com/Brochures/2018/70893GA0010001-00.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","70893GA001",,"GAN001","GAS001","GAF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010001-01","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/70893GA0010001-01.pdf","https://api.centene.com/Brochures/2018/70893GA0010001-01.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","70893GA001",,"GAN001","GAS001","GAF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010001-02","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/70893GA0010001-02.pdf","https://api.centene.com/Brochures/2018/70893GA0010001-02.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","70893GA001",,"GAN001","GAS001","GAF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010001-03","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/70893GA0010001-03.pdf","https://api.centene.com/Brochures/2018/70893GA0010001-03.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2018)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010002-00","Ambetter Balanced Care 1 (2018)","Standard Silver Off Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010002-00.pdf","https://api.centene.com/Brochures/2018/70893GA0010002-00.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2018)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010002-01","Ambetter Balanced Care 1 (2018)","Standard Silver On Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010002-01.pdf","https://api.centene.com/Brochures/2018/70893GA0010002-01.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2018)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010002-02","Ambetter Balanced Care 1 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010002-02.pdf","https://api.centene.com/Brochures/2018/70893GA0010002-02.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2018)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010002-03","Ambetter Balanced Care 1 (2018)","Limited Cost Sharing Plan Variation",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010002-03.pdf","https://api.centene.com/Brochures/2018/70893GA0010002-03.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2018)","70893GA001",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010002-06","Ambetter Balanced Care 1 (2018)","94% AV Level Silver Plan",,"0.949528260595198","Yes","Yes","No","100%",,"$0","$0","$950","$60","$0","$300","$400","$60","$0","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010002-06.pdf","https://api.centene.com/Brochures/2018/70893GA0010002-06.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2018)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010003-00","Ambetter Balanced Care 2 (2018)","Standard Silver Off Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010003-00.pdf","https://api.centene.com/Brochures/2018/70893GA0010003-00.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2018)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010003-01","Ambetter Balanced Care 2 (2018)","Standard Silver On Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010003-01.pdf","https://api.centene.com/Brochures/2018/70893GA0010003-01.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2018)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010003-02","Ambetter Balanced Care 2 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010003-02.pdf","https://api.centene.com/Brochures/2018/70893GA0010003-02.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2018)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010003-03","Ambetter Balanced Care 2 (2018)","Limited Cost Sharing Plan Variation",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010003-03.pdf","https://api.centene.com/Brochures/2018/70893GA0010003-03.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2018)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010003-04","Ambetter Balanced Care 2 (2018)","73% AV Level Silver Plan",,"0.729896135538709","Yes","Yes","No","100%",,"$4,600","$400","$0","$60","$1,900","$1,400","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010003-04.pdf","https://api.centene.com/Brochures/2018/70893GA0010003-04.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2018)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010003-05","Ambetter Balanced Care 2 (2018)","87% AV Level Silver Plan",,"0.867181007012531","Yes","Yes","No","100%",,"$1,700","$10","$0","$60","$1,500","$250","$0","$60","$1,600","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010003-05.pdf","https://api.centene.com/Brochures/2018/70893GA0010003-05.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2018)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010003-06","Ambetter Balanced Care 2 (2018)","94% AV Level Silver Plan",,"0.942313720589882","Yes","Yes","No","100%",,"$572","$3","$0","$60","$500","$70","$0","$60","$575","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010003-06.pdf","https://api.centene.com/Brochures/2018/70893GA0010003-06.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010009","Ambetter Balanced Care 4 (2018)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010009-00","Ambetter Balanced Care 4 (2018)","Standard Silver Off Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010009-00.pdf","https://api.centene.com/Brochures/2018/70893GA0010009-00.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010009","Ambetter Balanced Care 4 (2018)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010009-01","Ambetter Balanced Care 4 (2018)","Standard Silver On Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010009-01.pdf","https://api.centene.com/Brochures/2018/70893GA0010009-01.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010009","Ambetter Balanced Care 4 (2018)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010009-02","Ambetter Balanced Care 4 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010009-02.pdf","https://api.centene.com/Brochures/2018/70893GA0010009-02.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010009","Ambetter Balanced Care 4 (2018)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010009-03","Ambetter Balanced Care 4 (2018)","Limited Cost Sharing Plan Variation",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010009-03.pdf","https://api.centene.com/Brochures/2018/70893GA0010009-03.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010009","Ambetter Balanced Care 4 (2018)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010009-04","Ambetter Balanced Care 4 (2018)","73% AV Level Silver Plan",,"0.727430168333116","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$1,800","$1,300","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010009-04.pdf","https://api.centene.com/Brochures/2018/70893GA0010009-04.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010009","Ambetter Balanced Care 4 (2018)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010009-05","Ambetter Balanced Care 4 (2018)","87% AV Level Silver Plan",,"0.863154651499334","Yes","Yes","No","100%",,"$1,850","$0","$0","$60","$1,850","$0","$0","$60","$1,630","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010009-05.pdf","https://api.centene.com/Brochures/2018/70893GA0010009-05.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010009","Ambetter Balanced Care 4 (2018)","70893GA001",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010009-06","Ambetter Balanced Care 4 (2018)","94% AV Level Silver Plan",,"0.940719200046497","Yes","Yes","No","100%",,"$600","$0","$0","$60","$600","$0","$0","$60","$600","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010009-06.pdf","https://api.centene.com/Brochures/2018/70893GA0010009-06.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010006","Ambetter Essential Care 1 (2018)","70893GA001",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010006-00","Ambetter Essential Care 1 (2018)","Standard Bronze Off Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010006-00.pdf","https://api.centene.com/Brochures/2018/70893GA0010006-00.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010006","Ambetter Essential Care 1 (2018)","70893GA001",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010006-01","Ambetter Essential Care 1 (2018)","Standard Bronze On Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010006-01.pdf","https://api.centene.com/Brochures/2018/70893GA0010006-01.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010006","Ambetter Essential Care 1 (2018)","70893GA001",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010006-02","Ambetter Essential Care 1 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010006-02.pdf","https://api.centene.com/Brochures/2018/70893GA0010006-02.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010006","Ambetter Essential Care 1 (2018)","70893GA001",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010006-03","Ambetter Essential Care 1 (2018)","Limited Cost Sharing Plan Variation",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010006-03.pdf","https://api.centene.com/Brochures/2018/70893GA0010006-03.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010051","Ambetter Essential Care 2 HSA (2018)","70893GA001",,"GAN001","GAS001","GAF007","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010051-00","Ambetter Essential Care 2 HSA (2018)","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://api.centene.com/SBC/2018/70893GA0010051-00.pdf","https://api.centene.com/Brochures/2018/70893GA0010051-01.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010051","Ambetter Essential Care 2 HSA (2018)","70893GA001",,"GAN001","GAS001","GAF007","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010051-01","Ambetter Essential Care 2 HSA (2018)","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://api.centene.com/SBC/2018/70893GA0010051-01.pdf","https://api.centene.com/Brochures/2018/70893GA0010051-01.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010051","Ambetter Essential Care 2 HSA (2018)","70893GA001",,"GAN001","GAS001","GAF007","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010051-02","Ambetter Essential Care 2 HSA (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0010051-02.pdf","https://api.centene.com/Brochures/2018/70893GA0010051-02.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0010051","Ambetter Essential Care 2 HSA (2018)","70893GA001",,"GAN001","GAS001","GAF007","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0010051-03","Ambetter Essential Care 2 HSA (2018)","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://api.centene.com/SBC/2018/70893GA0010051-03.pdf","https://api.centene.com/Brochures/2018/70893GA0010051-03.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2018) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0020001-00","Ambetter Balanced Care 1 (2018) + Vision","Standard Silver Off Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0020001-00.pdf","https://api.centene.com/Brochures/2018/70893GA0020001-00.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2018) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0020001-01","Ambetter Balanced Care 1 (2018) + Vision","Standard Silver On Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0020001-01.pdf","https://api.centene.com/Brochures/2018/70893GA0020001-01.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2018) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0020001-02","Ambetter Balanced Care 1 (2018) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0020001-02.pdf","https://api.centene.com/Brochures/2018/70893GA0020001-02.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2018) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0020001-03","Ambetter Balanced Care 1 (2018) + Vision","Limited Cost Sharing Plan Variation",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0020001-03.pdf","https://api.centene.com/Brochures/2018/70893GA0020001-03.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2018) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0020001-04","Ambetter Balanced Care 1 (2018) + Vision","73% AV Level Silver Plan",,"0.739812128349422","Yes","Yes","No","100%",,"$3,000","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0020001-04.pdf","https://api.centene.com/Brochures/2018/70893GA0020001-04.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2018) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0020001-05","Ambetter Balanced Care 1 (2018) + Vision","87% AV Level Silver Plan",,"0.87931537568396","Yes","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$300","$400","$60","$750","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0020001-05.pdf","https://api.centene.com/Brochures/2018/70893GA0020001-05.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2018) + Vision","70893GA002",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0020001-06","Ambetter Balanced Care 1 (2018) + Vision","94% AV Level Silver Plan",,"0.949528260595198","Yes","Yes","No","100%",,"$0","$0","$950","$60","$0","$300","$400","$60","$0","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0020001-06.pdf","https://api.centene.com/Brochures/2018/70893GA0020001-06.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2018) + Vision","70893GA002",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0020002-00","Ambetter Balanced Care 2 (2018) + Vision","Standard Silver Off Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0020002-00.pdf","https://api.centene.com/Brochures/2018/70893GA0020002-00.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2018) + Vision","70893GA002",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0020002-01","Ambetter Balanced Care 2 (2018) + Vision","Standard Silver On Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0020002-01.pdf","https://api.centene.com/Brochures/2018/70893GA0020002-01.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2018) + Vision","70893GA002",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0020002-02","Ambetter Balanced Care 2 (2018) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0020002-02.pdf","https://api.centene.com/Brochures/2018/70893GA0020002-02.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2018) + Vision","70893GA002",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0020002-03","Ambetter Balanced Care 2 (2018) + Vision","Limited Cost Sharing Plan Variation",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0020002-03.pdf","https://api.centene.com/Brochures/2018/70893GA0020002-03.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2018) + Vision","70893GA002",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0020002-04","Ambetter Balanced Care 2 (2018) + Vision","73% AV Level Silver Plan",,"0.729896135538709","Yes","Yes","No","100%",,"$4,600","$400","$0","$60","$1,900","$1,400","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0020002-04.pdf","https://api.centene.com/Brochures/2018/70893GA0020002-04.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2018) + Vision","70893GA002",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0020002-05","Ambetter Balanced Care 2 (2018) + Vision","87% AV Level Silver Plan",,"0.867181007012531","Yes","Yes","No","100%",,"$1,700","$10","$0","$60","$1,500","$250","$0","$60","$1,600","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0020002-05.pdf","https://api.centene.com/Brochures/2018/70893GA0020002-05.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2018) + Vision","70893GA002",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0020002-06","Ambetter Balanced Care 2 (2018) + Vision","94% AV Level Silver Plan",,"0.942313720589882","Yes","Yes","No","100%",,"$572","$3","$0","$60","$500","$70","$0","$60","$575","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0020002-06.pdf","https://api.centene.com/Brochures/2018/70893GA0020002-06.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0020004","Ambetter Essential Care 1 (2018) + Vision","70893GA002",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0020004-00","Ambetter Essential Care 1 (2018) + Vision","Standard Bronze Off Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0020004-00.pdf","https://api.centene.com/Brochures/2018/70893GA0020004-00.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0020004","Ambetter Essential Care 1 (2018) + Vision","70893GA002",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0020004-01","Ambetter Essential Care 1 (2018) + Vision","Standard Bronze On Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0020004-01.pdf","https://api.centene.com/Brochures/2018/70893GA0020004-01.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0020004","Ambetter Essential Care 1 (2018) + Vision","70893GA002",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0020004-02","Ambetter Essential Care 1 (2018) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0020004-02.pdf","https://api.centene.com/Brochures/2018/70893GA0020004-02.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0020004","Ambetter Essential Care 1 (2018) + Vision","70893GA002",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9858",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0020004-03","Ambetter Essential Care 1 (2018) + Vision","Limited Cost Sharing Plan Variation",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0020004-03.pdf","https://api.centene.com/Brochures/2018/70893GA0020004-03.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9467",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0030001-00","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0030001-00.pdf","https://api.centene.com/Brochures/2018/70893GA0030001-00.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9467",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0030001-01","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0030001-01.pdf","https://api.centene.com/Brochures/2018/70893GA0030001-01.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9467",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0030001-02","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0030001-02.pdf","https://api.centene.com/Brochures/2018/70893GA0030001-02.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9467",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0030001-03","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0030001-03.pdf","https://api.centene.com/Brochures/2018/70893GA0030001-03.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9467",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0030001-04","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.739812128349422","Yes","Yes","No","100%",,"$3,000","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0030001-04.pdf","https://api.centene.com/Brochures/2018/70893GA0030001-04.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9467",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0030001-05","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.87931537568396","Yes","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$300","$400","$60","$750","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0030001-05.pdf","https://api.centene.com/Brochures/2018/70893GA0030001-05.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9467",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0030001-06","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949528260595198","Yes","Yes","No","100%",,"$0","$0","$950","$60","$0","$300","$400","$60","$0","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0030001-06.pdf","https://api.centene.com/Brochures/2018/70893GA0030001-06.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9467",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0030002-00","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0030002-00.pdf","https://api.centene.com/Brochures/2018/70893GA0030002-00.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9467",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0030002-01","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0030002-01.pdf","https://api.centene.com/Brochures/2018/70893GA0030002-01.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9467",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0030002-02","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0030002-02.pdf","https://api.centene.com/Brochures/2018/70893GA0030002-02.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9467",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0030002-03","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0030002-03.pdf","https://api.centene.com/Brochures/2018/70893GA0030002-03.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9467",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0030002-04","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.729896135538709","Yes","Yes","No","100%",,"$4,600","$400","$0","$60","$1,900","$1,400","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0030002-04.pdf","https://api.centene.com/Brochures/2018/70893GA0030002-04.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9467",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0030002-05","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.867181007012531","Yes","Yes","No","100%",,"$1,700","$10","$0","$60","$1,500","$250","$0","$60","$1,600","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0030002-05.pdf","https://api.centene.com/Brochures/2018/70893GA0030002-05.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9467",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0030002-06","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.942313720589882","Yes","Yes","No","100%",,"$572","$3","$0","$60","$500","$70","$0","$60","$575","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0030002-06.pdf","https://api.centene.com/Brochures/2018/70893GA0030002-06.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0030004","Ambetter Essential Care 1 (2018) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9467",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0030004-00","Ambetter Essential Care 1 (2018) + Vision + Adult Dental","Standard Bronze Off Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0030004-00.pdf","https://api.centene.com/Brochures/2018/70893GA0030004-00.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0030004","Ambetter Essential Care 1 (2018) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9467",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0030004-01","Ambetter Essential Care 1 (2018) + Vision + Adult Dental","Standard Bronze On Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0030004-01.pdf","https://api.centene.com/Brochures/2018/70893GA0030004-01.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0030004","Ambetter Essential Care 1 (2018) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9467",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0030004-02","Ambetter Essential Care 1 (2018) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0030004-02.pdf","https://api.centene.com/Brochures/2018/70893GA0030004-02.pdf"
"2018","GA","70893","HIOS","2017-09-27 03:20:22","Individual","No","36-4802632","70893GA0030004","Ambetter Essential Care 1 (2018) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9467",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","https://ambetter.pshpgeorgia.com/resources/pharmacy-resources.html","70893GA0030004-03","Ambetter Essential Care 1 (2018) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/70893GA0030004-03.pdf","https://api.centene.com/Brochures/2018/70893GA0030004-03.pdf"
"2018","GA","73231","HIOS","2017-05-26 02:20:19","Individual","Yes","47-0397286","73231GA0030001","Renaissance Individual Dental PPO, EHB Certified","73231GA003",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","73231GA0030001-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","GA","73231","HIOS","2017-05-26 02:20:19","Individual","Yes","47-0397286","73231GA0030002","Renaissance Individual Dental PPO, EHB Certified","73231GA003",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","73231GA0030002-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","GA","73231","HIOS","2017-05-26 02:20:19","Individual","Yes","47-0397286","73231GA0070001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","73231GA007",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231","","73231GA0070001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_EHB_High_2018","http://www.renaissancedental.com/GA_EHB_High_2018"
"2018","GA","73231","HIOS","2017-05-26 02:20:19","Individual","Yes","47-0397286","73231GA0070002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","73231GA007",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231","","73231GA0070002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_EHB_Low_2018","http://www.renaissancedental.com/GA_EHB_Low_2018"
"2018","GA","73231","HIOS","2017-05-26 02:20:19","Individual","Yes","47-0397286","73231GA0060001","Renaissance Individual Dental Pediatric-Only, EHB Certified","73231GA006",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","73231GA0060001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","GA","73231","HIOS","2017-05-26 02:20:19","Individual","Yes","47-0397286","73231GA0060002","Renaissance Individual Dental Pediatric-Only, EHB Certified","73231GA006",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","73231GA0060002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","GA","73231","HIOS","2017-05-26 02:20:19","Individual","Yes","47-0397286","73231GA0080001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","73231GA008",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231","","73231GA0080001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_Ped_High_2018","http://www.renaissancedental.com/GA_Ped_High_2018"
"2018","GA","73231","HIOS","2017-05-26 02:20:19","Individual","Yes","47-0397286","73231GA0080002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","73231GA008",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231","","73231GA0080002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_Ped_Low_2018","http://www.renaissancedental.com/GA_Ped_Low_2018"
"2018","GA","78196","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","93-0242990","78196GA0030002","EHB High Passive","78196GA003",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","78196GA0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2018","GA","78196","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","93-0242990","78196GA0030001","EHB Low Passive","78196GA003",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","78196GA0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2018","GA","86637","HIOS","2017-08-11 02:20:28","Individual","Yes","94-2761537","86637GA0010006","Delta Dental PPO Basic Plan for Families","86637GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0010006-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","$65 per person","per group not applicable",,,,,,"$65","$65 per person","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0010006-18"
"2018","GA","86637","HIOS","2017-08-11 02:20:28","Individual","Yes","94-2761537","86637GA0010004","Delta Dental PPO Preferred Plan for Families","86637GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0010004-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","$45 per person","per group not applicable",,,,,,"$45","$45 per person","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0010004-18"
"2018","GA","86681","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","86681GA0020003","DentaSpan Family High Option","86681GA002","7083617077","GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0020003-00","DentaSpan Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsga.dentalcareplus.com","http://hixpbdsga.dentalcareplus.com"
"2018","GA","86681","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","86681GA0010001","DentaTrust-PPO Pediatric High Option","86681GA001","7083617077","GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0010001-00","DentaTrust-PPO Pediatric High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtga.dentalcareplus.com","http://hixpbdtga.dentalcareplus.com"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","83502GA0020003","BESTOne Advantage Gold","83502GA002",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/GA/current/GA_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83502GA0010007","BESTDental Premium","83502GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010007-00","BESTDental Premium","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/current/GA_BESTDental_Premium_Plan.pdf"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83502GA0010007","BESTDental Premium","83502GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010007-01","BESTDental Premium","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/current/GA_BESTDental_Premium_Plan.pdf"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","83502GA0020003","BESTOne Advantage Gold","83502GA002",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/GA/current/GA_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","83502GA0020004","BESTOne Plus Gold","83502GA002",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/GA/current/GA_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83502GA0010008","BESTDental Standard - H","83502GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/current/GA_BESTDental_Standard-H_Plan.pdf"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83502GA0010008","BESTDental Standard - H","83502GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/current/GA_BESTDental_Standard-H_Plan.pdf"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","83502GA0020004","BESTOne Plus Gold","83502GA002",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/GA/current/GA_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83502GA0010010","BESTDental Choice - H","83502GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/current/GA_BESTDental_Standard-L_Plan.pdf"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83502GA0010010","BESTDental Choice - H","83502GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/current/GA_BESTDental_Standard-L_Plan.pdf"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83502GA0010009","BESTDental Standard - L","83502GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/current/GA_BESTDental_Choice-H_Plan.pdf"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","83502GA0020005","BESTOne Plus Silver","83502GA002",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/GA/current/GA_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","83502GA0020005","BESTOne Plus Silver","83502GA002",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/GA/current/GA_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83502GA0010009","BESTDental Standard - L","83502GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/current/GA_BESTDental_Choice-H_Plan.pdf"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83502GA0010011","BESTDental Choice - L","83502GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/current/GA_BESTDental_Choice-L_Plan.pdf"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","83502GA0020006","BESTOne Basic Silver","83502GA002",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/GA/current/GA_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","83502GA0020006","BESTOne Basic Silver","83502GA002",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/GA/current/GA_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83502GA0010011","BESTDental Choice - L","83502GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/current/GA_BESTDental_Choice-L_Plan.pdf"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83502GA0010012","BESTDental Value","83502GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/current/GA_BESTDental_Value_Plan.pdf"
"2018","GA","83502","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83502GA0010012","BESTDental Value","83502GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ga/current/GA_BESTDental_Value_Plan.pdf"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040023","SoloCare Platinum PPO 40023","83761GA004",,"GAN001","GAS001","GAF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040023-00","SoloCare Platinum PPO 40023","Standard Platinum Off Exchange Plan",,"0.860373815469458","Yes","Yes","No","100%",,"$275.00","$230.00","$1,825.00","$60.00","$275.00","$1,090.00","$346.00","$55.00","$275.00","$75.00","$326.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$275","$275 per person","$550 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,275","$20275 per person","$40550 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040023_00.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040023","SoloCare Platinum PPO 40023","83761GA004",,"GAN001","GAS001","GAF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040023-01","SoloCare Platinum PPO 40023","Standard Platinum On Exchange Plan",,"0.860373815469458","Yes","Yes","No","100%",,"$275.00","$230.00","$1,825.00","$60.00","$275.00","$1,090.00","$346.00","$55.00","$275.00","$75.00","$326.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$275","$275 per person","$550 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,275","$20275 per person","$40550 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040023_01.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040023","SoloCare Platinum PPO 40023","83761GA004",,"GAN001","GAS001","GAF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040023-02","SoloCare Platinum PPO 40023","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040023_02.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040031","SoloCare Bronze HDHP 40031","83761GA004",,"GAN001","GAS001","GAF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040031-03","SoloCare Bronze HDHP 40031","Limited Cost Sharing Plan Variation",,"0.615998942880685","Yes","Yes","No","100%",,"$6,650.00","$0.00","$0.00","$60.00","$6,650.00","$0.00","$0.00","$55.00","$1,925.00","$0.00","$0.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$26,650","$26650 per person","$53300 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040031_03.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","86681","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","86681GA0010004","DentaTrust-PPO Family Low Option","86681GA001","7083617077","GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0010004-00","DentaTrust-PPO Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtga.dentalcareplus.com","http://hixpbdtga.dentalcareplus.com"
"2018","GA","86681","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","86681GA0010004","DentaTrust-PPO Family Low Option","86681GA001","7083617077","GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0010004-01","DentaTrust-PPO Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtga.dentalcareplus.com","http://hixpbdtga.dentalcareplus.com"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060002","KP GA Gold 0/20/30/S5","89942GA006",,"GAN001","GAS001","GAF016","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060002-00","KP GA Gold 0/20/30/S5","Standard Gold Off Exchange Plan","81.97%","0.816830661917874","No","Yes","No","100%",,"$0","$80","$1,800","$60","$250","$1,400","$40","$60","$0","$1,200","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20GOLD%200_20_30_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060004","KP GA Silver 2500/30/50/S5","89942GA006",,"GAN001","GAS001","GAF018","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060004-01","KP GA Silver 2500/30/50/S5","Standard Silver On Exchange Plan","71.03%","0.708623021797257","No","Yes","No","100%",,"$2,500","$40","$2,300","$60","$500","$1,900","$0","$50","$1,500","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20SILVER%202500_30_50_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20% HSA","89942GA005",,"GAN001","GAS002","GAF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050006-06","KP GA Silver 100/5%/94% CSR","94% AV Level Silver Plan","94.56%","0.944391300184168","Yes","Yes","No","100%",,"$100","$30","$600","$60","$100","$800","$60","$60","$100","$0","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_100_5_94_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050023","KP GA Signature Silver Std 3500/30","89942GA005",,"GAN002","GAS003","GAF008","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050023-05","KP GA Signature Silver Std 700/10/87% CSR","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$20","$1,800","$60","$200","$800","$0","$50","$700","$80","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_STD_700_10_87_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040023","SoloCare Platinum PPO 40023","83761GA004",,"GAN001","GAS001","GAF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040023-03","SoloCare Platinum PPO 40023","Limited Cost Sharing Plan Variation",,"0.860373815469458","Yes","Yes","No","100%",,"$275.00","$230.00","$1,825.00","$60.00","$275.00","$1,090.00","$346.00","$55.00","$275.00","$75.00","$326.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$275","$275 per person","$550 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,275","$20275 per person","$40550 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040023_03.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040002","SoloCare Gold PPO 40002","83761GA004",,"GAN001","GAS001","GAF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040002-00","SoloCare Gold PPO 40002","Standard Gold Off Exchange Plan",,"0.760937786186523","Yes","Yes","No","100%",,"$2,300.00","$440.00","$1,825.00","$60.00","$1,382.00","$1,355.00","$346.00","$55.00","$1,305.00","$120.00","$326.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$22,300","$22300 per person","$44600 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040002_00.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040002","SoloCare Gold PPO 40002","83761GA004",,"GAN001","GAS001","GAF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040002-01","SoloCare Gold PPO 40002","Standard Gold On Exchange Plan",,"0.760937786186523","Yes","Yes","No","100%",,"$2,300.00","$440.00","$1,825.00","$60.00","$1,382.00","$1,355.00","$346.00","$55.00","$1,305.00","$120.00","$326.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$22,300","$22300 per person","$44600 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040002_01.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040002","SoloCare Gold PPO 40002","83761GA004",,"GAN001","GAS001","GAF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040002-02","SoloCare Gold PPO 40002","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040002_01.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040002","SoloCare Gold PPO 40002","83761GA004",,"GAN001","GAS001","GAF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040002-03","SoloCare Gold PPO 40002","Limited Cost Sharing Plan Variation",,"0.760937786186523","Yes","Yes","No","100%",,"$2,300.00","$440.00","$1,825.00","$60.00","$1,382.00","$1,355.00","$346.00","$55.00","$1,305.00","$120.00","$326.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$22,300","$22300 per person","$44600 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040002_03.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040010","SoloCare Silver PPO 40010","83761GA004",,"GAN001","GAS001","GAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040010-00","SoloCare Silver PPO 40010","Standard Silver Off Exchange Plan",,"0.70341285121802","Yes","Yes","No","100%",,"$4,193.00","$420.00","$2,737.00","$60.00","$1,210.00","$1,475.00","$518.00","$55.00","$1,142.00","$180.00","$490.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,750","$25750 per person","$51500 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040010_00.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040010","SoloCare Silver PPO 40010","83761GA004",,"GAN001","GAS001","GAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040010-01","SoloCare Silver PPO 40010","Standard Silver On Exchange Plan",,"0.70341285121802","Yes","Yes","No","100%",,"$4,193.00","$420.00","$2,737.00","$60.00","$1,210.00","$1,475.00","$518.00","$55.00","$1,142.00","$180.00","$490.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,750","$25750 per person","$51500 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040010_01.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040010","SoloCare Silver PPO 40010","83761GA004",,"GAN001","GAS001","GAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040010-02","SoloCare Silver PPO 40010","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040010_02.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040010","SoloCare Silver PPO 40010","83761GA004",,"GAN001","GAS001","GAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040010-03","SoloCare Silver PPO 40010","Limited Cost Sharing Plan Variation",,"0.70341285121802","Yes","Yes","No","100%",,"$4,193.00","$420.00","$2,737.00","$60.00","$1,210.00","$1,475.00","$518.00","$55.00","$1,142.00","$180.00","$490.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,750","$25750 per person","$51500 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040010_03.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040010","SoloCare Silver PPO 40010","83761GA004",,"GAN001","GAS001","GAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040010-04","SoloCare Silver PPO 40010","73% AV Level Silver Plan",,"0.726321410887697","Yes","Yes","No","100%",,"$2,693.00","$420.00","$2,737.00","$60.00","$1,210.00","$1,475.00","$518.00","$55.00","$1,142.00","$180.00","$490.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,750","$25750 per person","$51500 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040010_04.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040010","SoloCare Silver PPO 40010","83761GA004",,"GAN001","GAS001","GAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040010-05","SoloCare Silver PPO 40010","87% AV Level Silver Plan",,"0.860425624124029","Yes","Yes","No","100%",,"$485.00","$140.00","$1,825.00","$60.00","$1,275.00","$745.00","$346.00","$55.00","$1,275.00","$45.00","$326.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,275","$1275 per person","$2550 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,275","$21275 per person","$42550 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040010_05.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040010","SoloCare Silver PPO 40010","83761GA004",,"GAN001","GAS001","GAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040010-06","SoloCare Silver PPO 40010","94% AV Level Silver Plan",,"0.930517611862007","Yes","Yes","No","100%",,"$198.00","$140.00","$912.00","$60.00","$350.00","$395.00","$173.00","$55.00","$350.00","$45.00","$163.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,350","$20350 per person","$40700 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040010_06.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040017","SoloCare Silver PPO 40017","83761GA004",,"GAN001","GAS001","GAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040017-00","SoloCare Silver PPO 40017","Standard Silver Off Exchange Plan",,"0.660594629221893","Yes","Yes","No","100%",,"$3,423.00","$1,190.00","$2,737.00","$60.00","$1,210.00","$2,385.00","$518.00","$55.00","$1,142.00","$360.00","$490.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$27,000","$27000 per person","$54000 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040017_00.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040017","SoloCare Silver PPO 40017","83761GA004",,"GAN001","GAS001","GAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040017-01","SoloCare Silver PPO 40017","Standard Silver On Exchange Plan",,"0.660594629221893","Yes","Yes","No","100%",,"$3,423.00","$1,190.00","$2,737.00","$60.00","$1,210.00","$2,385.00","$518.00","$55.00","$1,142.00","$360.00","$490.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$27,000","$27000 per person","$54000 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040017_01.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040017","SoloCare Silver PPO 40017","83761GA004",,"GAN001","GAS001","GAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040017-02","SoloCare Silver PPO 40017","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040017_02.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040017","SoloCare Silver PPO 40017","83761GA004",,"GAN001","GAS001","GAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040017-03","SoloCare Silver PPO 40017","Limited Cost Sharing Plan Variation",,"0.660594629221893","Yes","Yes","No","100%",,"$3,423.00","$1,190.00","$2,737.00","$60.00","$1,210.00","$2,385.00","$518.00","$55.00","$1,142.00","$360.00","$490.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$27,000","$27000 per person","$54000 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040017_03.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040017","SoloCare Silver PPO 40017","83761GA004",,"GAN001","GAS001","GAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040017-04","SoloCare Silver PPO 40017","73% AV Level Silver Plan",,"0.720242014248498","Yes","Yes","No","100%",,"$2,413.00","$700.00","$2,737.00","$60.00","$1,210.00","$1,665.00","$518.00","$55.00","$1,142.00","$225.00","$490.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040017_04.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040017","SoloCare Silver PPO 40017","83761GA004",,"GAN001","GAS001","GAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040017-05","SoloCare Silver PPO 40017","87% AV Level Silver Plan",,"0.860018899062582","Yes","Yes","No","100%",,"$345.00","$280.00","$1,825.00","$60.00","$1,000.00","$875.00","$346.00","$55.00","$1,000.00","$120.00","$326.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,000","$21000 per person","$42000 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040017_05.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040017","SoloCare Silver PPO 40017","83761GA004",,"GAN001","GAS001","GAF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040017-06","SoloCare Silver PPO 40017","94% AV Level Silver Plan",,"0.930664279222249","Yes","Yes","No","100%",,"$198.00","$140.00","$912.00","$60.00","$300.00","$415.00","$173.00","$55.00","$300.00","$75.00","$163.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,300","$20300 per person","$40600 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040017_06.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040031","SoloCare Bronze HDHP 40031","83761GA004",,"GAN001","GAS001","GAF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040031-00","SoloCare Bronze HDHP 40031","Standard Bronze Off Exchange Plan",,"0.615998942880685","Yes","Yes","No","100%",,"$6,650.00","$0.00","$0.00","$60.00","$6,650.00","$0.00","$0.00","$55.00","$1,925.00","$0.00","$0.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$26,650","$26650 per person","$53300 per group","Yes",,,"http://www.alliantplans.com/2018/solocare/83761GA0040031_00.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040031","SoloCare Bronze HDHP 40031","83761GA004",,"GAN001","GAS001","GAF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040031-01","SoloCare Bronze HDHP 40031","Standard Bronze On Exchange Plan",,"0.615998942880685","Yes","Yes","No","100%",,"$6,650.00","$0.00","$0.00","$60.00","$6,650.00","$0.00","$0.00","$55.00","$1,925.00","$0.00","$0.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$26,650","$26650 per person","$53300 per group","Yes",,,"http://www.alliantplans.com/2018/solocare/83761GA0040031_01.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040031","SoloCare Bronze HDHP 40031","83761GA004",,"GAN001","GAS001","GAF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040031-02","SoloCare Bronze HDHP 40031","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040031_02.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040021","SoloCare Bronze PPO 40021","83761GA004",,"GAN001","GAS001","GAF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040021-00","SoloCare Bronze PPO 40021","Standard Bronze Off Exchange Plan",,"0.599723362353384","Yes","Yes","No","100%",,"$7,350.00","$0.00","$0.00","$60.00","$7,050.00","$0.00","$0.00","$55.00","$1,925.00","$0.00","$0.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$27,350","$27350 per person","$54700 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040021_0.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040021","SoloCare Bronze PPO 40021","83761GA004",,"GAN001","GAS001","GAF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040021-01","SoloCare Bronze PPO 40021","Standard Bronze On Exchange Plan",,"0.599723362353384","Yes","Yes","No","100%",,"$7,350.00","$0.00","$0.00","$60.00","$7,050.00","$0.00","$0.00","$55.00","$1,925.00","$0.00","$0.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$27,350","$27350 per person","$54700 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040021_01.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040021","SoloCare Bronze PPO 40021","83761GA004",,"GAN001","GAS001","GAF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040021-02","SoloCare Bronze PPO 40021","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040021_02.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","83761","HIOS","2017-11-03 02:20:17","Individual","No","58-2335921","83761GA0040021","SoloCare Bronze PPO 40021","83761GA004",,"GAN001","GAS001","GAF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","No","Coverage is available for emergency situations","No","In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjEw","83761GA0040021-03","SoloCare Bronze PPO 40021","Limited Cost Sharing Plan Variation",,"0.599723362353384","Yes","Yes","No","100%",,"$7,350.00","$0.00","$0.00","$60.00","$7,050.00","$0.00","$0.00","$55.00","$1,925.00","$0.00","$0.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","$27,350","$27350 per person","$54700 per group","No",,,"http://www.alliantplans.com/2018/solocare/83761GA0040021_03.pdf","http://www.alliantplans.com/2018/brochures/solocare-2018-brochure/"
"2018","GA","86637","HIOS","2017-08-11 02:20:28","Individual","Yes","94-2761537","86637GA0010002","Delta Dental PPO Pediatric Preferred Plan","86637GA001",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0010002-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","$45 per person","per group not applicable",,,,,,"$45","$45 per person","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0010002-18"
"2018","GA","86637","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","Yes","94-2761537","86637GA0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","86637GA002",,"GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0020002-00","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","$45 per person","per group not applicable",,,,,,"$45","$45 per person","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0020002-18"
"2018","GA","86637","HIOS","2017-08-11 02:20:28","Individual","Yes","94-2761537","86637GA0010001","Delta Dental PPO Pediatric Basic Plan","86637GA001",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0010001-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","$65 per person","per group not applicable",,,,,,"$65","$65 per person","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0010001-18"
"2018","GA","86637","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","Yes","94-2761537","86637GA0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","86637GA002",,"GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0020001-00","Delta Dental PPO Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","$65 per person","per group not applicable",,,,,,"$65","$65 per person","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0020001-18"
"2018","GA","86681","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","86681GA0010001","DentaTrust-PPO Pediatric High Option","86681GA001","7083617077","GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0010001-01","DentaTrust-PPO Pediatric High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtga.dentalcareplus.com","http://hixpbdtga.dentalcareplus.com"
"2018","GA","86681","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","86681GA0020003","DentaSpan Family High Option","86681GA002","7083617077","GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0020003-01","DentaSpan Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsga.dentalcareplus.com","http://hixpbdsga.dentalcareplus.com"
"2018","GA","86681","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","86681GA0020004","DentaSpan Family Low Option","86681GA002","7083617077","GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0020004-00","DentaSpan Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsga.dentalcareplus.com","http://hixpbdsga.dentalcareplus.com"
"2018","GA","86681","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","86681GA0010002","DentaTrust-PPO Pediatric Low Option","86681GA001","7083617077","GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0010002-00","DentaTrust-PPO Pediatric Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtga.dentalcareplus.com","http://hixpbdtga.dentalcareplus.com"
"2018","GA","86681","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","86681GA0010002","DentaTrust-PPO Pediatric Low Option","86681GA001","7083617077","GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0010002-01","DentaTrust-PPO Pediatric Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtga.dentalcareplus.com","http://hixpbdtga.dentalcareplus.com"
"2018","GA","86681","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","86681GA0020004","DentaSpan Family Low Option","86681GA002","7083617077","GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0020004-01","DentaSpan Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsga.dentalcareplus.com","http://hixpbdsga.dentalcareplus.com"
"2018","GA","86681","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","86681GA0030003","DentaSpan Dental-Family High Option-Off Exchange","86681GA003","7083617077","GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0030003-00","DentaSpan Dental-Family High Option-Off Exchange","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsga.dentalcareplus.com","http://hiopbdsga.dentalcareplus.com"
"2018","GA","86681","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","86681GA0030004","DentaSpan Dental-Family Low Option-Off Exchange","86681GA003","7083617077","GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0030004-00","DentaSpan Dental-Family Low Option-Off Exchange","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsga.dentalcareplus.com","http://hiopbdsga.dentalcareplus.com"
"2018","GA","86681","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","86681GA0030001","DentaSpan Pediatric High Option- Off Exchange","86681GA003","7083617077","GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0030001-00","DentaSpan Pediatric High Option- Off Exchange","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsga.dentalcareplus.com","http://hiopbdsga.dentalcareplus.com"
"2018","GA","86681","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","86681GA0010003","DentaTrust-PPO Family High Option","86681GA001","7083617077","GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0010003-00","DentaTrust-PPO Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtga.dentalcareplus.com","http://hixpbdtga.dentalcareplus.com"
"2018","GA","86681","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","86681GA0010003","DentaTrust-PPO Family High Option","86681GA001","7083617077","GAN001","GAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0010003-01","DentaTrust-PPO Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtga.dentalcareplus.com","http://hixpbdtga.dentalcareplus.com"
"2018","GA","86681","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","86681GA0030002","DentaSpan Pediatric Low Option- Off Exchange","86681GA003","7083617077","GAN001","GAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","86681GA0030002-00","DentaSpan Pediatric Low Option- Off Exchange","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsga.dentalcareplus.com","http://hiopbdsga.dentalcareplus.com"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050002","KP GA Gold 500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050002-00","KP GA Gold 500/20","Standard Gold Off Exchange Plan","81.00%","0.808188199018818","No","Yes","No","100%",,"$500","$30","$3,600","$60","$500","$1,200","$20","$50","$200","$700","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Gold_500_20.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060002","KP GA Gold 0/20/30/S5","89942GA006",,"GAN001","GAS001","GAF016","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060002-01","KP GA Gold 0/20/30/S5","Standard Gold On Exchange Plan","81.97%","0.816830661917874","No","Yes","No","100%",,"$0","$80","$1,800","$60","$250","$1,400","$40","$60","$0","$1,200","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20GOLD%200_20_30_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050002","KP GA Gold 500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050002-01","KP GA Gold 500/20","Standard Gold On Exchange Plan","81.00%","0.808188199018818","No","Yes","No","100%",,"$500","$30","$3,600","$60","$500","$1,200","$20","$50","$200","$700","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Gold_500_20.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050002","KP GA Gold 500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050002-02","KP GA Gold 500/20 - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Gold_500_20_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050002","KP GA Gold 500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050002-03","KP GA Gold 500/20 - AI/LTD","Limited Cost Sharing Plan Variation","81.00%","0.808188199018818","No","Yes","No","100%",,"$500","$30","$3,600","$60","$500","$1,200","$20","$50","$200","$700","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Gold_500_20_AI_Ltd.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050016","KP GA Signature Gold 500/20","89942GA005",,"GAN002","GAS003","GAF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050016-00","KP GA Signature Gold 500/20","Standard Gold Off Exchange Plan","81.04%","0.808188199018818","No","Yes","No","100%",,"$500","$30","$3,600","$60","$500","$1,200","$20","$50","$200","$700","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Gold_500_20.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050016","KP GA Signature Gold 500/20","89942GA005",,"GAN002","GAS003","GAF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050016-01","KP GA Signature Gold 500/20","Standard Gold On Exchange Plan","81.04%","0.808188199018818","No","Yes","No","100%",,"$500","$30","$3,600","$60","$500","$1,200","$20","$50","$200","$700","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_Signature_GA_Gold_500_20.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050016","KP GA Signature Gold 500/20","89942GA005",,"GAN002","GAS003","GAF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050016-02","KP GA Signature Gold 500/20 - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Gold_500_20_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050016","KP GA Signature Gold 500/20","89942GA005",,"GAN002","GAS003","GAF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050016-03","KP GA Signature Gold 500/20 - AI/LTD","Limited Cost Sharing Plan Variation","81.04%","0.808188199018818","No","Yes","No","100%",,"$500","$30","$3,600","$60","$500","$1,200","$20","$50","$200","$700","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Gold_500_20_AI_Ltd.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050012","KP GA Gold 1500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050012-00","KP GA Gold 1500/20","Standard Gold Off Exchange Plan","78.28%","0.781232169023135","No","Yes","No","100%",,"$1,500","$30","$2,800","$60","$1,500","$1,100","$10","$50","$1,500","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Gold_1500_20.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060003","KP GA Gold 1000/20/30/S5","89942GA006",,"GAN001","GAS001","GAF016","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060003-00","KP GA Gold 1000/20/30/S5","Standard Gold Off Exchange Plan","79.81%","0.796504095780277","No","Yes","No","100%",,"$1,000","$80","$1,600","$60","$300","$1,400","$0","$50","$200","$1,200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20GOLD%201000_20_30_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060003","KP GA Gold 1000/20/30/S5","89942GA006",,"GAN001","GAS001","GAF016","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060003-01","KP GA Gold 1000/20/30/S5","Standard Gold On Exchange Plan","79.81%","0.796504095780277","No","Yes","No","100%",,"$1,000","$80","$1,600","$60","$300","$1,400","$0","$50","$200","$1,200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20GOLD%201000_20_30_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050012","KP GA Gold 1500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050012-01","KP GA Gold 1500/20","Standard Gold On Exchange Plan","78.28%","0.781232169023135","No","Yes","No","100%",,"$1,500","$30","$2,800","$60","$1,500","$1,100","$10","$50","$1,500","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Gold_1500_20.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050012","KP GA Gold 1500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050012-02","KP GA Gold 1500/20 - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Gold_1500_20_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050012","KP GA Gold 1500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050012-03","KP GA Gold 1500/20 - AI/LTD","Limited Cost Sharing Plan Variation","78.28%","0.781232169023135","No","Yes","No","100%",,"$1,500","$30","$2,800","$60","$1,500","$1,100","$10","$50","$1,500","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Gold_1500_20_AI_Ltd.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050022","KP GA Signature Gold 1500/20","89942GA005",,"GAN002","GAS003","GAF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050022-00","KP GA Signature Gold 1500/20","Standard Gold Off Exchange Plan","78.31%","0.781232169023135","No","Yes","No","100%",,"$1,500","$30","$2,800","$60","$1,500","$1,100","$10","$50","$1,500","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Gold_1500_20.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050022","KP GA Signature Gold 1500/20","89942GA005",,"GAN002","GAS003","GAF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050022-01","KP GA Signature Gold 1500/20","Standard Gold On Exchange Plan","78.31%","0.781232169023135","No","Yes","No","100%",,"$1,500","$30","$2,800","$60","$1,500","$1,100","$10","$50","$1,500","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Gold_1500_20.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050014","KP GA Silver Std 3500/30","89942GA005",,"GAN001","GAS002","GAF007","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050014-03","KP GA Silver Std 3500/30 - AI/LTD","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$40","$1,800","$60","$200","$1,800","$0","$50","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_STD_3500_30_AI_Ltd.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050025","KP GA Signature Silver 4700/35","89942GA005",,"GAN002","GAS003","GAF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050025-03","KP GA Signature Silver 4700/35 - AI/LTD","Limited Cost Sharing Plan Variation","66.47%","0.661579785241012","Yes","Yes","No","100%",,"$4,700","$40","$2,400","$60","$3,800","$11,090","$0","$50","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_4700_35_AI_Ltd.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050009","KP GA Bronze 6200/40%/HSA","89942GA005",,"GAN001","GAS002","GAF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050009-01","KP GA Bronze 6200/40%/HSA","Standard Bronze On Exchange Plan","61.19%","0.605519376285678","Yes","Yes","No","100%",,"$6,200","$0","$400","$60","$6,200","$0","$400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Bronze_6200_40_HSA.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050009","KP GA Bronze 6200/40%/HSA","89942GA005",,"GAN001","GAS002","GAF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050009-02","KP GA Bronze 6200/40%/HSA - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Bronze_6200_40_HSA_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060017","KP GA Silver 4000/30/50/S5","89942GA006",,"GAN001","GAS001","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060017-00","KP GA Silver 4000/30/50/S5","Standard Silver Off Exchange Plan","68.92%","0.687745184954887","No","Yes","No","100%",,"$4,000","$40","$1,900","$60","$500","$1,900","$0","$50","$1,500","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20SILVER%204000_30_50_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010015","CareSource Bronze","54192IN001",,"INN001","INS001","INF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9938",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010015-02","CareSource Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-in-bronzezero-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010015","CareSource Bronze","54192IN001",,"INN001","INS001","INF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9938",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010015-03","CareSource Bronze Limited","Limited Cost Sharing Plan Variation",,"0.617591524943191","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-in-bronzeltd-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050022","KP GA Signature Gold 1500/20","89942GA005",,"GAN002","GAS003","GAF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050022-02","KP GA Signature Gold 1500/20 - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Gold_1500_20_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050022","KP GA Signature Gold 1500/20","89942GA005",,"GAN002","GAS003","GAF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050022-03","KP GA Signature Gold 1500/20 - AI/LTD","Limited Cost Sharing Plan Variation","78.31%","0.781232169023135","No","Yes","No","100%",,"$1,500","$30","$2,800","$60","$1,500","$1,100","$10","$50","$1,500","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Gold_1500_20_AI_Ltd.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050005","KP GA Silver 3000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050005-00","KP GA Silver 3000/30","Standard Silver Off Exchange Plan","70.80%","0.70446178994465","No","Yes","No","100%",,"$3,000","$40","$2,900","$60","$3,000","$1,200","$0","$50","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_3000_30.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060004","KP GA Silver 2500/30/50/S5","89942GA006",,"GAN001","GAS001","GAF018","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060004-00","KP GA Silver 2500/30/50/S5","Standard Silver Off Exchange Plan","71.03%","0.708623021797257","No","Yes","No","100%",,"$2,500","$40","$2,300","$60","$500","$1,900","$0","$50","$1,500","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20SILVER%202500_30_50_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050005","KP GA Silver 3000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050005-01","KP GA Silver 3000/30","Standard Silver On Exchange Plan","70.80%","0.70446178994465","No","Yes","No","100%",,"$3,000","$40","$2,900","$60","$3,000","$1,200","$0","$50","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_3000_30.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050005","KP GA Silver 3000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050005-02","KP GA Silver 3000/30 - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_3000_30_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050005","KP GA Silver 3000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050005-03","KP GA Silver 3000/30 - AI/LTD","Limited Cost Sharing Plan Variation","70.80%","0.70446178994465","No","Yes","No","100%",,"$3,000","$40","$2,900","$60","$3,000","$1,200","$0","$50","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_3000_30_AI_Ltd.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050005","KP GA Silver 3000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050005-04","KP GA Silver 2000/30/73% CSR","73% AV Level Silver Plan","73.95%","0.736079834677515","No","Yes","No","100%",,"$2,000","$0","$3,200","$60","$2,500","$1,300","$10","$50","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_2000_30_73_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050005","KP GA Silver 3000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050005-05","KP GA Silver 0/15/ 87% CSR","87% AV Level Silver Plan","87.91%","0.874199347892811","No","Yes","No","100%",,"$0","$40","$2,300","$60","$0","$1,500","$60","$60","$0","$100","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_0_15_87_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050005","KP GA Silver 3000/30","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050005-06","KP GA Silver 0/5/94% CSR","94% AV Level Silver Plan","94.75%","0.947708698063416","No","Yes","No","100%",,"$0","$20","$1,000","$60","$0","$500","$30","$60","$0","$50","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_0_5_94_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050017","KP GA Signature Silver 3000/30","89942GA005",,"GAN002","GAS003","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050017-00","KP GA Signature Silver 3000/30","Standard Silver Off Exchange Plan","70.83%","0.70446178994465","No","Yes","No","100%",,"$3,000","$40","$2,900","$60","$3,000","$1,200","$0","$50","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_3000_30.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050017","KP GA Signature Silver 3000/30","89942GA005",,"GAN002","GAS003","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050017-01","KP GA Signature Silver 3000/30","Standard Silver On Exchange Plan","70.83%","0.70446178994465","No","Yes","No","100%",,"$3,000","$40","$2,900","$60","$3,000","$1,200","$0","$50","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_3000_30.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050017","KP GA Signature Silver 3000/30","89942GA005",,"GAN002","GAS003","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050017-02","KP GA SignatureSilver 3000/30 - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_3000_30_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050017","KP GA Signature Silver 3000/30","89942GA005",,"GAN002","GAS003","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050017-03","KP GA Signature Silver 3000/30 - AI/LTD","Limited Cost Sharing Plan Variation","70.83%","0.70446178994465","No","Yes","No","100%",,"$3,000","$40","$2,900","$60","$3,000","$1,200","$0","$50","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_3000_30_AI_Ltd.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050017","KP GA Signature Silver 3000/30","89942GA005",,"GAN002","GAS003","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050017-04","KP GA Signature Silver 2000/30/73% CSR","73% AV Level Silver Plan","73.98%","0.736079834677515","No","Yes","No","100%",,"$2,000","$0","$3,200","$60","$2,500","$1,300","$10","$50","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_2000_30_73_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050017","KP GA Signature Silver 3000/30","89942GA005",,"GAN002","GAS003","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050017-05","KP GA Signature Silver 0/15/ 87% CSR","87% AV Level Silver Plan","87.93%","0.874199347892811","No","Yes","No","100%",,"$0","$40","$2,300","$60","$0","$1,500","$60","$60","$0","$100","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_0_15_87_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050017","KP GA Signature Silver 3000/30","89942GA005",,"GAN002","GAS003","GAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050017-06","KP  GA Signature Silver 0/5/94% CSR","94% AV Level Silver Plan","94.77%","0.947708698063416","No","Yes","No","100%",,"$0","$20","$1,000","$60","$0","$500","$30","$60","$0","$50","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_0_5_94_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20% HSA","89942GA005",,"GAN001","GAS002","GAF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050006-00","KP GA Silver 2750/20% HSA","Standard Silver Off Exchange Plan","69.18%","0.686585392862569","Yes","Yes","No","100%",,"$2,750","$40","$2,000","$60","$2,750","$1,000","$90","$50","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_2750_20_HSA.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060005","KP GA Silver 2000/40/40/S5","89942GA006",,"GAN001","GAS001","GAF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060005-00","KP GA Silver 2000/40/40/S5","Standard Silver Off Exchange Plan","71.66%","0.714975868426162","No","Yes","No","100%",,"$2,000","$40","$3,300","$60","$500","$1,800","$0","$50","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20SILVER%202000_40_40_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060005","KP GA Silver 2000/40/40/S5","89942GA006",,"GAN001","GAS001","GAF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060005-01","KP GA Silver 2000/40/40/S5","Standard Silver On Exchange Plan","71.66%","0.714975868426162","No","Yes","No","100%",,"$2,000","$40","$3,300","$60","$500","$1,800","$0","$50","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20SILVER%202000_40_40_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20% HSA","89942GA005",,"GAN001","GAS002","GAF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050006-01","KP GA Silver 2750/20% HSA","Standard Silver On Exchange Plan","69.18%","0.686585392862569","Yes","Yes","No","100%",,"$2,750","$40","$2,000","$60","$2,750","$1,000","$90","$50","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_2750_20_HSA.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20% HSA","89942GA005",,"GAN001","GAS002","GAF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050006-02","KP GA Silver 2750/20% HSA - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_2750_20_HSA_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20% HSA","89942GA005",,"GAN001","GAS002","GAF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050006-03","KP GA Silver 2750/20% HSA - AI/L","Limited Cost Sharing Plan Variation","69.18%","0.686585392862569","Yes","Yes","No","100%",,"$2,750","$40","$2,000","$60","$2,750","$1,000","$90","$50","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_2750_20_HSA_AI_Ltd.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20% HSA","89942GA005",,"GAN001","GAS002","GAF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050006-04","KP GA Silver 1700/20%/73% CSR","73% AV Level Silver Plan","73.87%","0.737957820506329","Yes","Yes","No","100%",,"$1,700","$40","$2,200","$60","$1,700","$1,200","$100","$60","$1,700","$0","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_1700_20_73_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20% HSA","89942GA005",,"GAN001","GAS002","GAF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050006-05","KP GA Silver 500/10%/87% CSR","87% AV Level Silver Plan","87.39%","0.87323577097334","Yes","Yes","No","100%",,"$500","$30","$1,200","$60","$500","$800","$100","$60","$500","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_500_10_87_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050018","KP GA Signature Silver 2750/20% HSA","89942GA005",,"GAN002","GAS003","GAF006","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050018-00","KP GA Signature Silver 2750/20% HSA","Standard Silver Off Exchange Plan","69.19%","0.686585392862569","Yes","Yes","No","100%",,"$2,750","$40","$2,000","$60","$2,750","$1,000","$90","$50","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_2750_20_HSA.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050018","KP GA Signature Silver 2750/20% HSA","89942GA005",,"GAN002","GAS003","GAF006","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050018-01","KP GA Signature Silver 2750/20% HSA","Standard Silver On Exchange Plan","69.19%","0.686585392862569","Yes","Yes","No","100%",,"$2,750","$40","$2,000","$60","$2,750","$1,000","$90","$50","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_2750_20_HSA.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050018","KP GA Signature Silver 2750/20% HSA","89942GA005",,"GAN002","GAS003","GAF006","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050018-02","KP GA Signature Silver 2750/20% HSA - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_2750_20_HSA_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050018","KP GA Signature Silver 2750/20% HSA","89942GA005",,"GAN002","GAS003","GAF006","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050018-03","KP GA Signature Silver 2750/20% HSA - AI/LTD","Limited Cost Sharing Plan Variation","69.19%","0.686585392862569","Yes","Yes","No","100%",,"$2,750","$40","$2,000","$60","$2,750","$1,000","$90","$50","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_2750_20_HSA_AI_Ltd.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050018","KP GA Signature Silver 2750/20% HSA","89942GA005",,"GAN002","GAS003","GAF006","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050018-04","KP GA Signature Silver 1700/20%/73% CSR","73% AV Level Silver Plan","73.88%","0.737957820506329","Yes","Yes","No","100%",,"$1,700","$40","$2,200","$60","$1,700","$1,200","$100","$60","$1,700","$0","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_1700_20_73_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050018","KP GA Signature Silver 2750/20% HSA","89942GA005",,"GAN002","GAS003","GAF006","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050018-05","KP GA Signature Silver 500/10%/87% CSR","87% AV Level Silver Plan","87.41%","0.87323577097334","Yes","Yes","No","100%",,"$500","$30","$1,200","$60","$500","$800","$100","$60","$500","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_500_10_87_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050018","KP GA Signature Silver 2750/20% HSA","89942GA005",,"GAN002","GAS003","GAF006","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050018-06","KP GA Signature Silver 100/5%/94% CSR","94% AV Level Silver Plan","94.58%","0.944391300184168","Yes","Yes","No","100%",,"$100","$30","$600","$60","$100","$800","$60","$60","$100","$0","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_100_5_94_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050014","KP GA Silver Std 3500/30","89942GA005",,"GAN001","GAS002","GAF007","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050014-00","KP GA Silver Std 3500/30","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$40","$1,800","$60","$200","$1,800","$0","$50","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_STD_3500_30.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060006","KP GA Bronze 5250/40/40/S5","89942GA006",,"GAN001","GAS001","GAF018","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060006-00","KP GA Bronze 5250/40/40/S5","Standard Bronze Off Exchange Plan","63.37%","0.630433293742581","Yes","Yes","No","100%",,"$5,250","$40","$2,000","$60","$4,100","$1,000","$0","$50","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20BRONZE%205250_40_40_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060006","KP GA Bronze 5250/40/40/S5","89942GA006",,"GAN001","GAS001","GAF018","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060006-01","KP GA Bronze 5250/40/40/S5","Standard Bronze On Exchange Plan","63.37%","0.630433293742581","Yes","Yes","No","100%",,"$5,250","$40","$2,000","$60","$4,100","$1,000","$0","$50","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20BRONZE%205250_40_40_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050014","KP GA Silver Std 3500/30","89942GA005",,"GAN001","GAS002","GAF007","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050014-01","KP GA Silver Std 3500/30","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$40","$1,800","$60","$200","$1,800","$0","$50","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_STD_3500_30.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050014","KP GA Silver Std 3500/30","89942GA005",,"GAN001","GAS002","GAF007","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050014-02","KP GA Silver Std 3500/30 - AI/0","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_STD_3500_30_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050014","KP GA Silver Std 3500/30","89942GA005",,"GAN001","GAS002","GAF007","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050014-04","KP GA Silver Std 3000/30/73% CSR","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$40","$1,900","$60","$200","$1,800","$0","$50","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_STD_3000_30_73_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050014","KP GA Silver Std 3500/30","89942GA005",,"GAN001","GAS002","GAF007","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050014-05","KP GA Silver Std 700/10/87% CSR","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$20","$1,800","$60","$200","$800","$0","$50","$700","$80","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_STD_700_10_87_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050014","KP GA Silver Std 3500/30","89942GA005",,"GAN001","GAS002","GAF007","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050014-06","KP GA Silver Std 250/5 94% CSR","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$10","$600","$60","$200","$300","$0","$50","$250","$30","$70","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_STD_250_5_94_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050023","KP GA Signature Silver Std 3500/30","89942GA005",,"GAN002","GAS003","GAF008","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050023-00","KP GA Signature Silver Std 3500/30","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$40","$1,800","$60","$200","$1,800","$0","$50","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_STD_3500_30.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050023","KP GA Signature Silver Std 3500/30","89942GA005",,"GAN002","GAS003","GAF008","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050023-01","KP GA Signature Silver Std 3500/30","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$40","$1,800","$60","$200","$1,800","$0","$50","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_STD_3500_30.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050023","KP GA Signature Silver Std 3500/30","89942GA005",,"GAN002","GAS003","GAF008","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050023-02","KP GA Signature Silver Std 3500/30 - AI/0","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_STD_3500_30_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050023","KP GA Signature Silver Std 3500/30","89942GA005",,"GAN002","GAS003","GAF008","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050023-03","KP GA Signature Silver Std 3500/30 - AI/LTD","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$40","$1,800","$60","$200","$1,800","$0","$50","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_STD_3500_30_AI_Ltd.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050023","KP GA Signature Silver Std 3500/30","89942GA005",,"GAN002","GAS003","GAF008","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050023-04","KP GA Signature Silver Std 3000/30/73% CSR","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$40","$1,900","$60","$200","$1,800","$0","$50","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_STD_3000_30_73_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050023","KP GA Signature Silver Std 3500/30","89942GA005",,"GAN002","GAS003","GAF008","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050023-06","KP GA Signature Silver Std 250/5/ 94% CSR","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$10","$600","$60","$200","$300","$0","$50","$250","$30","$70","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_STD_250_5_94_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050024","KP GA Silver 4700/35","89942GA005",,"GAN001","GAS002","GAF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050024-00","KP GA Silver 4700/35","Standard Silver Off Exchange Plan","66.45%","0.661579785241012","Yes","Yes","No","100%",,"$4,700","$40","$2,400","$60","$3,800","$11,090","$0","$50","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_4700_35.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060007","KP GA Silver HDHP/2800/20/S5","89942GA006",,"GAN001","GAS001","GAF019","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060007-00","KP GA Silver HDHP/2800/20/S5","Standard Silver Off Exchange Plan","69.31%","0.693141781845102","Yes","Yes","No","100%",,"$2,800","$0","$1,500","$60","$2,800","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/HDHP%20SILVER%202800_20_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060007","KP GA Silver HDHP/2800/20/S5","89942GA006",,"GAN001","GAS001","GAF019","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060007-01","KP GA Silver HDHP/2800/20/S5","Standard Silver On Exchange Plan","69.31%","0.693141781845102","Yes","Yes","No","100%",,"$2,800","$0","$1,500","$60","$2,800","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/HDHP%20SILVER%202800_20_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050024","KP GA Silver 4700/35","89942GA005",,"GAN001","GAS002","GAF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050024-01","KP GA Silver 4700/35","Standard Silver On Exchange Plan","66.45%","0.661579785241012","Yes","Yes","No","100%",,"$4,700","$40","$2,400","$60","$3,800","$11,090","$0","$50","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_4700_35.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050024","KP GA Silver 4700/35","89942GA005",,"GAN001","GAS002","GAF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050024-02","KP GA Silver 4700/35 - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_4700_35_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050024","KP GA Silver 4700/35","89942GA005",,"GAN001","GAS002","GAF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050024-03","KP GA Silver 4700/35 - AI/LTD","Limited Cost Sharing Plan Variation","66.45%","0.661579785241012","Yes","Yes","No","100%",,"$4,700","$40","$2,400","$60","$3,800","$11,090","$0","$50","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_4700_35_AI_Ltd.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050024","KP GA Silver 4700/35","89942GA005",,"GAN001","GAS002","GAF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050024-04","KP GA 2000/35  73% CSR","73% AV Level Silver Plan","73.45%","0.731654859451033","Yes","Yes","No","100%",,"$2,000","$40","$3,200","$60","$2,000","$1,500","$10","$50","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_4700_35_73_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050024","KP GA Silver 4700/35","89942GA005",,"GAN001","GAS002","GAF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050024-05","KP GA 500/15  87% CSR","87% AV Level Silver Plan","87.94%","0.878391084205738","Yes","Yes","No","100%",,"$500","$30","$1,500","$60","$500","$1,000","$10","$50","$500","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_4700_35_87_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050024","KP GA Silver 4700/35","89942GA005",,"GAN001","GAS002","GAF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050024-06","KP GA 100/5  94% CSR","94% AV Level Silver Plan","94.04%","0.939315771022796","Yes","Yes","No","100%",,"$100","$30","$900","$60","$100","$900","$20","$50","$100","$50","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Silver_4700_35_94_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050025","KP GA Signature Silver 4700/35","89942GA005",,"GAN002","GAS003","GAF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050025-00","KP GA Signature Silver 4700/35","Standard Silver Off Exchange Plan","66.47%","0.661579785241012","Yes","Yes","No","100%",,"$4,700","$40","$2,400","$60","$3,800","$11,090","$0","$50","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_4700_35.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050025","KP GA Signature Silver 4700/35","89942GA005",,"GAN002","GAS003","GAF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050025-01","KP GA Signature Silver 4700/35","Standard Silver On Exchange Plan","66.47%","0.661579785241012","Yes","Yes","No","100%",,"$4,700","$40","$2,400","$60","$3,800","$11,090","$0","$50","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_4700_35.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050025","KP GA Signature Silver 4700/35","89942GA005",,"GAN002","GAS003","GAF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050025-02","KP GA Signature Silver 4700/35 - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_4700_35_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050025","KP GA Signature Silver 4700/35","89942GA005",,"GAN002","GAS003","GAF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050025-04","KP GA Signature Silver 2000-35  73% CSR","73% AV Level Silver Plan","73.47%","0.731654859451033","Yes","Yes","No","100%",,"$2,000","$40","$3,200","$60","$2,000","$1,500","$10","$50","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_4700_35_73_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050025","KP GA Signature Silver 4700/35","89942GA005",,"GAN002","GAS003","GAF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050025-05","KP GA Signature Silver 500-15  87% CSR","87% AV Level Silver Plan","87.96%","0.878391084205738","Yes","Yes","No","100%",,"$500","$30","$1,500","$60","$500","$1,000","$10","$50","$500","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_4700_35_87_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050025","KP GA Signature Silver 4700/35","89942GA005",,"GAN002","GAS003","GAF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050025-06","KP GA Signature 100-5  94% CSR","94% AV Level Silver Plan","94.06%","0.939315771022796","Yes","Yes","No","100%",,"$100","$30","$900","$60","$100","$900","$20","$50","$100","$50","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Silver_4700_35_94_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050007","KP GA Bronze 5000/50","89942GA005",,"GAN001","GAS002","GAF009","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050007-00","KP GA Bronze 5000/50","Standard Bronze Off Exchange Plan","61.89%","0.606490766728951","No","Yes","No","100%",,"$5,000","$40","$2,400","$60","$3,800","$1,700","$0","$50","$1,700","$200","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Bronze_5000_50.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060009","KP GA Bronze HDHP/5000/40/S5","89942GA006",,"GAN001","GAS001","GAF020","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060009-00","KP GA Bronze HDHP/5000/40/S5","Standard Bronze Off Exchange Plan","61.32%","0.61323259612226","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$60","$5,000","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/HDHP%20BRONZE%205000_40_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060009","KP GA Bronze HDHP/5000/40/S5","89942GA006",,"GAN001","GAS001","GAF020","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060009-01","KP GA Bronze HDHP/5000/40/S5","Standard Bronze On Exchange Plan","61.32%","0.61323259612226","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$60","$5,000","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/HDHP%20BRONZE%205000_40_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050007","KP GA Bronze 5000/50","89942GA005",,"GAN001","GAS002","GAF009","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050007-01","KP GA Bronze 5000/50","Standard Bronze On Exchange Plan","61.89%","0.606490766728951","No","Yes","No","100%",,"$5,000","$40","$2,400","$60","$3,800","$1,700","$0","$50","$1,700","$200","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Bronze_5000_50.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050007","KP GA Bronze 5000/50","89942GA005",,"GAN001","GAS002","GAF009","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050007-02","KP GA Bronze 5000/50 - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Bronze_5000_50_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","IN","28856","HIOS","2017-07-30 02:12:13","Individual","Yes","35-1545647","28856IN0220001","Delta Dental Individual PPO, EHB Certified (Exchange)","28856IN022",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28856","","28856IN0220001-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalin.com/IN_EHB_High_2018","http://www.deltadentalin.com/IN_EHB_High_2018"
"2018","IN","28856","HIOS","2017-07-30 02:12:13","SHOP (Small Group)","Yes","35-1545647","28856IN0190003","Delta Dental Group PPO, EHB Certified","28856IN019",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0190003-00","Delta Dental Group PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","28856","HIOS","2017-07-30 02:12:13","SHOP (Small Group)","Yes","35-1545647","28856IN0190004","Delta Dental Group PPO, EHB Certified","28856IN019",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0190004-00","Delta Dental Group PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","28856","HIOS","2017-07-30 02:12:13","Individual","Yes","35-1545647","28856IN0220002","Delta Dental Individual PPO, EHB Certified (Exchange)","28856IN022",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28856","","28856IN0220002-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalin.com/IN_EHB_Low_2018","http://www.deltadentalin.com/IN_EHB_Low_2018"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010017","CareSource Hoosier Choice Bronze","54192IN001",,"INN002","INS002","INF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9938",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010017-02","CareSource Hoosier Choice Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-bronzezero-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010017","CareSource Hoosier Choice Bronze","54192IN001",,"INN002","INS002","INF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9938",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010017-03","CareSource Hoosier Choice Bronze Limited","Limited Cost Sharing Plan Variation",,"0.617591524943191","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-bronzeltd-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010014","CareSource Silver","54192IN001",,"INN001","INS001","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9948",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010014-00","CareSource Silver","Standard Silver Off Exchange Plan",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-in-silver-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010014","CareSource Silver","54192IN001",,"INN001","INS001","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9948",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010014-01","CareSource Silver","Standard Silver On Exchange Plan",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-in-silver-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050007","KP GA Bronze 5000/50","89942GA005",,"GAN001","GAS002","GAF009","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050007-03","KP GA Bronze 5000/50 - AI/LTD","Limited Cost Sharing Plan Variation","61.89%","0.606490766728951","No","Yes","No","100%",,"$5,000","$40","$2,400","$60","$3,800","$1,700","$0","$50","$1,700","$200","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Bronze_5000_50_AI_Ltd.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050019","KP GA Signature Bronze 5000/50","89942GA005",,"GAN001","GAS003","GAF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050019-00","KP GA Signature Bronze 5000/50","Standard Bronze Off Exchange Plan","61.89%","0.606490766728951","No","Yes","No","100%",,"$5,000","$40","$2,400","$60","$3,800","$1,700","$0","$50","$1,700","$200","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Bronze_5000_50.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050019","KP GA Signature Bronze 5000/50","89942GA005",,"GAN001","GAS003","GAF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050019-01","KP GA Signature Bronze 5000/50","Standard Bronze On Exchange Plan","61.89%","0.606490766728951","No","Yes","No","100%",,"$5,000","$40","$2,400","$60","$3,800","$1,700","$0","$50","$1,700","$200","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Bronze_5000_50.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050019","KP GA Signature Bronze 5000/50","89942GA005",,"GAN001","GAS003","GAF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050019-02","KP GA Signature Bronze 5000/50 - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Bronze_5000_50_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050019","KP GA Signature Bronze 5000/50","89942GA005",,"GAN001","GAS003","GAF010","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050019-03","KP GA Signature Bronze 5000/50 - AI/LTD","Limited Cost Sharing Plan Variation","61.89%","0.606490766728951","No","Yes","No","100%",,"$5,000","$40","$2,400","$60","$3,800","$1,700","$0","$50","$1,700","$200","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Bronze_5000_50_AI_Ltd.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050009","KP GA Bronze 6200/40%/HSA","89942GA005",,"GAN001","GAS002","GAF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050009-00","KP GA Bronze 6200/40%/HSA","Standard Bronze Off Exchange Plan","61.19%","0.605519376285678","Yes","Yes","No","100%",,"$6,200","$0","$400","$60","$6,200","$0","$400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Bronze_6200_40_HSA.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060011","KP GA Silver HRA/2000/40/S5","89942GA006",,"GAN001","GAS001","GAF020","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060011-00","KP GA Silver HRA/2000/40/S5","Standard Silver Off Exchange Plan","71.80%","0.717986441059444","Yes","Yes","No","100%",,"$2,800","$0","$1,500","$60","$2,800","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","Yes","$350.00","http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20HRA%20SILVER%202000_40_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060011","KP GA Silver HRA/2000/40/S5","89942GA006",,"GAN001","GAS001","GAF020","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060011-01","KP GA Silver HRA/2000/40/S5","Standard Silver On Exchange Plan","71.80%","0.717986441059444","Yes","Yes","No","100%",,"$2,800","$0","$1,500","$60","$2,800","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","Yes","$350.00","http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20HRA%20SILVER%202000_40_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050009","KP GA Bronze 6200/40%/HSA","89942GA005",,"GAN001","GAS002","GAF011","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050009-03","KP GA Bronze 6200/40%/HSA - AI/LTD","Limited Cost Sharing Plan Variation","61.19%","0.605519376285678","Yes","Yes","No","100%",,"$6,200","$0","$400","$60","$6,200","$0","$400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Bronze_6200_40_HSA_AI_Ltd.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050020","KP GA Signature Bronze 6200/40%/HSA","89942GA005",,"GAN001","GAS003","GAF012","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050020-00","KP GA Signature Bronze 6200/40%/HSA","Standard Bronze Off Exchange Plan","61.19%","0.605519376285678","Yes","Yes","No","100%",,"$6,200","$0","$400","$60","$6,200","$0","$400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Bronze_6200_40_HSA.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050020","KP GA Signature Bronze 6200/40%/HSA","89942GA005",,"GAN001","GAS003","GAF012","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050020-01","KP GA Signature Bronze 6200/40%/HSA","Standard Bronze On Exchange Plan","61.19%","0.605519376285678","Yes","Yes","No","100%",,"$6,200","$0","$400","$60","$6,200","$0","$400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Bronze_6200_40_HSA.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050020","KP GA Signature Bronze 6200/40%/HSA","89942GA005",,"GAN001","GAS003","GAF012","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050020-02","KP GA Signature Bronze 6200/40%/HSA - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Bronze_6200_40_HSA_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050020","KP GA Signature Bronze 6200/40%/HSA","89942GA005",,"GAN001","GAS003","GAF012","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050020-03","KP GA Signature Bronze 6200/40%/HSA - AI/LTD","Limited Cost Sharing Plan Variation","61.19%","0.605519376285678","Yes","Yes","No","100%",,"$6,200","$0","$400","$60","$6,200","$0","$400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Bronze_6200_40_HSA_AI_Ltd.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050010","KP GA Catastrophic 7350/0","89942GA005",,"GAN001","GAS002","GAF013","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050010-00","KP GA Catastrophic 7350/0","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Catastrophic_7350_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060012","KP GA Gold 1500/0/30/S5","89942GA006",,"GAN001","GAS001","GAF015","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060012-00","KP GA Gold 1500/0/30/S5","Standard Gold Off Exchange Plan","81.61%","0.815910582530223","No","Yes","No","100%",,"$1,500","$50","$0","$60","$70","$1,400","$0","$50","$200","$1,200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20GOLD%201500_0_30_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060012","KP GA Gold 1500/0/30/S5","89942GA006",,"GAN001","GAS001","GAF015","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060012-01","KP GA Gold 1500/0/30/S5","Standard Gold On Exchange Plan","81.61%","0.815910582530223","No","Yes","No","100%",,"$1,500","$50","$0","$60","$70","$1,400","$0","$50","$200","$1,200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20GOLD%201500_0_30_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050010","KP GA Catastrophic 7350/0","89942GA005",,"GAN001","GAS002","GAF013","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050010-01","KP GA Catastrophic 7350/0","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Catastrophic_7350_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050021","KP GA Signature Catastrophic 7350/0","89942GA005",,"GAN002","GAS003","GAF014","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050021-00","KP GA Signature Catastrophic 7350/0","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Catastrophic_7350_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","Individual","No","58-1592076","89942GA0050021","KP GA Signature Catastrophic 7350/0","89942GA005",,"GAN002","GAS003","GAF014","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.990849161228205",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0050021-01","KP GA Signature Catastrophic 7350/0","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/2018-ON-Exchange/KP_GA_Signature_Catastrophic_7350_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060013","KP GA Silver 3000/20/50/S5","89942GA006",,"GAN001","GAS001","GAF018","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060013-00","KP GA Silver 3000/20/50/S5","Standard Silver Off Exchange Plan","71.66%","0.714828635880563","No","Yes","No","100%",,"$3,000","$200","$1,200","$60","$300","$1,900","$0","$50","$1,500","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20SILVER%203000_20_50_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060013","KP GA Silver 3000/20/50/S5","89942GA006",,"GAN001","GAS001","GAF018","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060013-01","KP GA Silver 3000/20/50/S5","Standard Silver On Exchange Plan","71.66%","0.714828635880563","No","Yes","No","100%",,"$3,000","$200","$1,200","$60","$300","$1,900","$0","$50","$1,500","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20SILVER%203000_20_50_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060014","KP GA Gold 500/20/30/S5","89942GA006",,"GAN001","GAS001","GAF015","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060014-00","KP GA Gold 500/20/30/S5","Standard Gold Off Exchange Plan","81.41%","0.813372494621378","No","Yes","No","100%",,"$500","$80","$1,700","$60","$70","$1,400","$0","$50","$200","$1,200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20GOLD%20500_20_30_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060014","KP GA Gold 500/20/30/S5","89942GA006",,"GAN001","GAS001","GAF015","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060014-01","KP GA Gold 500/20/30/S5","Standard Gold On Exchange Plan","81.41%","0.813372494621378","No","Yes","No","100%",,"$500","$80","$1,700","$60","$70","$1,400","$0","$50","$200","$1,200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20GOLD%20500_20_30_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060015","KP GA Bronze 6000/40/50/S5","89942GA006",,"GAN001","GAS001","GAF021","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060015-00","KP GA Bronze 6000/40/50/S5","Standard Bronze Off Exchange Plan","62.44%","0.621021084064394","Yes","Yes","No","100%",,"$6,000","$40","$1,400","$60","$4,100","$1,100","$0","$50","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20BRONZE%206000_40_50_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060015","KP GA Bronze 6000/40/50/S5","89942GA006",,"GAN001","GAS001","GAF021","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060015-01","KP GA Bronze 6000/40/50/S5","Standard Bronze On Exchange Plan","62.44%","0.621021084064394","Yes","Yes","No","100%",,"$6,000","$40","$1,400","$60","$4,100","$1,100","$0","$50","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20BRONZE%206000_40_50_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060016","KP GA Bronze HDHP/6550/0/S5","89942GA006",,"GAN001","GAS001","GAF022","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060016-00","KP GA Bronze HDHP/6550/0/S5","Standard Bronze Off Exchange Plan","60.49%","0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/HDHP%20BRONZE%206550_0_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060016","KP GA Bronze HDHP/6550/0/S5","89942GA006",,"GAN001","GAS001","GAF022","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060016-01","KP GA Bronze HDHP/6550/0/S5","Standard Bronze On Exchange Plan","60.49%","0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/HDHP%20BRONZE%206550_0_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060018","KP GA Gold 1750/20/50/S5","89942GA006",,"GAN001","GAS001","GAF016","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060018-00","KP GA Gold 1750/20/50/S5","Standard Gold Off Exchange Plan","76.48%","0.757377293803469","No","Yes","No","100%",,"$1,800","$80","$1,500","$60","$300","$1,600","$0","$50","$1,500","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20GOLD%201750_20_50_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060018","KP GA Gold 1750/20/50/S5","89942GA006",,"GAN001","GAS001","GAF016","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060018-01","KP GA Gold 1750/20/50/S5","Standard Gold On Exchange Plan","76.48%","0.757377293803469","No","Yes","No","100%",,"$1,800","$80","$1,500","$60","$300","$1,600","$0","$50","$1,500","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20GOLD%201750_20_50_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","GA","89942","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","No","58-1592076","89942GA0060017","KP GA Silver 4000/30/50/S5","89942GA006",,"GAN001","GAS001","GAF018","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.984090494418256",,,"2018-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierformulary_2018.pdf","89942GA0060017-01","KP GA Silver 4000/30/50/S5","Standard Silver On Exchange Plan","68.92%","0.687745184954887","No","Yes","No","100%",,"$4,000","$40","$1,900","$60","$500","$1,900","$0","$50","$1,500","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org//healthplans/georgia/smallbusiness/pdfs/2018-ON-Exchange/KP%20SILVER%204000_30_50_S5.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/ga2018planbrochure.pdf"
"2018","IN","17575","HIOS","2017-08-05 02:21:19","SHOP (Small Group)","Yes","35-0781558","17575IN0890003","Anthem Dental Family","17575IN089",,"INN005","INS019",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","17575IN0890003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e214300.pdf",
"2018","IN","17575","HIOS","2017-08-05 02:21:19","Individual","Yes","35-0781558","17575IN0860005","Anthem Dental Family Value","17575IN086",,"INN005","INS019",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","17575IN0860005-01","Anthem Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e214302.pdf",
"2018","IN","17575","HIOS","2017-08-05 02:21:19","Individual","Yes","35-0781558","17575IN0920005","Anthem Dental Family Value","17575IN092",,"INN005","INS019",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","17575IN0920005-00","Anthem Dental Family Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e214302.pdf",
"2018","IN","17575","HIOS","2017-08-05 02:21:19","Individual","Yes","35-0781558","17575IN0860003","Anthem Dental Family","17575IN086",,"INN005","INS019",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","17575IN0860003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e214300.pdf",
"2018","IN","17575","HIOS","2017-08-05 02:21:19","SHOP (Small Group)","Yes","35-0781558","17575IN0890004","Anthem Dental Family Enhanced","17575IN089",,"INN005","INS019",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.834","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","17575IN0890004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e214301.pdf",
"2018","IN","17575","HIOS","2017-08-05 02:21:19","Individual","Yes","35-0781558","17575IN0920003","Anthem Dental Family","17575IN092",,"INN005","INS019",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","17575IN0920003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e214300.pdf",
"2018","IN","17575","HIOS","2017-08-05 02:21:19","Individual","Yes","35-0781558","17575IN0860004","Anthem Dental Family Enhanced","17575IN086",,"INN005","INS019",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.834","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","17575IN0860004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e214301.pdf",
"2018","IN","17575","HIOS","2017-08-05 02:21:19","Individual","Yes","35-0781558","17575IN0920004","Anthem Dental Family Enhanced","17575IN092",,"INN005","INS019",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.834","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","17575IN0920004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e214301.pdf",
"2018","IN","28856","HIOS","2017-07-30 02:12:13","Individual","Yes","35-1545647","28856IN0160001","Delta Dental Individual PPO, EHB Certified","28856IN016",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0160001-00","Delta Dental Individual PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","28856","HIOS","2017-07-30 02:12:13","SHOP (Small Group)","Yes","35-1545647","28856IN0190001","Delta Dental Group PPO, EHB Certified","28856IN019",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0190001-00","Delta Dental Group PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","28856","HIOS","2017-07-30 02:12:13","SHOP (Small Group)","Yes","35-1545647","28856IN0190002","Delta Dental Group PPO, EHB Certified","28856IN019",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0190002-00","Delta Dental Group PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","28856","HIOS","2017-07-30 02:12:13","Individual","Yes","35-1545647","28856IN0160002","Delta Dental Individual PPO, EHB Certified","28856IN016",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0160002-00","Delta Dental Individual PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","28856","HIOS","2017-07-30 02:12:13","Individual","Yes","35-1545647","28856IN0170001","Delta Dental Individual Pediatric-Only PPO, EHB Certified","28856IN017",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0170001-00","Delta Dental Individual Pediatric-Only PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","28856","HIOS","2017-07-30 02:12:13","SHOP (Small Group)","Yes","35-1545647","28856IN0180001","Delta Dental Group Pediatric-Only PPO, EHB Certified","28856IN018",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0180001-00","Delta Dental Group Pediatric-Only PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","28856","HIOS","2017-07-30 02:12:13","SHOP (Small Group)","Yes","35-1545647","28856IN0180002","Delta Dental Group Pediatric-Only PPO, EHB Certified","28856IN018",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0180002-00","Delta Dental Group Pediatric-Only PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","28856","HIOS","2017-07-30 02:12:13","Individual","Yes","35-1545647","28856IN0170002","Delta Dental Individual Pediatric-Only PPO, EHB Certified","28856IN017",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0170002-00","Delta Dental Individual Pediatric-Only PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","28856","HIOS","2017-07-30 02:12:13","Individual","Yes","35-1545647","28856IN0230001","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","28856IN023",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28856","","28856IN0230001-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalin.com/IN_Ped_High_2018","http://www.deltadentalin.com/IN_Ped_High_2018"
"2018","IN","28856","HIOS","2017-07-30 02:12:13","SHOP (Small Group)","Yes","35-1545647","28856IN0180003","Delta Dental Group Pediatric-Only PPO, EHB Certified","28856IN018",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0180003-00","Delta Dental Group Pediatric-Only PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","28856","HIOS","2017-07-30 02:12:13","Individual","Yes","35-1545647","28856IN0230002","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","28856IN023",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28856","","28856IN0230002-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalin.com/IN_Ped_Low_2018","http://www.deltadentalin.com/IN_Ped_Low_2018"
"2018","IN","28856","HIOS","2017-07-30 02:12:13","SHOP (Small Group)","Yes","35-1545647","28856IN0180004","Delta Dental Group Pediatric-Only PPO, EHB Certified","28856IN018",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28856IN0180004-00","Delta Dental Group Pediatric-Only PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010010","CareSource HSA Bronze","54192IN001",,"INN001","INS001","INF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9943",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010010-00","CareSource HSA Bronze","Standard Bronze Off Exchange Plan",,"0.618651277477805","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"https://www.caresource.com/document/MP-2018-in-hsa-bronze-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010010","CareSource HSA Bronze","54192IN001",,"INN001","INS001","INF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9943",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010010-01","CareSource HSA Bronze","Standard Bronze On Exchange Plan",,"0.618651277477805","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"https://www.caresource.com/document/MP-2018-in-hsa-bronze-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010010","CareSource HSA Bronze","54192IN001",,"INN001","INS001","INF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9943",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010010-02","CareSource HSA Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hsa-bronzezero-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010010","CareSource HSA Bronze","54192IN001",,"INN001","INS001","INF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9943",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010010-03","CareSource HSA Bronze Limited","Limited Cost Sharing Plan Variation",,"0.618651277477805","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"https://www.caresource.com/document/MP-2018-in-hsa-bronzeltd-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010011","CareSource Low Premium Silver","54192IN001",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010011-00","CareSource Low Premium Silver","Standard Silver Off Exchange Plan",,"0.6859280333684","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-in-lp-silver-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010011","CareSource Low Premium Silver","54192IN001",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010011-01","CareSource Low Premium Silver","Standard Silver On Exchange Plan",,"0.6859280333684","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-in-lp-silver-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010011","CareSource Low Premium Silver","54192IN001",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010011-02","CareSource Low Premium Silver Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-in-lp-silverzero-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010011","CareSource Low Premium Silver","54192IN001",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010011-03","CareSource Low Premium Silver Limited","Limited Cost Sharing Plan Variation",,"0.6859280333684","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-in-lp-silverltd-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010011","CareSource Low Premium Silver","54192IN001",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010011-04","CareSource Low Premium Silver 1","73% AV Level Silver Plan",,"0.724944892077978","Yes","Yes","No","100%",,"$4,800","$465","$516","$60","$1,582","$1,305","$279","$55","$1,387","$105","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,800","$5800 per person","$11600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,800","$4800 per person","$9600 per group","No",,,"https://www.caresource.com/document/MP-2018-in-lp-silver1-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010011","CareSource Low Premium Silver","54192IN001",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010011-05","CareSource Low Premium Silver 2","87% AV Level Silver Plan",,"0.87726632792384","Yes","Yes","No","100%",,"$950","$306","$344","$60","$909","$590","$101","$55","$950","$90","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","No",,,"https://www.caresource.com/document/MP-2018-in-lp-silver2-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010011","CareSource Low Premium Silver","54192IN001",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010011-06","CareSource Low Premium Silver 3","94% AV Level Silver Plan",,"0.932542887793143","Yes","Yes","No","100%",,"$571","$0","$129","$60","$517","$155","$28","$55","$600","$33","$67","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","No",,,"https://www.caresource.com/document/MP-2018-in-lp-silver3-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010012","CareSource Gold","54192IN001",,"INN001","INS001","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010012-00","CareSource Gold","Standard Gold Off Exchange Plan",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-in-gold-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010012","CareSource Gold","54192IN001",,"INN001","INS001","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010012-01","CareSource Gold","Standard Gold On Exchange Plan",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-in-gold-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010012","CareSource Gold","54192IN001",,"INN001","INS001","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010012-02","CareSource Gold Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-in-goldzero-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010012","CareSource Gold","54192IN001",,"INN001","INS001","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010012-03","CareSource Gold Limited","Limited Cost Sharing Plan Variation",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-in-goldltd-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010015","CareSource Bronze","54192IN001",,"INN001","INS001","INF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9938",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010015-00","CareSource Bronze","Standard Bronze Off Exchange Plan",,"0.617591524943191","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-in-bronze-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010015","CareSource Bronze","54192IN001",,"INN001","INS001","INF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9938",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010015-01","CareSource Bronze","Standard Bronze On Exchange Plan",,"0.617591524943191","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-in-bronze-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010013","CareSource Hoosier Choice Gold","54192IN001",,"INN002","INS002","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010013-00","CareSource Hoosier Choice Gold","Standard Gold Off Exchange Plan",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-gold-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010013","CareSource Hoosier Choice Gold","54192IN001",,"INN002","INS002","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010013-01","CareSource Hoosier Choice Gold","Standard Gold On Exchange Plan",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-gold-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010013","CareSource Hoosier Choice Gold","54192IN001",,"INN002","INS002","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010013-02","CareSource Hoosier Choice Gold Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-goldzero-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010013","CareSource Hoosier Choice Gold","54192IN001",,"INN002","INS002","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010013-03","CareSource Hoosier Choice Gold Limited","Limited Cost Sharing Plan Variation",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-goldltd-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010017","CareSource Hoosier Choice Bronze","54192IN001",,"INN002","INS002","INF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9938",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010017-00","CareSource Hoosier Choice Bronze","Standard Bronze Off Exchange Plan",,"0.617591524943191","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-bronze-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010017","CareSource Hoosier Choice Bronze","54192IN001",,"INN002","INS002","INF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9938",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010017-01","CareSource Hoosier Choice Bronze","Standard Bronze On Exchange Plan",,"0.617591524943191","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-bronze-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010014","CareSource Silver","54192IN001",,"INN001","INS001","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9948",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010014-02","CareSource Silver Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-in-silverzero-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010014","CareSource Silver","54192IN001",,"INN001","INS001","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9948",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010014-03","CareSource Silver Limited","Limited Cost Sharing Plan Variation",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-in-silverltd-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010014","CareSource Silver","54192IN001",,"INN001","INS001","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9948",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010014-04","CareSource Silver 1","73% AV Level Silver Plan",,"0.735310449914442","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,320","$518","$55","$970","$430","$416","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-in-silver1-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010014","CareSource Silver","54192IN001",,"INN001","INS001","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9948",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010014-05","CareSource Silver 2","87% AV Level Silver Plan",,"0.877634618592318","Yes","Yes","No","100%",,"$950","$591","$359","$60","$781","$980","$139","$55","$950","$145","$208","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","No",,,"https://www.caresource.com/document/MP-2018-in-silver2-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010014","CareSource Silver","54192IN001",,"INN001","INS001","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9948",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010014-06","CareSource Silver 3","94% AV Level Silver Plan",,"0.945421805242358","Yes","Yes","No","100%",,"$205","$300","$120","$60","$244","$369","$13","$55","$325","$75","$69","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$625","$625 per person","$1250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$625","$625 per person","$1250 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$325","$325 per person","$650 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$325","$325 per person","$650 per group","No",,,"https://www.caresource.com/document/MP-2018-in-silver3-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010016","CareSource Hoosier Choice Silver","54192IN001",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9948",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010016-00","CareSource Hoosier Choice Silver","Standard Silver Off Exchange Plan",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-silver-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010016","CareSource Hoosier Choice Silver","54192IN001",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9948",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010016-01","CareSource Hoosier Choice Silver","Standard Silver On Exchange Plan",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-silver-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010016","CareSource Hoosier Choice Silver","54192IN001",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9948",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010016-02","CareSource Hoosier Choice Silver Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-silverzero-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010016","CareSource Hoosier Choice Silver","54192IN001",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9948",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010016-03","CareSource Hoosier Choice Silver Limited","Limited Cost Sharing Plan Variation",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-silverltd-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010016","CareSource Hoosier Choice Silver","54192IN001",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9948",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010016-04","CareSource Hoosier Choice Silver 1","73% AV Level Silver Plan",,"0.735310449914442","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,320","$518","$55","$970","$430","$416","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-silver1-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010016","CareSource Hoosier Choice Silver","54192IN001",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9948",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010016-05","CareSource Hoosier Choice Silver 2","87% AV Level Silver Plan",,"0.877634618592318","Yes","Yes","No","100%",,"$950","$591","$359","$60","$781","$980","$139","$55","$950","$145","$208","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-silver2-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0010016","CareSource Hoosier Choice Silver","54192IN001",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9948",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0010016-06","CareSource Hoosier Choice Silver 3","94% AV Level Silver Plan",,"0.945421805242358","Yes","Yes","No","100%",,"$205","$300","$120","$60","$244","$369","$13","$55","$325","$75","$69","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$625","$625 per person","$1250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$625","$625 per person","$1250 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$325","$325 per person","$650 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$325","$325 per person","$650 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-silver3-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020011","CareSource Low Premium Silver Dental and Vision","54192IN002",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9438",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020011-00","CareSource Low Premium Silver Dental and Vision","Standard Silver Off Exchange Plan",,"0.6859280333684","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-in-lp-silver-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020011","CareSource Low Premium Silver Dental and Vision","54192IN002",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9438",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020011-01","CareSource Low Premium Silver Dental and Vision","Standard Silver On Exchange Plan",,"0.6859280333684","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-in-lp-silver-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020011","CareSource Low Premium Silver Dental and Vision","54192IN002",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9438",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020011-02","CareSource Low Premium Silver Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-in-lp-silverzero-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020011","CareSource Low Premium Silver Dental and Vision","54192IN002",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9438",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020011-03","CareSource Low Premium Silver Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.6859280333684","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-in-lp-silverltd-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020011","CareSource Low Premium Silver Dental and Vision","54192IN002",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9438",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020011-04","CareSource Low Premium Silver 1 Dental and Vision","73% AV Level Silver Plan",,"0.724944892077978","Yes","Yes","No","100%",,"$4,800","$465","$516","$60","$1,582","$1,305","$279","$55","$1,387","$105","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,800","$5800 per person","$11600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,800","$4800 per person","$9600 per group","No",,,"https://www.caresource.com/document/MP-2018-in-lp-silver1-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020011","CareSource Low Premium Silver Dental and Vision","54192IN002",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9438",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020011-05","CareSource Low Premium Silver 2 Dental and Vision","87% AV Level Silver Plan",,"0.87726632792384","Yes","Yes","No","100%",,"$950","$306","$344","$60","$909","$590","$101","$55","$950","$90","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","No",,,"https://www.caresource.com/document/MP-2018-in-lp-silver2-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020011","CareSource Low Premium Silver Dental and Vision","54192IN002",,"INN001","INS001","INF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9438",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020011-06","CareSource Low Premium Silver 3 Dental and Vision","94% AV Level Silver Plan",,"0.932542887793143","Yes","Yes","No","100%",,"$571","$0","$129","$60","$517","$155","$28","$55","$600","$33","$67","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","No",,,"https://www.caresource.com/document/MP-2018-in-lp-silver3-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020012","CareSource Gold Dental and Vision","54192IN002",,"INN001","INS001","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9583",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020012-00","CareSource Gold Dental and Vision","Standard Gold Off Exchange Plan",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-in-gold-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020012","CareSource Gold Dental and Vision","54192IN002",,"INN001","INS001","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9583",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020012-01","CareSource Gold Dental and Vision","Standard Gold On Exchange Plan",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-in-gold-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020012","CareSource Gold Dental and Vision","54192IN002",,"INN001","INS001","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9583",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020012-02","CareSource Gold Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-in-goldzero-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020012","CareSource Gold Dental and Vision","54192IN002",,"INN001","INS001","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9583",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020012-03","CareSource Gold Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-in-goldltd-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020015","CareSource Bronze Dental and Vision","54192IN002",,"INN001","INS001","INF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9366",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020015-00","CareSource Bronze Dental and Vision","Standard Bronze Off Exchange Plan",,"0.617591524943191","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-in-bronze-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020015","CareSource Bronze Dental and Vision","54192IN002",,"INN001","INS001","INF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9366",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020015-01","CareSource Bronze Dental and Vision","Standard Bronze On Exchange Plan",,"0.617591524943191","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-in-bronze-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020015","CareSource Bronze Dental and Vision","54192IN002",,"INN001","INS001","INF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9366",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020015-02","CareSource Bronze Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-in-bronzezero-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020015","CareSource Bronze Dental and Vision","54192IN002",,"INN001","INS001","INF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9366",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020015-03","CareSource Bronze Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.617591524943191","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-in-bronzeltd-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020013","CareSource Hoosier Choice Gold Dental and Vision","54192IN002",,"INN002","INS002","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9583",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020013-00","CareSource Hoosier Choice Gold Dental and Vision","Standard Gold Off Exchange Plan",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-gold-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020013","CareSource Hoosier Choice Gold Dental and Vision","54192IN002",,"INN002","INS002","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9583",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020013-01","CareSource Hoosier Choice Gold Dental and Vision","Standard Gold On Exchange Plan",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-gold-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020013","CareSource Hoosier Choice Gold Dental and Vision","54192IN002",,"INN002","INS002","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9583",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020013-02","CareSource Hoosier Choice Gold Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-goldzero-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020013","CareSource Hoosier Choice Gold Dental and Vision","54192IN002",,"INN002","INS002","INF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9583",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020013-03","CareSource Hoosier Choice Gold Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-goldltd-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020017","CareSource Hoosier Choice Bronze Dental and Vision","54192IN002",,"INN002","INS002","INF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9366",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020017-00","CareSource Hoosier Choice Bronze Dental and Vision","Standard Bronze Off Exchange Plan",,"0.617591524943191","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-bronze-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020017","CareSource Hoosier Choice Bronze Dental and Vision","54192IN002",,"INN002","INS002","INF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9366",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020017-01","CareSource Hoosier Choice Bronze Dental and Vision","Standard Bronze On Exchange Plan",,"0.617591524943191","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-bronze-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020017","CareSource Hoosier Choice Bronze Dental and Vision","54192IN002",,"INN002","INS002","INF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9366",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020017-02","CareSource Hoosier Choice Bronze Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-bronzezero-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020017","CareSource Hoosier Choice Bronze Dental and Vision","54192IN002",,"INN002","INS002","INF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9366",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020017-03","CareSource Hoosier Choice Bronze Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.617591524943191","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-bronzeltd-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020014","CareSource Silver Dental and Vision","54192IN002",,"INN001","INS001","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9468",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020014-00","CareSource Silver Dental and Vision","Standard Silver Off Exchange Plan",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-in-silver-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020014","CareSource Silver Dental and Vision","54192IN002",,"INN001","INS001","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9468",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020014-01","CareSource Silver Dental and Vision","Standard Silver On Exchange Plan",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-in-silver-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020014","CareSource Silver Dental and Vision","54192IN002",,"INN001","INS001","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9468",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020014-02","CareSource Silver Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-in-silverzero-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020014","CareSource Silver Dental and Vision","54192IN002",,"INN001","INS001","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9468",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020014-03","CareSource Silver Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-in-silverltd-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020014","CareSource Silver Dental and Vision","54192IN002",,"INN001","INS001","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9468",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020014-04","CareSource Silver 1 Dental and Vision","73% AV Level Silver Plan",,"0.735310449914442","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,320","$518","$55","$970","$430","$416","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-in-silver1-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020014","CareSource Silver Dental and Vision","54192IN002",,"INN001","INS001","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9468",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020014-05","CareSource Silver 2 Dental and Vision","87% AV Level Silver Plan",,"0.877634618592318","Yes","Yes","No","100%",,"$950","$591","$359","$60","$781","$980","$139","$55","$950","$145","$208","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","No",,,"https://www.caresource.com/document/MP-2018-in-silver2-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020014","CareSource Silver Dental and Vision","54192IN002",,"INN001","INS001","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9468",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020014-06","CareSource Silver 3 Dental and Vision","94% AV Level Silver Plan",,"0.945421805242358","Yes","Yes","No","100%",,"$205","$300","$120","$60","$244","$369","$13","$55","$325","$75","$69","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$625","$625 per person","$1250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$625","$625 per person","$1250 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$325","$325 per person","$650 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$325","$325 per person","$650 per group","No",,,"https://www.caresource.com/document/MP-2018-in-silver3-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020016","CareSource Hoosier Choice Silver Dental and Vision","54192IN002",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9468",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020016-00","CareSource Hoosier Choice Silver Dental and Vision","Standard Silver Off Exchange Plan",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-silver-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020016","CareSource Hoosier Choice Silver Dental and Vision","54192IN002",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9468",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020016-01","CareSource Hoosier Choice Silver Dental and Vision","Standard Silver On Exchange Plan",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-silver-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020016","CareSource Hoosier Choice Silver Dental and Vision","54192IN002",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9468",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020016-02","CareSource Hoosier Choice Silver Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-silverzero-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020016","CareSource Hoosier Choice Silver Dental and Vision","54192IN002",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9468",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020016-03","CareSource Hoosier Choice Silver Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-silverltd-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020016","CareSource Hoosier Choice Silver Dental and Vision","54192IN002",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9468",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020016-04","CareSource Hoosier Choice Silver 1 Dental and Vision","73% AV Level Silver Plan",,"0.735310449914442","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,320","$518","$55","$970","$430","$416","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-silver1-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020016","CareSource Hoosier Choice Silver Dental and Vision","54192IN002",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9468",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020016-05","CareSource Hoosier Choice Silver 2 Dental and Vision","87% AV Level Silver Plan",,"0.877634618592318","Yes","Yes","No","100%",,"$950","$591","$359","$60","$781","$980","$139","$55","$950","$145","$208","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-silver2-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0020016","CareSource Hoosier Choice Silver Dental and Vision","54192IN002",,"INN002","INS002","INF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9468",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0020016-06","CareSource Hoosier Choice Silver 3 Dental and Vision","94% AV Level Silver Plan",,"0.945421805242358","Yes","Yes","No","100%",,"$205","$300","$120","$60","$244","$369","$13","$55","$325","$75","$69","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$625","$625 per person","$1250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$625","$625 per person","$1250 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$325","$325 per person","$650 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$325","$325 per person","$650 per group","No",,,"https://www.caresource.com/document/MP-2018-in-hc-silver3-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0030004","CareSource Federal Simple Choice Silver","54192IN003",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0030004-00","CareSource Federal Simple Choice Silver","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-silver-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0030004","CareSource Federal Simple Choice Silver","54192IN003",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0030004-01","CareSource Federal Simple Choice Silver","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-silver-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0030004","CareSource Federal Simple Choice Silver","54192IN003",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0030004-02","CareSource Federal Simple Choice Silver Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-silverzero-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0030004","CareSource Federal Simple Choice Silver","54192IN003",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0030004-03","CareSource Federal Simple Choice Silver Limited","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-silverltd-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0030004","CareSource Federal Simple Choice Silver","54192IN003",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0030004-04","CareSource Federal Simple Choice Silver 1","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-silver1-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0030004","CareSource Federal Simple Choice Silver","54192IN003",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0030004-05","CareSource Federal Simple Choice Silver 2","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$700","$610","$372","$55","$700","$75","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-silver2-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0030004","CareSource Federal Simple Choice Silver","54192IN003",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0030004-06","CareSource Federal Simple Choice Silver 3","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$22","$620","$60","$250","$218","$93","$55","$250","$30","$82","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-silver3-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0030005","CareSource Federal Simple Choice Bronze","54192IN003",,"INN001","INS001","INF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0030005-00","CareSource Federal Simple Choice Bronze","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,445","$1,515","$1,998","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-bronze-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0030005","CareSource Federal Simple Choice Bronze","54192IN003",,"INN001","INS001","INF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0030005-01","CareSource Federal Simple Choice Bronze","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,445","$1,515","$1,998","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-bronze-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0030005","CareSource Federal Simple Choice Bronze","54192IN003",,"INN001","INS001","INF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0030005-02","CareSource Federal Simple Choice Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-bronzezero-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0030005","CareSource Federal Simple Choice Bronze","54192IN003",,"INN001","INS001","INF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0030005-03","CareSource Federal Simple Choice Bronze Limited","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,445","$1,515","$1,998","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-bronzeltd-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0050004","CareSource Federal Simple Choice Silver Dental and Vision","54192IN005",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9482",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0050004-00","CareSource Federal Simple Choice Silver Dental and Vision","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-silver-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0050004","CareSource Federal Simple Choice Silver Dental and Vision","54192IN005",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9482",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0050004-01","CareSource Federal Simple Choice Silver Dental and Vision","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-silver-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0050004","CareSource Federal Simple Choice Silver Dental and Vision","54192IN005",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9482",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0050004-02","CareSource Federal Simple Choice Silver Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-silverzero-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0050004","CareSource Federal Simple Choice Silver Dental and Vision","54192IN005",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9482",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0050004-03","CareSource Federal Simple Choice Silver Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-silverltd-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0050004","CareSource Federal Simple Choice Silver Dental and Vision","54192IN005",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9482",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0050004-04","CareSource Federal Simple Choice Silver 1 Dental and Vision","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-silver1-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0050004","CareSource Federal Simple Choice Silver Dental and Vision","54192IN005",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9482",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0050004-05","CareSource Federal Simple Choice Silver 2 Dental and Vision","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$700","$610","$372","$55","$700","$75","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-silver2-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0050004","CareSource Federal Simple Choice Silver Dental and Vision","54192IN005",,"INN001","INS001","INF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9482",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0050004-06","CareSource Federal Simple Choice Silver 3 Dental and Vision","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$22","$620","$60","$250","$218","$93","$55","$250","$30","$82","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-silver3-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0050005","CareSource Federal Simple Choice Bronze Dental and Vision","54192IN005",,"INN001","INS001","INF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9436",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0050005-00","CareSource Federal Simple Choice Bronze Dental and Vision","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,445","$1,515","$1,998","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-bronze-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0050005","CareSource Federal Simple Choice Bronze Dental and Vision","54192IN005",,"INN001","INS001","INF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9436",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0050005-01","CareSource Federal Simple Choice Bronze Dental and Vision","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,445","$1,515","$1,998","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-bronze-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0050005","CareSource Federal Simple Choice Bronze Dental and Vision","54192IN005",,"INN001","INS001","INF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9436",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0050005-02","CareSource Federal Simple Choice Bronze Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-bronzezero-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","54192","HIOS","2017-11-01 02:20:20","Individual","No","32-0121856","54192IN0050005","CareSource Federal Simple Choice Bronze Dental and Vision","54192IN005",,"INN001","INS001","INF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9436",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","54192IN0050005-03","CareSource Federal Simple Choice Bronze Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,445","$1,515","$1,998","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-in-fedstd-bronzeltd-dv-sum","https://www.caresource.com/document/MP-2018-in-a-broch"
"2018","IN","57874","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","57874IN0040001","Delta Dental Individual PPO, EHB Certified","57874IN004",,"INN002","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","57874IN0040001-00","Delta Dental Individual PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","57874","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","57874IN0040002","Delta Dental Individual PPO, EHB Certified","57874IN004",,"INN002","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","57874IN0040002-00","Delta Dental Individual PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","57874","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","57874IN0050003","Renaissance Individual Dental PPO, EHB Certified","57874IN005",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","57874IN0050003-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","57874","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","57874IN0050004","Renaissance Individual Dental PPO, EHB Certified","57874IN005",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","57874IN0050004-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","57874","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","57874IN0070001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","57874IN007",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/57874","","57874IN0070001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/IN_EHB_High_2018","http://www.renaissancedental.com/IN_EHB_High_2018"
"2018","IN","57874","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","57874IN0070002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","57874IN007",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/57874","","57874IN0070002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/IN_EHB_Low_2018","http://www.renaissancedental.com/IN_EHB_Low_2018"
"2018","IN","57874","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","57874IN0090001","Renaissance Individual Dental Pediatric-Only, EHB Certified","57874IN009",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","57874IN0090001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","57874","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","57874IN0090002","Renaissance Individual Dental Pediatric-Only, EHB Certified","57874IN009",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","57874IN0090002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","57874","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","57874IN0080001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","57874IN008",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/57874","","57874IN0080001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/IN_Ped_High_2018","http://www.renaissancedental.com/IN_Ped_High_2018"
"2018","IN","57874","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","57874IN0080002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","57874IN008",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/57874","","57874IN0080002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/IN_Ped_Low_2018","http://www.renaissancedental.com/IN_Ped_Low_2018"
"2018","IN","59560","HIOS","2017-06-30 02:20:18","Individual","Yes","13-5123390","59560IN0070002","Guardian Essentials for Families and Individuals","59560IN007",,"INN002","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","59560IN0070002-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/indiana/","https://dentalexchange.guardianlife.com/our-plans/indiana/"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1 (2018)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110002-04","Ambetter Balanced Care 1 (2018)","73% AV Level Silver Plan",,"0.739812128349422","Yes","Yes","No","100%",,"$3,000","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110002-04.pdf","https://api.centene.com/Brochures/2018/76179IN0110002-04.pdf"
"2018","IN","59560","HIOS","2017-06-30 02:20:18","SHOP (Small Group)","Yes","13-5123390","59560IN0010003","Guardian Pediatric Advantage","59560IN001",,"INN001","INS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","59560IN0010003-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","59560","HIOS","2017-06-30 02:20:18","SHOP (Small Group)","Yes","13-5123390","59560IN0020004","Guardian Pediatric Essentials","59560IN002",,"INN001","INS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","59560IN0020004-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","76179IN011",,"INN001","INS001","INF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110001-01","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/76179IN0110001-01.pdf","https://api.centene.com/Brochures/2018/76179IN0110001-01.pdf"
"2018","IN","59560","HIOS","2017-06-30 02:20:18","Individual","Yes","13-5123390","59560IN0070002","Guardian Essentials for Families and Individuals","59560IN007",,"INN002","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","59560IN0070002-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/indiana/","https://dentalexchange.guardianlife.com/our-plans/indiana/"
"2018","IN","59560","HIOS","2017-06-30 02:20:18","Individual","Yes","13-5123390","59560IN0080001","Guardian Select for Families and Individuals","59560IN008",,"INN002","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","59560IN0080001-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/indiana/","https://dentalexchange.guardianlife.com/our-plans/indiana/"
"2018","IN","59560","HIOS","2017-06-30 02:20:18","Individual","Yes","13-5123390","59560IN0080001","Guardian Select for Families and Individuals","59560IN008",,"INN002","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","59560IN0080001-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/indiana/","https://dentalexchange.guardianlife.com/our-plans/indiana/"
"2018","IN","59560","HIOS","2017-06-30 02:20:18","Individual","Yes","13-5123390","59560IN0090001","Guardian Basics for Families and Individuals","59560IN009",,"INN002","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","59560IN0090001-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/indiana/","https://dentalexchange.guardianlife.com/our-plans/indiana/"
"2018","IN","59560","HIOS","2017-06-30 02:20:18","Individual","Yes","13-5123390","59560IN0090001","Guardian Basics for Families and Individuals","59560IN009",,"INN002","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","59560IN0090001-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/indiana/","https://dentalexchange.guardianlife.com/our-plans/indiana/"
"2018","IN","69051","HIOS","2017-06-20 02:20:27","SHOP (Small Group)","Yes","13-5581829","69051IN0110001","EHB Basic Dental Plan (Low)","69051IN011",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","69051IN0110001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","76179IN011",,"INN001","INS001","INF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110001-00","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/76179IN0110001-00.pdf","https://api.centene.com/Brochures/2018/76179IN0110001-00.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","76179IN011",,"INN001","INS001","INF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110001-02","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/76179IN0110001-02.pdf","https://api.centene.com/Brochures/2018/76179IN0110001-02.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","76179IN011",,"INN001","INS001","INF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110001-03","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/76179IN0110001-03.pdf","https://api.centene.com/Brochures/2018/76179IN0110001-03.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1 (2018)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110002-00","Ambetter Balanced Care 1 (2018)","Standard Silver Off Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110002-00.pdf","https://api.centene.com/Brochures/2018/76179IN0110002-00.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1 (2018)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110002-01","Ambetter Balanced Care 1 (2018)","Standard Silver On Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110002-01.pdf","https://api.centene.com/Brochures/2018/76179IN0110002-01.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1 (2018)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110002-02","Ambetter Balanced Care 1 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110002-02.pdf","https://api.centene.com/Brochures/2018/76179IN0110002-02.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1 (2018)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110002-03","Ambetter Balanced Care 1 (2018)","Limited Cost Sharing Plan Variation",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110002-03.pdf","https://api.centene.com/Brochures/2018/76179IN0110002-03.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1 (2018)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110002-05","Ambetter Balanced Care 1 (2018)","87% AV Level Silver Plan",,"0.87931537568396","Yes","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$300","$400","$60","$750","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110002-05.pdf","https://api.centene.com/Brochures/2018/76179IN0110002-05.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1 (2018)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110002-06","Ambetter Balanced Care 1 (2018)","94% AV Level Silver Plan",,"0.949528260595198","Yes","Yes","No","100%",,"$0","$0","$950","$60","$0","$300","$400","$60","$0","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110002-06.pdf","https://api.centene.com/Brochures/2018/76179IN0110002-06.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2018)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110003-00","Ambetter Balanced Care 2 (2018)","Standard Silver Off Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110003-00.pdf","https://api.centene.com/Brochures/2018/76179IN0110003-00.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2018)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110003-01","Ambetter Balanced Care 2 (2018)","Standard Silver On Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110003-01.pdf","https://api.centene.com/Brochures/2018/76179IN0110003-01.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2018)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110003-02","Ambetter Balanced Care 2 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110003-02.pdf","https://api.centene.com/Brochures/2018/76179IN0110003-02.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2018)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110003-03","Ambetter Balanced Care 2 (2018)","Limited Cost Sharing Plan Variation",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110003-03.pdf","https://api.centene.com/Brochures/2018/76179IN0110003-03.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2018)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110003-04","Ambetter Balanced Care 2 (2018)","73% AV Level Silver Plan",,"0.729896135538709","Yes","Yes","No","100%",,"$4,600","$400","$0","$60","$1,900","$1,400","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110003-04.pdf","https://api.centene.com/Brochures/2018/76179IN0110003-04.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2018)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110003-05","Ambetter Balanced Care 2 (2018)","87% AV Level Silver Plan",,"0.867181007012531","Yes","Yes","No","100%",,"$1,700","$10","$0","$60","$1,500","$250","$0","$60","$1,600","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110003-05.pdf","https://api.centene.com/Brochures/2018/76179IN0110003-05.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2018)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110003-06","Ambetter Balanced Care 2 (2018)","94% AV Level Silver Plan",,"0.942313720589882","Yes","Yes","No","100%",,"$572","$3","$0","$60","$500","$70","$0","$60","$575","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110003-06.pdf","https://api.centene.com/Brochures/2018/76179IN0110003-06.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2018)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110005-00","Ambetter Balanced Care 10 (2018)","Standard Silver Off Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110005-00.pdf","https://api.centene.com/Brochures/2018/76179IN0110005-00.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2018)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110005-01","Ambetter Balanced Care 10 (2018)","Standard Silver On Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110005-01.pdf","https://api.centene.com/Brochures/2018/76179IN0110005-01.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2018)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110005-02","Ambetter Balanced Care 10 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110005-02.pdf","https://api.centene.com/Brochures/2018/76179IN0110005-02.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2018)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110005-03","Ambetter Balanced Care 10 (2018)","Limited Cost Sharing Plan Variation",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110005-03.pdf","https://api.centene.com/Brochures/2018/76179IN0110005-03.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2018)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110005-04","Ambetter Balanced Care 10 (2018)","73% AV Level Silver Plan",,"0.73985223196154","Yes","Yes","No","100%",,"$3,700","$100","$2,000","$60","$1,500","$900","$400","$60","$1,300","$90","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110005-04.pdf","https://api.centene.com/Brochures/2018/76179IN0110005-04.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2018)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110005-05","Ambetter Balanced Care 10 (2018)","87% AV Level Silver Plan",,"0.879858510990049","Yes","Yes","No","100%",,"$800","$0","$1,400","$60","$850","$300","$400","$60","$850","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110005-05.pdf","https://api.centene.com/Brochures/2018/76179IN0110005-05.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2018)","76179IN011",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110005-06","Ambetter Balanced Care 10 (2018)","94% AV Level Silver Plan",,"0.949794807417026","Yes","Yes","No","100%",,"$250","$0","$300","$60","$250","$160","$185","$60","$250","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$595","$595 per person","$1190 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110005-06.pdf","https://api.centene.com/Brochures/2018/76179IN0110005-06.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110008","Ambetter Balanced Care 4 (2018)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110008-00","Ambetter Balanced Care 4 (2018)","Standard Silver Off Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110008-00.pdf","https://api.centene.com/Brochures/2018/76179IN0110008-00.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110008","Ambetter Balanced Care 4 (2018)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110008-01","Ambetter Balanced Care 4 (2018)","Standard Silver On Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110008-01.pdf","https://api.centene.com/Brochures/2018/76179IN0110008-01.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110008","Ambetter Balanced Care 4 (2018)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110008-02","Ambetter Balanced Care 4 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110008-02.pdf","https://api.centene.com/Brochures/2018/76179IN0110008-02.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110008","Ambetter Balanced Care 4 (2018)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110008-03","Ambetter Balanced Care 4 (2018)","Limited Cost Sharing Plan Variation",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110008-03.pdf","https://api.centene.com/Brochures/2018/76179IN0110008-03.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110008","Ambetter Balanced Care 4 (2018)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110008-04","Ambetter Balanced Care 4 (2018)","73% AV Level Silver Plan",,"0.727430168333116","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$1,800","$1,300","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110008-04.pdf","https://api.centene.com/Brochures/2018/76179IN0110008-04.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110008","Ambetter Balanced Care 4 (2018)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110008-05","Ambetter Balanced Care 4 (2018)","87% AV Level Silver Plan",,"0.863154651499334","Yes","Yes","No","100%",,"$1,850","$0","$0","$60","$1,850","$0","$0","$60","$1,630","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110008-05.pdf","https://api.centene.com/Brochures/2018/76179IN0110008-05.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110008","Ambetter Balanced Care 4 (2018)","76179IN011",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110008-06","Ambetter Balanced Care 4 (2018)","94% AV Level Silver Plan",,"0.940719200046497","Yes","Yes","No","100%",,"$600","$0","$0","$60","$600","$0","$0","$60","$600","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110008-06.pdf","https://api.centene.com/Brochures/2018/76179IN0110008-06.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110009","Ambetter Balanced Care 12 (2018)","76179IN011",,"INN001","INS001","INF004","Existing","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110009-00","Ambetter Balanced Care 12 (2018)","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/76179IN0110009-00.pdf","https://api.centene.com/Brochures/2018/76179IN0110009-00.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110009","Ambetter Balanced Care 12 (2018)","76179IN011",,"INN001","INS001","INF004","Existing","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110009-01","Ambetter Balanced Care 12 (2018)","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/76179IN0110009-01.pdf","https://api.centene.com/Brochures/2018/76179IN0110009-01.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110009","Ambetter Balanced Care 12 (2018)","76179IN011",,"INN001","INS001","INF004","Existing","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110009-02","Ambetter Balanced Care 12 (2018)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/76179IN0110009-02.pdf","https://api.centene.com/Brochures/2018/76179IN0110009-02.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110009","Ambetter Balanced Care 12 (2018)","76179IN011",,"INN001","INS001","INF004","Existing","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110009-03","Ambetter Balanced Care 12 (2018)","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/76179IN0110009-03.pdf","https://api.centene.com/Brochures/2018/76179IN0110009-03.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110009","Ambetter Balanced Care 12 (2018)","76179IN011",,"INN001","INS001","INF004","Existing","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110009-04","Ambetter Balanced Care 12 (2018)","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/76179IN0110009-04.pdf","https://api.centene.com/Brochures/2018/76179IN0110009-04.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110009","Ambetter Balanced Care 12 (2018)","76179IN011",,"INN001","INS001","INF004","Existing","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110009-05","Ambetter Balanced Care 12 (2018)","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$100","$1,600","$60","$700","$600","$400","$60","$700","$80","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/76179IN0110009-05.pdf","https://api.centene.com/Brochures/2018/76179IN0110009-05.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110009","Ambetter Balanced Care 12 (2018)","76179IN011",,"INN001","INS001","INF004","Existing","EPO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110009-06","Ambetter Balanced Care 12 (2018)","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$100","$500","$60","$250","$200","$90","$60","$250","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/76179IN0110009-06.pdf","https://api.centene.com/Brochures/2018/76179IN0110009-06.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110067","Ambetter Balanced Care 5 (2018)","76179IN011",,"INN001","INS001","INF005","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110067-00","Ambetter Balanced Care 5 (2018)","Standard Silver Off Exchange Plan","66.25%","0.661631852049009","Yes","Yes","No","100%",,"$6,800","$550","$0","$60","$1,900","$1,900","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110067-00.pdf","https://api.centene.com/Brochures/2018/76179IN0110067-00.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110067","Ambetter Balanced Care 5 (2018)","76179IN011",,"INN001","INS001","INF005","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110067-01","Ambetter Balanced Care 5 (2018)","Standard Silver On Exchange Plan","66.25%","0.661631852049009","Yes","Yes","No","100%",,"$6,800","$550","$0","$60","$1,900","$1,900","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110067-01.pdf","https://api.centene.com/Brochures/2018/76179IN0110067-01.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110067","Ambetter Balanced Care 5 (2018)","76179IN011",,"INN001","INS001","INF005","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110067-02","Ambetter Balanced Care 5 (2018)","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110067-02.pdf","https://api.centene.com/Brochures/2018/76179IN0110067-02.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110067","Ambetter Balanced Care 5 (2018)","76179IN011",,"INN001","INS001","INF005","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110067-03","Ambetter Balanced Care 5 (2018)","Limited Cost Sharing Plan Variation","66.25%","0.661631852049009","Yes","Yes","No","100%",,"$6,800","$550","$0","$60","$1,900","$1,900","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110067-03.pdf","https://api.centene.com/Brochures/2018/76179IN0110067-03.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110067","Ambetter Balanced Care 5 (2018)","76179IN011",,"INN001","INS001","INF005","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110067-04","Ambetter Balanced Care 5 (2018)","73% AV Level Silver Plan","72.15%","0.718557057101132","Yes","Yes","No","100%",,"$5,000","$300","$0","$60","$1,900","$1,500","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110067-04.pdf","https://api.centene.com/Brochures/2018/76179IN0110067-04.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110067","Ambetter Balanced Care 5 (2018)","76179IN011",,"INN001","INS001","INF005","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110067-05","Ambetter Balanced Care 5 (2018)","87% AV Level Silver Plan","86.18%","0.858472329117886","Yes","Yes","No","100%",,"$1,950","$0","$0","$60","$1,600","$300","$0","$60","$1,600","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110067-05.pdf","https://api.centene.com/Brochures/2018/76179IN0110067-05.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110067","Ambetter Balanced Care 5 (2018)","76179IN011",,"INN001","INS001","INF005","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110067-06","Ambetter Balanced Care 5 (2018)","94% AV Level Silver Plan","93.63%","0.935092701963358","Yes","Yes","No","100%",,"$675","$0","$0","$60","$565","$100","$0","$60","$675","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110067-06.pdf","https://api.centene.com/Brochures/2018/76179IN0110067-06.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110052","Ambetter Essential Care 2 HSA (2018)","76179IN011",,"INN001","INS001","INF006","New","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110052-00","Ambetter Essential Care 2 HSA (2018)","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://api.centene.com/SBC/2018/76179IN0110052-00.pdf","https://api.centene.com/Brochures/2018/76179IN0110052-00.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110052","Ambetter Essential Care 2 HSA (2018)","76179IN011",,"INN001","INS001","INF006","New","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110052-01","Ambetter Essential Care 2 HSA (2018)","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://api.centene.com/SBC/2018/76179IN0110052-01.pdf","https://api.centene.com/Brochures/2018/76179IN0110052-01.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110052","Ambetter Essential Care 2 HSA (2018)","76179IN011",,"INN001","INS001","INF006","New","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110052-02","Ambetter Essential Care 2 HSA (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0110052-02.pdf","https://api.centene.com/Brochures/2018/76179IN0110052-02.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0110052","Ambetter Essential Care 2 HSA (2018)","76179IN011",,"INN001","INS001","INF006","New","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0110052-03","Ambetter Essential Care 2 HSA (2018)","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://api.centene.com/SBC/2018/76179IN0110052-03.pdf","https://api.centene.com/Brochures/2018/76179IN0110052-03.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2018) + Vision","76179IN012",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120001-00","Ambetter Balanced Care 1 (2018) + Vision","Standard Silver Off Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120001-00.pdf","https://api.centene.com/Brochures/2018/76179IN0120001-00.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2018) + Vision","76179IN012",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120001-01","Ambetter Balanced Care 1 (2018) + Vision","Standard Silver On Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120001-01.pdf","https://api.centene.com/Brochures/2018/76179IN0120001-01.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2018) + Vision","76179IN012",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120001-02","Ambetter Balanced Care 1 (2018) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120001-02.pdf","https://api.centene.com/Brochures/2018/76179IN0120001-02.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2018) + Vision","76179IN012",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120001-03","Ambetter Balanced Care 1 (2018) + Vision","Limited Cost Sharing Plan Variation",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120001-03.pdf","https://api.centene.com/Brochures/2018/76179IN0120001-03.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2018) + Vision","76179IN012",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120001-04","Ambetter Balanced Care 1 (2018) + Vision","73% AV Level Silver Plan",,"0.739812128349422","Yes","Yes","No","100%",,"$3,000","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120001-04.pdf","https://api.centene.com/Brochures/2018/76179IN0120001-04.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2018) + Vision","76179IN012",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120001-05","Ambetter Balanced Care 1 (2018) + Vision","87% AV Level Silver Plan",,"0.87931537568396","Yes","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$300","$400","$60","$750","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120001-05.pdf","https://api.centene.com/Brochures/2018/76179IN0120001-05.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2018) + Vision","76179IN012",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120001-06","Ambetter Balanced Care 1 (2018) + Vision","94% AV Level Silver Plan",,"0.949528260595198","Yes","Yes","No","100%",,"$0","$0","$950","$60","$0","$300","$400","$60","$0","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120001-06.pdf","https://api.centene.com/Brochures/2018/76179IN0120001-06.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2018) + Vision","76179IN012",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120002-00","Ambetter Balanced Care 2 (2018) + Vision","Standard Silver Off Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120002-00.pdf","https://api.centene.com/Brochures/2018/76179IN0120002-00.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2018) + Vision","76179IN012",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120002-01","Ambetter Balanced Care 2 (2018) + Vision","Standard Silver On Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120002-01.pdf","https://api.centene.com/Brochures/2018/76179IN0120002-01.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2018) + Vision","76179IN012",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120002-02","Ambetter Balanced Care 2 (2018) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120002-02.pdf","https://api.centene.com/Brochures/2018/76179IN0120002-02.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2018) + Vision","76179IN012",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120002-03","Ambetter Balanced Care 2 (2018) + Vision","Limited Cost Sharing Plan Variation",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120002-03.pdf","https://api.centene.com/Brochures/2018/76179IN0120002-03.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2018) + Vision","76179IN012",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120002-04","Ambetter Balanced Care 2 (2018) + Vision","73% AV Level Silver Plan",,"0.729896135538709","Yes","Yes","No","100%",,"$4,600","$400","$0","$60","$1,900","$1,400","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120002-04.pdf","https://api.centene.com/Brochures/2018/76179IN0120002-04.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2018) + Vision","76179IN012",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120002-05","Ambetter Balanced Care 2 (2018) + Vision","87% AV Level Silver Plan",,"0.867181007012531","Yes","Yes","No","100%",,"$1,700","$10","$0","$60","$1,500","$250","$0","$60","$1,600","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120002-05.pdf","https://api.centene.com/Brochures/2018/76179IN0120002-05.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2018) + Vision","76179IN012",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120002-06","Ambetter Balanced Care 2 (2018) + Vision","94% AV Level Silver Plan",,"0.942313720589882","Yes","Yes","No","100%",,"$572","$3","$0","$60","$500","$70","$0","$60","$575","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120002-06.pdf","https://api.centene.com/Brochures/2018/76179IN0120002-06.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2018) + Vision","76179IN012",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120004-00","Ambetter Balanced Care 10 (2018) + Vision","Standard Silver Off Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120004-00.pdf","https://api.centene.com/Brochures/2018/76179IN0120004-00.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2018) + Vision","76179IN012",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120004-01","Ambetter Balanced Care 10 (2018) + Vision","Standard Silver On Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120004-01.pdf","https://api.centene.com/Brochures/2018/76179IN0120004-01.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2018) + Vision","76179IN012",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120004-02","Ambetter Balanced Care 10 (2018) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120004-02.pdf","https://api.centene.com/Brochures/2018/76179IN0120004-02.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2018) + Vision","76179IN012",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120004-03","Ambetter Balanced Care 10 (2018) + Vision","Limited Cost Sharing Plan Variation",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120004-03.pdf","https://api.centene.com/Brochures/2018/76179IN0120004-03.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2018) + Vision","76179IN012",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120004-04","Ambetter Balanced Care 10 (2018) + Vision","73% AV Level Silver Plan",,"0.73985223196154","Yes","Yes","No","100%",,"$3,700","$100","$2,000","$60","$1,500","$900","$400","$60","$1,300","$90","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120004-04.pdf","https://api.centene.com/Brochures/2018/76179IN0120004-04.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2018) + Vision","76179IN012",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120004-05","Ambetter Balanced Care 10 (2018) + Vision","87% AV Level Silver Plan",,"0.879858510990049","Yes","Yes","No","100%",,"$800","$0","$1,400","$60","$850","$300","$400","$60","$850","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120004-05.pdf","https://api.centene.com/Brochures/2018/76179IN0120004-05.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2018) + Vision","76179IN012",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9865",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0120004-06","Ambetter Balanced Care 10 (2018) + Vision","94% AV Level Silver Plan",,"0.949794807417026","Yes","Yes","No","100%",,"$250","$0","$300","$60","$250","$160","$185","$60","$250","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$595","$595 per person","$1190 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0120004-06.pdf","https://api.centene.com/Brochures/2018/76179IN0120004-06.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130001-00","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130001-00.pdf","https://api.centene.com/Brochures/2018/76179IN0130001-00.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130001-01","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130001-01.pdf","https://api.centene.com/Brochures/2018/76179IN0130001-01.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130001-02","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130001-02.pdf","https://api.centene.com/Brochures/2018/76179IN0130001-02.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130001-03","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130001-03.pdf","https://api.centene.com/Brochures/2018/76179IN0130001-03.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130001-04","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.739812128349422","Yes","Yes","No","100%",,"$3,000","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130001-04.pdf","https://api.centene.com/Brochures/2018/76179IN0130001-04.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130001-05","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.87931537568396","Yes","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$300","$400","$60","$750","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130001-05.pdf","https://api.centene.com/Brochures/2018/76179IN0130001-05.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130001-06","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949528260595198","Yes","Yes","No","100%",,"$0","$0","$950","$60","$0","$300","$400","$60","$0","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130001-06.pdf","https://api.centene.com/Brochures/2018/76179IN0130001-06.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130002-00","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130002-00.pdf","https://api.centene.com/Brochures/2018/76179IN0130002-00.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130002-01","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130002-01.pdf","https://api.centene.com/Brochures/2018/76179IN0130002-01.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130002-02","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130002-02.pdf","https://api.centene.com/Brochures/2018/76179IN0130002-02.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130002-03","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130002-03.pdf","https://api.centene.com/Brochures/2018/76179IN0130002-03.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130002-04","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.729896135538709","Yes","Yes","No","100%",,"$4,600","$400","$0","$60","$1,900","$1,400","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130002-04.pdf","https://api.centene.com/Brochures/2018/76179IN0130002-04.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130002-05","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.867181007012531","Yes","Yes","No","100%",,"$1,700","$10","$0","$60","$1,500","$250","$0","$60","$1,600","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130002-05.pdf","https://api.centene.com/Brochures/2018/76179IN0130002-05.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130002-06","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.942313720589882","Yes","Yes","No","100%",,"$572","$3","$0","$60","$500","$70","$0","$60","$575","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130002-06.pdf","https://api.centene.com/Brochures/2018/76179IN0130002-06.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130004-00","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130004-00.pdf","https://api.centene.com/Brochures/2018/76179IN0130004-00.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130004-01","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130004-01.pdf","https://api.centene.com/Brochures/2018/76179IN0130004-01.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130004-02","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130004-02.pdf","https://api.centene.com/Brochures/2018/76179IN0130004-02.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130004-03","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130004-03.pdf","https://api.centene.com/Brochures/2018/76179IN0130004-03.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130004-04","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.73985223196154","Yes","Yes","No","100%",,"$3,700","$100","$2,000","$60","$1,500","$900","$400","$60","$1,300","$90","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130004-04.pdf","https://api.centene.com/Brochures/2018/76179IN0130004-04.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130004-05","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.879858510990049","Yes","Yes","No","100%",,"$800","$0","$1,400","$60","$850","$300","$400","$60","$850","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130004-05.pdf","https://api.centene.com/Brochures/2018/76179IN0130004-05.pdf"
"2018","IN","76179","HIOS","2017-09-23 02:26:22","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9371",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","https://ambetter.mhsindiana.com/resources/pharmacy-resources.html","76179IN0130004-06","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949794807417026","Yes","Yes","No","100%",,"$250","$0","$300","$60","$250","$160","$185","$60","$250","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$595","$595 per person","$1190 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/76179IN0130004-06.pdf","https://api.centene.com/Brochures/2018/76179IN0130004-06.pdf"
"2018","IN","79503","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","79503IN0010001","DentaTrust - PPO Pediatric High Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010001-00","DentaTrust - PPO Pediatric High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtin.dentalcareplus.com","http://hixpbdtin.dentalcareplus.com"
"2018","IN","79503","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","79503IN0020003","DentaSpan Family High Option","79503IN002","7083617077","INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0020003-00","DentaSpan Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsin.dentalcareplus.com","http://hiopbdsin.dentalcareplus.com"
"2018","IN","79503","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","79503IN0020003","DentaSpan Family High Option","79503IN002","7083617077","INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0020003-01","DentaSpan Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsin.dentalcareplus.com","http://hixpbdsin.dentalcareplus.com"
"2018","IN","79503","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","79503IN0010001","DentaTrust - PPO Pediatric High Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010001-01","DentaTrust - PPO Pediatric High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtin.dentalcareplus.com","http://hixpbdtin.dentalcareplus.com"
"2018","IN","79503","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","79503IN0010002","DentaTrust - PPO Pediatric Low Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010002-00","DentaTrust - PPO Pediatric Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtin.dentalcareplus.com","http://hixpbdtin.dentalcareplus.com"
"2018","IN","79503","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","79503IN0020004","DentaSpan Family Low Option","79503IN002","7083617077","INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0020004-00","DentaSpan Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsin.dentalcareplus.com","http://hiopbdsin.dentalcareplus.com"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83557IN0010007","BESTDental Premium","83557IN001",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010007-01","BESTDental Premium","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTDental_Premium_Plan.pdf"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","83557IN0020003","BESTOne Advantage Gold","83557IN002",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","83557IN0020004","BESTOne Plus Gold","83557IN002",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83557IN0010008","BESTDental Standard - H","83557IN001",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTDental_Standard-H_Plan.pdf"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220013","Blue POS 70/50 $4500","19636LA022",,"LAN005","LAS007","LAF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220013-01","Blue POS 70/50 $4500","Standard Bronze On Exchange Plan",,"0.607072260093228","Yes","Yes","No","100%",,"$4,500","$0","$2,380","$60","$4,500","$0","$1,140","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220013-01&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240011","Blue Connect 70/50 $4500 (L)","19636LA024",,"LAN006","LAS008","LAF003","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240011-02","Blue Connect 100/100 $0 CSR 000-02 (L)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240011-02&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","IN","79503","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","79503IN0020004","DentaSpan Family Low Option","79503IN002","7083617077","INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0020004-01","DentaSpan Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsin.dentalcareplus.com","http://hixpbdsin.dentalcareplus.com"
"2018","IN","79503","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","79503IN0010002","DentaTrust - PPO Pediatric Low Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010002-01","DentaTrust - PPO Pediatric Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtin.dentalcareplus.com","http://hixpbdtin.dentalcareplus.com"
"2018","IN","79503","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","79503IN0030003","DentaSpan Family High Option- Off Exchange","79503IN003","7083617077","INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0030003-00","DentaSpan Family High Option- Off Exchange","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsin.dentalcareplus.com","http://hiopbdsin.dentalcareplus.com"
"2018","IN","79503","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","79503IN0030004","DentaSpan Family Low Option- Off Exchange","79503IN003","7083617077","INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0030004-00","DentaSpan Family Low Option- Off Exchange","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsin.dentalcareplus.com","http://hiopbdsin.dentalcareplus.com"
"2018","IN","79503","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","79503IN0030001","DentaSpan Pediatric High Option- Off Exchange","79503IN003","7083617077","INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0030001-00","DentaSpan Pediatric High Option- Off Exchange","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsin.dentalcareplus.com","http://hiopbdsin.dentalcareplus.com"
"2018","IN","79503","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","79503IN0010003","DentaTrust - PPO Family High Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010003-00","DentaTrust - PPO Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtin.dentalcareplus.com","http://hixpbdtin.dentalcareplus.com"
"2018","IN","79503","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","79503IN0010003","DentaTrust - PPO Family High Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010003-01","DentaTrust - PPO Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtin.dentalcareplus.com","http://hixpbdtin.dentalcareplus.com"
"2018","IN","79503","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","79503IN0030002","DentaSpan Pediatric Low Option- Off Exchange","79503IN003","7083617077","INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0030002-00","DentaSpan Pediatric Low Option- Off Exchange","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsin.dentalcareplus.com","http://hiopbdsin.dentalcareplus.com"
"2018","IN","79503","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","79503IN0010004","DentaTrust - PPO Family Low Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010004-00","DentaTrust - PPO Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtin.dentalcareplus.com","http://hixpbdtin.dentalcareplus.com"
"2018","IN","79503","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","79503IN0010004","DentaTrust - PPO Family Low Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010004-01","DentaTrust - PPO Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtin.dentalcareplus.com","http://hixpbdtin.dentalcareplus.com"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","83557IN0020003","BESTOne Advantage Gold","83557IN002",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83557IN0010007","BESTDental Premium","83557IN001",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010007-00","BESTDental Premium","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTDental_Premium_Plan.pdf"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83557IN0010008","BESTDental Standard - H","83557IN001",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTDental_Standard-H_Plan.pdf"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","83557IN0020004","BESTOne Plus Gold","83557IN002",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83557IN0010010","BESTDental Choice - H","83557IN001",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTDental_Choice-H_Plan.pdf"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83557IN0010010","BESTDental Choice - H","83557IN001",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTDental_Choice-H_Plan.pdf"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83557IN0010009","BESTDental Standard - L","83557IN001",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTDental_Standard-L_Plan.pdf"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","83557IN0020005","BESTOne Plus Silver","83557IN002",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","83557IN0020005","BESTOne Plus Silver","83557IN002",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83557IN0010009","BESTDental Standard - L","83557IN001",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTDental_Standard-L_Plan.pdf"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83557IN0010011","BESTDental Choice - L","83557IN001",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTDental_Choice-L_Plan.pdf"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","83557IN0020006","BESTOne Basic Silver","83557IN002",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","83557IN0020006","BESTOne Basic Silver","83557IN002",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83557IN0010011","BESTDental Choice - L","83557IN001",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTDental_Choice-L_Plan.pdf"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83557IN0010012","BESTDental Value","83557IN001",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTDental_Value_Plan.pdf"
"2018","IN","83557","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","83557IN0010012","BESTDental Value","83557IN001",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/current/IN_BESTDental_Value_Plan.pdf"
"2018","IN","87417","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","87417IN0010001","TruAssure Basic Adult or Child Dental Plan","87417IN001",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered  Benefits","Yes","https://www.truassure.com/payment","","87417IN0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IN","https://www.truassure.com/brochure?state=IN"
"2018","IN","87417","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","87417IN0040001","TruAssure Dental Small Group Basic Plan","87417IN004",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","87417IN0040001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","87417","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","87417IN0030001","TruAssure Dental Small Group Preferred Plan","87417IN003",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","87417IN0030001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IN","87417","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","87417IN0010001","TruAssure Basic Adult or Child Dental Plan","87417IN001",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered  Benefits","Yes","https://www.truassure.com/payment","","87417IN0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IN","https://www.truassure.com/brochure?state=IN"
"2018","IN","87417","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","87417IN0020001","TruAssure Preferred Adult or Child Dental Plan","87417IN002",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","87417IN0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IN","https://www.truassure.com/brochure?state=IN"
"2018","IN","87417","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","87417IN0020001","TruAssure Preferred Adult or Child Dental Plan","87417IN002",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","87417IN0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IN","https://www.truassure.com/brochure?state=IN"
"2018","IN","91920","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","91920IN0010001","Dentegra Dental PPO Pediatric Basic Plan","91920IN001",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","91920IN0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/in/91920in0010001-18"
"2018","IN","91920","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","91920IN0010012","Dentegra Dental PPO Family Preferred Plan","91920IN001",,"INN001","INS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","91920IN0010012-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","$45 per person","per group not applicable",,,,,,"$45","$45 per person","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/in/91920in0010012-18"
"2018","IN","91920","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","91920IN0010011","Dentegra Dental PPO Family Basic Plan","91920IN001",,"INN001","INS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","91920IN0010011-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/in/91920in0010011-18"
"2018","LA","18802","HIOS","2017-08-11 02:20:28","Individual","Yes","94-2761537","18802LA0010002","Delta Dental PPO Pediatric Preferred Plan","18802LA001",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0010002-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$35","$35 per person","per group not applicable","$35","$35 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0010002-18"
"2018","LA","18802","HIOS","2017-08-11 02:20:28","Individual","Yes","94-2761537","18802LA0010001","Delta Dental PPO Pediatric Basic Plan","18802LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0010001-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0010001-18"
"2018","LA","18802","HIOS","2017-08-11 02:20:28","Individual","Yes","94-2761537","18802LA0010006","Delta Dental PPO Basic Plan for Families","18802LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0010006-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0010006-18"
"2018","LA","18802","HIOS","2017-08-11 02:20:28","Individual","Yes","94-2761537","18802LA0010004","Delta Dental PPO Preferred Plan for Families","18802LA001",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0010004-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$35","$35 per person","per group not applicable","$35","$35 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0010004-18"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220010-00","Blue POS 100/80 $3500","Standard Silver Off Exchange Plan",,"0.694960902235875","Yes","Yes","No","100%",,"$3,500","$0","$0","$60","$3,500","$0","$570","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0.00%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-00&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220010-01","Blue POS 100/80 $3500","Standard Silver On Exchange Plan",,"0.694960902235875","Yes","Yes","No","100%",,"$3,500","$0","$0","$60","$3,500","$0","$570","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0.00%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-01&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220010-02","Blue POS 100/100 $0 CSR 0010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-02&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220010-03","Blue POS 100/80 $3500 CSR 0010-03","Limited Cost Sharing Plan Variation",,"0.694960902235875","Yes","Yes","No","100%",,"$3,500","$0","$0","$60","$3,500","$0","$570","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0.00%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-03&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220010-04","Blue POS 100/80 $2800 CSR 0010-04","73% AV Level Silver Plan",,"0.729696001363234","Yes","Yes","No","100%",,"$2,800","$0","$0","$60","$2,800","$0","$700","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$14,700","$14700 per person","$29400 per group","$20,400","$20400 per person","$40800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$8400 per group","0.00%",,,,,"$7,000","$7000 per person","$21000 per group","$9,800","$9800 per person","$29400 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-04&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220010-05","Blue POS 100/80 $950 CSR 0010-05","87% AV Level Silver Plan",,"0.861064951612679","Yes","Yes","No","100%",,"$950","$0","$0","$60","$950","$0","$950","$90","$950","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$14,700","$14700 per person","$29400 per group","$17,050","$17050 per person","$34100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$2850 per group","0.00%",,,,,"$7,000","$7000 per person","$21000 per group","$7,950","$7950 per person","$23850 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-05&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220010-06","Blue POS 100/80 $200 CSR 0010-06","94% AV Level Silver Plan",,"0.93878226550303","Yes","Yes","No","100%",,"$200","$0","$0","$60","$200","$0","$1,060","$90","$200","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$14,700","$14700 per person","$29400 per group","$16,950","$16950 per person","$33900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","0.00%",,,,,"$7,000","$7000 per person","$21000 per group","$7,200","$7200 per person","$21600 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-06&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220012","Blue POS 60/40 $6500","19636LA022",,"LAN005","LAS007","LAF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220012-00","Blue POS 60/40 $6500","Standard Bronze Off Exchange Plan",,"0.586933667336033","Yes","Yes","No","100%",,"$6,500","$0","$850","$60","$6,500","$0","$200","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$14700 per group","40.00%",,,,,"$13,000","$13000 per person","$29400 per group","$19,500","$19500 per person","$44100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220012-00&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220012","Blue POS 60/40 $6500","19636LA022",,"LAN005","LAS007","LAF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220012-01","Blue POS 60/40 $6500","Standard Bronze On Exchange Plan",,"0.586933667336033","Yes","Yes","No","100%",,"$6,500","$0","$850","$60","$6,500","$0","$200","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$14700 per group","40.00%",,,,,"$13,000","$13000 per person","$29400 per group","$19,500","$19500 per person","$44100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220012-01&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220012","Blue POS 60/40 $6500","19636LA022",,"LAN005","LAS007","LAF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220012-02","Blue POS 100/100 $0 CSR 0012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220012-02&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220012","Blue POS 60/40 $6500","19636LA022",,"LAN005","LAS007","LAF005","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220012-03","Blue POS 60/40 $6500 CSR 0012-03","Limited Cost Sharing Plan Variation",,"0.586933667336033","Yes","Yes","No","100%",,"$6,500","$0","$850","$60","$6,500","$0","$200","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$14700 per group","40.00%",,,,,"$13,000","$13000 per person","$29400 per group","$19,500","$19500 per person","$44100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220012-03&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220013","Blue POS 70/50 $4500","19636LA022",,"LAN005","LAS007","LAF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220013-00","Blue POS 70/50 $4500","Standard Bronze Off Exchange Plan",,"0.607072260093228","Yes","Yes","No","100%",,"$4,500","$0","$2,380","$60","$4,500","$0","$1,140","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220013-00&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240011","Blue Connect 70/50 $4500 (L)","19636LA024",,"LAN006","LAS008","LAF003","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240011-03","Blue Connect 70/50 $4500 CSR 0006-03 (L)","Limited Cost Sharing Plan Variation",,"0.607072260093228","Yes","Yes","No","100%",,"$4,500","$0","$2,380","$60","$4,500","$0","$1,140","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240011-03&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240013","Blue Connect 80/60 $3200 (S)","19636LA024",,"LAN006","LAS010","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240013-00","Blue Connect 80/60 $3200 (S)","Standard Silver Off Exchange Plan",,"0.661666073810778","Yes","Yes","No","100%",,"$3,200","$0","$1,850","$60","$3,200","$0","$1,350","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$9600 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$9,600","$9600 per person","$28800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240013-00&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240013","Blue Connect 80/60 $3200 (S)","19636LA024",,"LAN006","LAS010","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240013-01","Blue Connect 80/60 $3200 (S)","Standard Silver On Exchange Plan",,"0.661666073810778","Yes","Yes","No","100%",,"$3,200","$0","$1,850","$60","$3,200","$0","$1,350","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$9600 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$9,600","$9600 per person","$28800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240013-01&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240013","Blue Connect 80/60 $3200 (S)","19636LA024",,"LAN006","LAS010","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240013-02","Blue Connect 100/100 $0 CSR 0013-02 (S)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240013-02&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240013","Blue Connect 80/60 $3200 (S)","19636LA024",,"LAN006","LAS010","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240013-03","Blue Connect 80/60 $3200 CSR 0013-03 (S)","Limited Cost Sharing Plan Variation",,"0.661666073810778","Yes","Yes","No","100%",,"$3,200","$0","$1,850","$60","$3,200","$0","$1,350","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$9600 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$9,600","$9600 per person","$28800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240013-03&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220013","Blue POS 70/50 $4500","19636LA022",,"LAN005","LAS007","LAF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220013-02","Blue POS 100/100 $0 CSR 0013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220013-02&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220013","Blue POS 70/50 $4500","19636LA022",,"LAN005","LAS007","LAF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220013-03","Blue POS 70/50 $4500 CSR 0013-03","Limited Cost Sharing Plan Variation",,"0.607072260093228","Yes","Yes","No","100%",,"$4,500","$0","$2,380","$60","$4,500","$0","$1,140","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220013-03&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220014","Blue POS 80/60 $3200","19636LA022",,"LAN005","LAS007","LAF006","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220014-00","Blue POS 80/60 $3200","Standard Silver Off Exchange Plan",,"0.661666073810778","Yes","Yes","No","100%",,"$3,200","$0","$1,850","$60","$3,200","$0","$1,350","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$9600 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$9,600","$9600 per person","$28800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220014-00&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220014","Blue POS 80/60 $3200","19636LA022",,"LAN005","LAS007","LAF006","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220014-01","Blue POS 80/60 $3200","Standard Silver On Exchange Plan",,"0.661666073810778","Yes","Yes","No","100%",,"$3,200","$0","$1,850","$60","$3,200","$0","$1,350","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$9600 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$9,600","$9600 per person","$28800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220014-01&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220014","Blue POS 80/60 $3200","19636LA022",,"LAN005","LAS007","LAF006","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220014-02","Blue POS 100/100 $0 CSR 0014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220014-02&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220014","Blue POS 80/60 $3200","19636LA022",,"LAN005","LAS007","LAF006","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220014-03","Blue POS 80/60 $3200 CSR 0014-03","Limited Cost Sharing Plan Variation",,"0.661666073810778","Yes","Yes","No","100%",,"$3,200","$0","$1,850","$60","$3,200","$0","$1,350","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$9600 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$9,600","$9600 per person","$28800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220014-03&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220014","Blue POS 80/60 $3200","19636LA022",,"LAN005","LAS007","LAF006","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220014-04","Blue POS 80/60 $2000 CSR 0014-04","73% AV Level Silver Plan",,"0.725618698666918","Yes","Yes","No","100%",,"$2,000","$0","$2,090","$60","$2,000","$0","$1,800","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"$13,200","$13200 per person","$26400 per group","$17,900","$17900 per person","$35800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$8,400","$8400 per person","$25200 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220014-04&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220014","Blue POS 80/60 $3200","19636LA022",,"LAN005","LAS007","LAF006","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220014-05","Blue POS 90/60 $600 CSR 0014-05","87% AV Level Silver Plan",,"0.860022479952856","Yes","Yes","No","100%",,"$600","$0","$1,180","$60","$600","$0","$1,610","$90","$600","$0","$130","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$13,200","$13200 per person","$26400 per group","$15,550","$15550 per person","$31100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","10.00%",,,,,"$6,400","$6400 per person","$19200 per group","$7,000","$7000 per person","$21000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220014-05&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220014","Blue POS 80/60 $3200","19636LA022",,"LAN005","LAS007","LAF006","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0220014-06","Blue POS 95/60 $100 CSR 0014-06","94% AV Level Silver Plan",,"0.931450156815217","Yes","Yes","No","100%",,"$100","$0","$620","$60","$100","$0","$1,420","$90","$100","$0","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"$13,200","$13200 per person","$26400 per group","$15,100","$15100 per person","$30200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","5.00%",,,,,"$6,400","$6400 per person","$19200 per group","$6,500","$6500 per person","$19500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220014-06&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0230006","Community Blue 70/50 $4500","19636LA023",,"LAN007","LAS006","LAF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0230006-00","Community Blue 70/50 $4500","Standard Bronze Off Exchange Plan",,"0.607072260093228","Yes","Yes","No","100%",,"$4,500","$0","$2,380","$60","$4,500","$0","$1,140","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230006-00&Year=2018","http://www.bcbsla.com/individual-communityblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0230006","Community Blue 70/50 $4500","19636LA023",,"LAN007","LAS006","LAF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0230006-01","Community Blue 70/50 $4500","Standard Bronze On Exchange Plan",,"0.607072260093228","Yes","Yes","No","100%",,"$4,500","$0","$2,380","$60","$4,500","$0","$1,140","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230006-01&Year=2018","http://www.bcbsla.com/individual-communityblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0230006","Community Blue 70/50 $4500","19636LA023",,"LAN007","LAS006","LAF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0230006-02","Community Blue 100/100 $0 CSR 0006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230006-02&Year=2018","http://www.bcbsla.com/individual-communityblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0230006","Community Blue 70/50 $4500","19636LA023",,"LAN007","LAS006","LAF003","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0230006-03","Community Blue 70/50 $4500 CSR 0006-03","Limited Cost Sharing Plan Variation",,"0.607072260093228","Yes","Yes","No","100%",,"$4,500","$0","$2,380","$60","$4,500","$0","$1,140","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230006-03&Year=2018","http://www.bcbsla.com/individual-communityblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240007","Blue Connect 80/60 $3200 (N)","19636LA024",,"LAN006","LAS005","LAF006","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240007-00","Blue Connect 80/60 $3200 (N)","Standard Silver Off Exchange Plan",,"0.661666073810778","Yes","Yes","No","100%",,"$3,200","$0","$1,850","$60","$3,200","$0","$1,350","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$9600 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$9,600","$9600 per person","$28800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240007-00&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240007","Blue Connect 80/60 $3200 (N)","19636LA024",,"LAN006","LAS005","LAF006","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240007-01","Blue Connect 80/60 $3200 (N)","Standard Silver On Exchange Plan",,"0.661666073810778","Yes","Yes","No","100%",,"$3,200","$0","$1,850","$60","$3,200","$0","$1,350","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$9600 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$9,600","$9600 per person","$28800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240007-01&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240007","Blue Connect 80/60 $3200 (N)","19636LA024",,"LAN006","LAS005","LAF006","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240007-02","Blue Connect 100/100 $0 CSR 0007-02 (N)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240007-02&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240007","Blue Connect 80/60 $3200 (N)","19636LA024",,"LAN006","LAS005","LAF006","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240007-03","Blue Connect 80/60 $3200 CSR 0007-03 (N)","Limited Cost Sharing Plan Variation",,"0.661666073810778","Yes","Yes","No","100%",,"$3,200","$0","$1,850","$60","$3,200","$0","$1,350","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$9600 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$9,600","$9600 per person","$28800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240007-03&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240007","Blue Connect 80/60 $3200 (N)","19636LA024",,"LAN006","LAS005","LAF006","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240007-04","Blue Connect 80/60 $2000 CSR 0007-04 (N)","73% AV Level Silver Plan",,"0.725618698666918","Yes","Yes","No","100%",,"$2,000","$0","$2,090","$60","$2,000","$0","$1,800","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"$13,200","$13200 per person","$26400 per group","$17,900","$17900 per person","$35800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$8,400","$8400 per person","$25200 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240007-04&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240007","Blue Connect 80/60 $3200 (N)","19636LA024",,"LAN006","LAS005","LAF006","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240007-05","Blue Connect 90/60 $600 CSR 0007-05 (N)","87% AV Level Silver Plan",,"0.860022479952856","Yes","Yes","No","100%",,"$600","$0","$1,180","$60","$600","$0","$1,610","$90","$600","$0","$130","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$13,200","$13200 per person","$26400 per group","$15,550","$15550 per person","$31100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","10.00%",,,,,"$6,400","$6400 per person","$19200 per group","$7,000","$7000 per person","$21000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240007-05&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240007","Blue Connect 80/60 $3200 (N)","19636LA024",,"LAN006","LAS005","LAF006","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240007-06","Blue Connect 95/60 $100 CSR 0007-06 (N)","94% AV Level Silver Plan",,"0.931450156815217","Yes","Yes","No","100%",,"$100","$0","$620","$60","$100","$0","$1,420","$90","$100","$0","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"$13,200","$13200 per person","$26400 per group","$15,100","$15100 per person","$30200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","5.00%",,,,,"$6,400","$6400 per person","$19200 per group","$6,500","$6500 per person","$19500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240007-06&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240010","Blue Connect 80/60 $3200 (L)","19636LA024",,"LAN006","LAS008","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240010-00","Blue Connect 80/60 $3200 (L)","Standard Silver Off Exchange Plan",,"0.661666073810778","Yes","Yes","No","100%",,"$3,200","$0","$1,850","$60","$3,200","$0","$1,350","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$9600 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$9,600","$9600 per person","$28800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240010-00&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240010","Blue Connect 80/60 $3200 (L)","19636LA024",,"LAN006","LAS008","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240010-01","Blue Connect 80/60 $3200 (L)","Standard Silver On Exchange Plan",,"0.661666073810778","Yes","Yes","No","100%",,"$3,200","$0","$1,850","$60","$3,200","$0","$1,350","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$9600 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$9,600","$9600 per person","$28800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240010-01&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240010","Blue Connect 80/60 $3200 (L)","19636LA024",,"LAN006","LAS008","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240010-02","Blue Connect 100/100 $0 CSR 0010-02 (L)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240010-02&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240010","Blue Connect 80/60 $3200 (L)","19636LA024",,"LAN006","LAS008","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240010-03","Blue Connect 80/60 $3200 CSR 0010-03 (L)","Limited Cost Sharing Plan Variation",,"0.661666073810778","Yes","Yes","No","100%",,"$3,200","$0","$1,850","$60","$3,200","$0","$1,350","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$9600 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$9,600","$9600 per person","$28800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240010-03&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240010","Blue Connect 80/60 $3200 (L)","19636LA024",,"LAN006","LAS008","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240010-04","Blue Connect 80/60 $2000 CSR 0010-04 (L)","73% AV Level Silver Plan",,"0.725618698666918","Yes","Yes","No","100%",,"$2,000","$0","$2,090","$60","$2,000","$0","$1,800","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"$13,200","$13200 per person","$26400 per group","$17,900","$17900 per person","$35800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$8,400","$8400 per person","$25200 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240010-04&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240010","Blue Connect 80/60 $3200 (L)","19636LA024",,"LAN006","LAS008","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240010-05","Blue Connect 90/60 $600 CSR 0010-05 (L)","87% AV Level Silver Plan",,"0.860022479952856","Yes","Yes","No","100%",,"$600","$0","$1,180","$60","$600","$0","$1,610","$90","$600","$0","$130","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$13,200","$13200 per person","$26400 per group","$15,550","$15550 per person","$31100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","10.00%",,,,,"$6,400","$6400 per person","$19200 per group","$7,000","$7000 per person","$21000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240010-05&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240010","Blue Connect 80/60 $3200 (L)","19636LA024",,"LAN006","LAS008","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240010-06","Blue Connect 95/60 $100 CSR 0010-06 (L)","94% AV Level Silver Plan",,"0.931450156815217","Yes","Yes","No","100%",,"$100","$0","$620","$60","$100","$0","$1,420","$90","$100","$0","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"$13,200","$13200 per person","$26400 per group","$15,100","$15100 per person","$30200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","5.00%",,,,,"$6,400","$6400 per person","$19200 per group","$6,500","$6500 per person","$19500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240010-06&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240011","Blue Connect 70/50 $4500 (L)","19636LA024",,"LAN006","LAS008","LAF003","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240011-00","Blue Connect 70/50 $4500 (L)","Standard Bronze Off Exchange Plan",,"0.607072260093228","Yes","Yes","No","100%",,"$4,500","$0","$2,380","$60","$4,500","$0","$1,140","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240011-00&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240011","Blue Connect 70/50 $4500 (L)","19636LA024",,"LAN006","LAS008","LAF003","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240011-01","Blue Connect 70/50 $4500 (L)","Standard Bronze On Exchange Plan",,"0.607072260093228","Yes","Yes","No","100%",,"$4,500","$0","$2,380","$60","$4,500","$0","$1,140","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240011-01&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240013","Blue Connect 80/60 $3200 (S)","19636LA024",,"LAN006","LAS010","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240013-04","Blue Connect 80/60 $2000 CSR 0013-04 (S)","73% AV Level Silver Plan",,"0.725618698666918","Yes","Yes","No","100%",,"$2,000","$0","$2,090","$60","$2,000","$0","$1,800","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"$13,200","$13200 per person","$26400 per group","$17,900","$17900 per person","$35800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$8,400","$8400 per person","$25200 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240013-04&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240013","Blue Connect 80/60 $3200 (S)","19636LA024",,"LAN006","LAS010","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240013-05","Blue Connect 90/60 $600 CSR 0013-05 (S)","87% AV Level Silver Plan",,"0.860022479952856","Yes","Yes","No","100%",,"$600","$0","$1,180","$60","$600","$0","$1,610","$90","$600","$0","$130","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$13,200","$13200 per person","$26400 per group","$15,550","$15550 per person","$31100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","10.00%",,,,,"$6,400","$6400 per person","$19200 per group","$7,000","$7000 per person","$21000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240013-05&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240013","Blue Connect 80/60 $3200 (S)","19636LA024",,"LAN006","LAS010","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240013-06","Blue Connect 95/60 $100 CSR 0013-06 (S)","94% AV Level Silver Plan",,"0.931450156815217","Yes","Yes","No","100%",,"$100","$0","$620","$60","$100","$0","$1,420","$90","$100","$0","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"$13,200","$13200 per person","$26400 per group","$15,100","$15100 per person","$30200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","5.00%",,,,,"$6,400","$6400 per person","$19200 per group","$6,500","$6500 per person","$19500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240013-06&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240014","Blue Connect 70/50 $4500 (S)","19636LA024",,"LAN006","LAS010","LAF003","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240014-00","Blue Connect 70/50 $4500 (S)","Standard Bronze Off Exchange Plan",,"0.607072260093228","Yes","Yes","No","100%",,"$4,500","$0","$2,380","$60","$4,500","$0","$1,140","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240014-00&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240014","Blue Connect 70/50 $4500 (S)","19636LA024",,"LAN006","LAS010","LAF003","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240014-01","Blue Connect 70/50 $4500 (S)","Standard Bronze On Exchange Plan",,"0.607072260093228","Yes","Yes","No","100%",,"$4,500","$0","$2,380","$60","$4,500","$0","$1,140","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240014-01&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240014","Blue Connect 70/50 $4500 (S)","19636LA024",,"LAN006","LAS010","LAF003","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240014-02","Blue Connect 100/100 $0 CSR 000-02 (S)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240014-02&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240014","Blue Connect 70/50 $4500 (S)","19636LA024",,"LAN006","LAS010","LAF003","New","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240014-03","Blue Connect 70/50 $4500 CSR 0006-03 (S)","Limited Cost Sharing Plan Variation",,"0.607072260093228","Yes","Yes","No","100%",,"$4,500","$0","$2,380","$60","$4,500","$0","$1,140","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30.00%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240014-03&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0590003","Signature Blue 80/60 $3200","19636LA059",,"LAN008","LAS009","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0590003-00","Signature Blue 80/60 $3200","Standard Silver Off Exchange Plan",,"0.661666073810778","Yes","Yes","No","100%",,"$3,200","$0","$1,850","$60","$3,200","$0","$1,350","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$9600 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$9,600","$9600 per person","$28800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0590003-00&Year=2018","http://www.bcbsla.com/individual-signatureblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0590003","Signature Blue 80/60 $3200","19636LA059",,"LAN008","LAS009","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0590003-01","Signature Blue 80/60 $3200","Standard Silver On Exchange Plan",,"0.661666073810778","Yes","Yes","No","100%",,"$3,200","$0","$1,850","$60","$3,200","$0","$1,350","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$9600 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$9,600","$9600 per person","$28800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0590003-01&Year=2018","http://www.bcbsla.com/individual-signatureblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0590003","Signature Blue 80/60 $3200","19636LA059",,"LAN008","LAS009","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0590003-02","Signature Blue 100/100 $0 CSR 0003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0590003-02&Year=2018","http://www.bcbsla.com/individual-signatureblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0590003","Signature Blue 80/60 $3200","19636LA059",,"LAN008","LAS009","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0590003-03","Signature Blue 80/60 $3200 CSR 0003-03","Limited Cost Sharing Plan Variation",,"0.661666073810778","Yes","Yes","No","100%",,"$3,200","$0","$1,850","$60","$3,200","$0","$1,350","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$9600 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$9,600","$9600 per person","$28800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0590003-03&Year=2018","http://www.bcbsla.com/individual-signatureblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0590003","Signature Blue 80/60 $3200","19636LA059",,"LAN008","LAS009","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0590003-04","Signature Blue 80/60 $2000 CSR 0003-04","73% AV Level Silver Plan",,"0.725618698666918","Yes","Yes","No","100%",,"$2,000","$0","$2,090","$60","$2,000","$0","$1,800","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"$13,200","$13200 per person","$26400 per group","$17,900","$17900 per person","$35800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20.00%",,,,,"$6,400","$6400 per person","$19200 per group","$8,400","$8400 per person","$25200 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0590003-04&Year=2018","http://www.bcbsla.com/individual-signatureblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0590003","Signature Blue 80/60 $3200","19636LA059",,"LAN008","LAS009","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0590003-05","Signature Blue 90/60 $600 CSR 0003-05","87% AV Level Silver Plan",,"0.860022479952856","Yes","Yes","No","100%",,"$600","$0","$1,180","$60","$600","$0","$1,610","$90","$600","$0","$130","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$13,200","$13200 per person","$26400 per group","$15,550","$15550 per person","$31100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","10.00%",,,,,"$6,400","$6400 per person","$19200 per group","$7,000","$7000 per person","$21000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0590003-05&Year=2018","http://www.bcbsla.com/individual-signatureblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0590003","Signature Blue 80/60 $3200","19636LA059",,"LAN008","LAS009","LAF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0590003-06","Signature Blue 95/60 $100 CSR 0003-06","94% AV Level Silver Plan",,"0.931450156815217","Yes","Yes","No","100%",,"$100","$0","$620","$60","$100","$0","$1,420","$90","$100","$0","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"$13,200","$13200 per person","$26400 per group","$15,100","$15100 per person","$30200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","5.00%",,,,,"$6,400","$6400 per person","$19200 per group","$6,500","$6500 per person","$19500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0590003-06&Year=2018","http://www.bcbsla.com/individual-signatureblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0230003","Community Blue Copay 70/50 $2100","19636LA023",,"LAN007","LAS006","LAF003","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0230003-00","Community Blue copay 70/50 $2100","Standard Silver Off Exchange Plan","71.65%","0.710831187093455","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-00&Year=2018","http://www.bcbsla.com/individual-communityblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220005","Blue POS Copay 80/60 $1000","19636LA022",,"LAN005","LAS007","LAF009","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0220005-01","Blue POS Copay 80/60 $1000","Standard Gold On Exchange Plan",,"0.762512855533808","No","Yes","No","100%",,"$1,040","$60","$1,590","$60","$560","$610","$990","$90","$200","$560","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$9000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-01&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220005","Blue POS Copay 80/60 $1000","19636LA022",,"LAN005","LAS007","LAF009","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0220005-02","Blue POS copay 100/100 $0 CSR 0005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-02&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220005","Blue POS Copay 80/60 $1000","19636LA022",,"LAN005","LAS007","LAF009","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0220005-03","Blue POS copay 80/60 $1000 CSR 0005-03","Limited Cost Sharing Plan Variation",,"0.762512855533808","No","Yes","No","100%",,"$1,040","$60","$1,590","$60","$560","$610","$990","$90","$200","$560","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$9000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-03&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220007","Blue POS Copay 60/40 $3300","19636LA022",,"LAN005","LAS007","LAF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0220007-00","Blue POS Copay 60/40 $3300","Standard Silver Off Exchange Plan",,"0.708231653361625","No","Yes","No","100%",,"$3,340","$60","$2,260","$60","$560","$770","$990","$90","$200","$560","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$3,300","$3300 per person","$9900 per group","40.00%",,,,,"$6,600","$6600 per person","$19800 per group","$9,900","$9900 per person","$29700 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-00&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220007","Blue POS Copay 60/40 $3300","19636LA022",,"LAN005","LAS007","LAF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0220007-01","Blue POS Copay 60/40 $3300","Standard Silver On Exchange Plan",,"0.708231653361625","No","Yes","No","100%",,"$3,340","$60","$2,260","$60","$560","$770","$990","$90","$200","$560","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$3,300","$3300 per person","$9900 per group","40.00%",,,,,"$6,600","$6600 per person","$19800 per group","$9,900","$9900 per person","$29700 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-01&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220007","Blue POS Copay 60/40 $3300","19636LA022",,"LAN005","LAS007","LAF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0220007-02","Blue POS copay 100/100 $0 CSR 0007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-02&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220007","Blue POS Copay 60/40 $3300","19636LA022",,"LAN005","LAS007","LAF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0220007-03","Blue POS copay 60/40 $3300 CSR 0007-03","Limited Cost Sharing Plan Variation",,"0.708231653361625","No","Yes","No","100%",,"$3,340","$60","$2,260","$60","$560","$770","$990","$90","$200","$560","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$3,300","$3300 per person","$9900 per group","40.00%",,,,,"$6,600","$6600 per person","$19800 per group","$9,900","$9900 per person","$29700 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-03&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0230003","Community Blue Copay 70/50 $2100","19636LA023",,"LAN007","LAS006","LAF003","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0230003-01","Community Blue copay 70/50 $2100","Standard Silver On Exchange Plan","71.65%","0.710831187093455","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-01&Year=2018","http://www.bcbsla.com/individual-communityblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0230003","Community Blue Copay 70/50 $2100","19636LA023",,"LAN007","LAS006","LAF003","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0230003-02","Community Blue copay 100/100 $0 CSR 0003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-02&Year=2018","http://www.bcbsla.com/individual-communityblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240003","Blue Connect Copay 70/50 $2100 (N)","19636LA024",,"LAN006","LAS005","LAF003","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240003-02","Blue Connect copay 100/100 $0 CSR 0003-02 (N)","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-02&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240003","Blue Connect Copay 70/50 $2100 (N)","19636LA024",,"LAN006","LAS005","LAF003","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240003-03","Blue Connect copay 70/50 $2100 CSR 0003-03 (N)","Limited Cost Sharing Plan Variation","71.65%","0.710831187093455","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-03&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240003","Blue Connect Copay 70/50 $2100 (N)","19636LA024",,"LAN006","LAS005","LAF003","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240003-04","Blue Connect copay 70/50 $2100 CSR 0003-04 (N)","73% AV Level Silver Plan","73.73%","0.73233781501899","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group",,,,"$14,700","$14700 per person","$29400 per group","$20,350","$20350 per person","$40700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-04&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240003","Blue Connect Copay 70/50 $2100 (N)","19636LA024",,"LAN006","LAS005","LAF003","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240003-05","Blue Connect copay 80/50 $500 CSR 0003-05 (N)","87% AV Level Silver Plan","86.27%","0.860322033678768","Yes","Yes","No","100%",,"$500","$40","$1,700","$60","$500","$160","$1,790","$90","$200","$370","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$14,700","$14700 per person","$29400 per group","$17,150","$17150 per person","$34300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%",,,,,"$4,200","$4200 per person","$12600 per group","$4,700","$4700 per person","$14100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-05&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240003","Blue Connect Copay 70/50 $2100 (N)","19636LA024",,"LAN006","LAS005","LAF003","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240003-06","Blue Connect copay 95/50 $200 CSR 0003-06 (N)","94% AV Level Silver Plan","93.03%","0.928764602616934","Yes","Yes","No","100%",,"$200","$30","$440","$60","$200","$120","$890","$90","$200","$320","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$14,700","$14700 per person","$29400 per group","$15,900","$15900 per person","$31800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","5.00%",,,,,"$4,200","$4200 per person","$12600 per group","$4,400","$4400 per person","$13200 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-06&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240009","Blue Connect Copay 70/50 $2100 (L)","19636LA024",,"LAN006","LAS008","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240009-00","Blue Connect Copay 70/50 $2100 (L)","Standard Silver Off Exchange Plan","71.65%","0.710831187093455","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240009-00&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240009","Blue Connect Copay 70/50 $2100 (L)","19636LA024",,"LAN006","LAS008","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240009-01","Blue Connect Copay 70/50 $2100 (L)","Standard Silver On Exchange Plan","71.65%","0.710831187093455","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240009-01&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0230003","Community Blue Copay 70/50 $2100","19636LA023",,"LAN007","LAS006","LAF003","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0230003-03","Community Blue copay 70/50 $2100 CSR 0003-03","Limited Cost Sharing Plan Variation","71.65%","0.710831187093455","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-03&Year=2018","http://www.bcbsla.com/individual-communityblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0230003","Community Blue Copay 70/50 $2100","19636LA023",,"LAN007","LAS006","LAF003","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0230003-04","Community Blue copay 70/50 $2100 CSR 0003-04","73% AV Level Silver Plan","73.73%","0.73233781501899","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group",,,,"$14,700","$14700 per person","$29400 per group","$20,350","$20350 per person","$40700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-04&Year=2018","http://www.bcbsla.com/individual-communityblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0230003","Community Blue Copay 70/50 $2100","19636LA023",,"LAN007","LAS006","LAF003","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0230003-05","Community Blue copay 80/50 $500 CSR 0003-05","87% AV Level Silver Plan","86.27%","0.860322033678768","Yes","Yes","No","100%",,"$500","$40","$1,700","$60","$500","$160","$1,790","$90","$200","$370","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$14,700","$14700 per person","$29400 per group","$17,150","$17150 per person","$34300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%",,,,,"$4,200","$4200 per person","$12600 per group","$4,700","$4700 per person","$14100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-05&Year=2018","http://www.bcbsla.com/individual-communityblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0230003","Community Blue Copay 70/50 $2100","19636LA023",,"LAN007","LAS006","LAF003","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0230003-06","Community Blue copay 95/50 $200 CSR 0003-06","94% AV Level Silver Plan","93.03%","0.928764602616934","Yes","Yes","No","100%",,"$200","$30","$440","$60","$200","$120","$890","$90","$200","$320","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$14,700","$14700 per person","$29400 per group","$15,900","$15900 per person","$31800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","5.00%",,,,,"$4,200","$4200 per person","$12600 per group","$4,400","$4400 per person","$13200 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-06&Year=2018","http://www.bcbsla.com/individual-communityblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240003","Blue Connect Copay 70/50 $2100 (N)","19636LA024",,"LAN006","LAS005","LAF003","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240003-00","Blue Connect Copay 70/50 $2100 (N)","Standard Silver Off Exchange Plan","71.65%","0.710831187093455","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-00&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240003","Blue Connect Copay 70/50 $2100 (N)","19636LA024",,"LAN006","LAS005","LAF003","Existing","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240003-01","Blue Connect Copay 70/50 $2100 (N)","Standard Silver On Exchange Plan","71.65%","0.710831187093455","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-01&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240009","Blue Connect Copay 70/50 $2100 (L)","19636LA024",,"LAN006","LAS008","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240009-02","Blue Connect copay 100/100 $0 CSR 0009-02 (L)","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240009-02&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240009","Blue Connect Copay 70/50 $2100 (L)","19636LA024",,"LAN006","LAS008","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240009-03","Blue Connect copay 70/50 $2100 CSR 0009-03 (L)","Limited Cost Sharing Plan Variation","71.65%","0.710831187093455","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240009-03&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240009","Blue Connect Copay 70/50 $2100 (L)","19636LA024",,"LAN006","LAS008","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240009-04","Blue Connect copay 70/50 $2100 CSR 0009-04 (L)","73% AV Level Silver Plan","73.73%","0.73233781501899","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group",,,,"$14,700","$14700 per person","$29400 per group","$20,350","$20350 per person","$40700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240009-04&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240009","Blue Connect Copay 70/50 $2100 (L)","19636LA024",,"LAN006","LAS008","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240009-05","Blue Connect copay 80/50 $500 CSR 0009-05 (L)","87% AV Level Silver Plan","86.27%","0.860322033678768","Yes","Yes","No","100%",,"$500","$40","$1,700","$60","$500","$160","$1,790","$90","$200","$370","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$14,700","$14700 per person","$29400 per group","$17,150","$17150 per person","$34300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%",,,,,"$4,200","$4200 per person","$12600 per group","$4,700","$4700 per person","$14100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240009-05&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240009","Blue Connect Copay 70/50 $2100 (L)","19636LA024",,"LAN006","LAS008","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240009-06","Blue Connect copay 95/50 $200 CSR 0009-06 (L)","94% AV Level Silver Plan","93.03%","0.928764602616934","Yes","Yes","No","100%",,"$200","$30","$440","$60","$200","$120","$890","$90","$200","$320","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$14,700","$14700 per person","$29400 per group","$15,900","$15900 per person","$31800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","5.00%",,,,,"$4,200","$4200 per person","$12600 per group","$4,400","$4400 per person","$13200 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240009-06&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240012","Blue Connect Copay 70/50 $2100 (S)","19636LA024",,"LAN006","LAS010","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240012-00","Blue Connect Copay 70/50 $2100 (S)","Standard Silver Off Exchange Plan","71.65%","0.710831187093455","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240012-00&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240012","Blue Connect Copay 70/50 $2100 (S)","19636LA024",,"LAN006","LAS010","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240012-01","Blue Connect Copay 70/50 $2100 (S)","Standard Silver On Exchange Plan","71.65%","0.710831187093455","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240012-01&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240012","Blue Connect Copay 70/50 $2100 (S)","19636LA024",,"LAN006","LAS010","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240012-02","Blue Connect copay 100/100 $0 CSR 0012-02 (S)","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240012-02&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240012","Blue Connect Copay 70/50 $2100 (S)","19636LA024",,"LAN006","LAS010","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240012-03","Blue Connect copay 70/50 $2100 CSR 0012-03 (S)","Limited Cost Sharing Plan Variation","71.65%","0.710831187093455","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240012-03&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240012","Blue Connect Copay 70/50 $2100 (S)","19636LA024",,"LAN006","LAS010","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240012-04","Blue Connect copay 70/50 $2100 CSR 0012-04 (S)","73% AV Level Silver Plan","73.73%","0.73233781501899","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group",,,,"$14,700","$14700 per person","$29400 per group","$20,350","$20350 per person","$40700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240012-04&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240012","Blue Connect Copay 70/50 $2100 (S)","19636LA024",,"LAN006","LAS010","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240012-05","Blue Connect copay 80/50 $500 CSR 0012-05 (S)","87% AV Level Silver Plan","86.27%","0.860322033678768","Yes","Yes","No","100%",,"$500","$40","$1,700","$60","$500","$160","$1,790","$90","$200","$370","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$14,700","$14700 per person","$29400 per group","$17,150","$17150 per person","$34300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%",,,,,"$4,200","$4200 per person","$12600 per group","$4,700","$4700 per person","$14100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240012-05&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240012","Blue Connect Copay 70/50 $2100 (S)","19636LA024",,"LAN006","LAS010","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0240012-06","Blue Connect copay 95/50 $200 CSR 0012-06 (S)","94% AV Level Silver Plan","93.03%","0.928764602616934","Yes","Yes","No","100%",,"$200","$30","$440","$60","$200","$120","$890","$90","$200","$320","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$14,700","$14700 per person","$29400 per group","$15,900","$15900 per person","$31800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","5.00%",,,,,"$4,200","$4200 per person","$12600 per group","$4,400","$4400 per person","$13200 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240012-06&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0590002","Signature Blue Copay 70/50 $2100","19636LA059",,"LAN008","LAS009","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0590002-00","Signature Blue Copay 70/50 $2100","Standard Silver Off Exchange Plan","71.65%","0.710831187093455","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0590002-00&Year=2018","http://www.bcbsla.com/individual-signatureblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220007","Blue POS Copay 60/40 $3300","19636LA022",,"LAN005","LAS007","LAF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0220007-05","Blue POS copay 95/40 $500 CSR 0007-05","87% AV Level Silver Plan",,"0.860375563416224","No","Yes","No","100%",,"$540","$40","$420","$60","$560","$570","$990","$90","$200","$440","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$14,700","$14700 per person","$29400 per group","$16,950","$16950 per person","$33900 per group","$500","$500 per person","$1500 per group","5.00%",,,,,"$6,600","$6600 per person","$19800 per group","$7,100","$7100 per person","$21300 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-05&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220007","Blue POS Copay 60/40 $3300","19636LA022",,"LAN005","LAS007","LAF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0220007-06","Blue POS copay 100/40 $25 CSR 0007-06","94% AV Level Silver Plan",,"0.93107569919255","No","Yes","No","100%",,"$60","$30","$0","$60","$530","$120","$60","$90","$30","$320","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$14,700","$14700 per person","$29400 per group","$15,400","$15400 per person","$30800 per group","$25","$25 per person","$75 per group","0.00%",,,,,"$6,600","$6600 per person","$19800 per group","$6,625","$6625 per person","$19875 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-06&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0230002","Community Blue Copay 80/60 $1000","19636LA023",,"LAN007","LAS006","LAF009","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0230002-00","Community Blue Copay 80/60 $1000","Standard Gold Off Exchange Plan",,"0.770848543005262","No","Yes","No","100%",,"$1,040","$60","$1,590","$60","$560","$530","$990","$90","$200","$560","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-00&Year=2018","http://www.bcbsla.com/individual-communityblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0590002","Signature Blue Copay 70/50 $2100","19636LA059",,"LAN008","LAS009","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0590002-01","Signature Blue Copay 70/50 $2100","Standard Silver On Exchange Plan","71.65%","0.710831187093455","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0590002-01&Year=2018","http://www.bcbsla.com/individual-signatureblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0590002","Signature Blue Copay 70/50 $2100","19636LA059",,"LAN008","LAS009","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0590002-02","Signature Blue copay 100/100 $0 CSR 0002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0590002-02&Year=2018","http://www.bcbsla.com/individual-signatureblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0590002","Signature Blue Copay 70/50 $2100","19636LA059",,"LAN008","LAS009","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0590002-03","Signature Blue copay 70/50 $2100 CSR 0002-03","Limited Cost Sharing Plan Variation","71.65%","0.710831187093455","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0590002-03&Year=2018","http://www.bcbsla.com/individual-signatureblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0590002","Signature Blue Copay 70/50 $2100","19636LA059",,"LAN008","LAS009","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0590002-04","Signature Blue copay 70/50 $2100 CSR 0002-04","73% AV Level Silver Plan","73.73%","0.73233781501899","Yes","Yes","No","100%",,"$2,100","$60","$2,070","$60","$2,100","$320","$1,760","$90","$200","$560","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group",,,,"$14,700","$14700 per person","$29400 per group","$20,350","$20350 per person","$40700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","30.00%",,,,,"$4,200","$4200 per person","$12600 per group","$6,300","$6300 per person","$18900 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0590002-04&Year=2018","http://www.bcbsla.com/individual-signatureblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0590002","Signature Blue Copay 70/50 $2100","19636LA059",,"LAN008","LAS009","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0590002-05","Signature Blue copay 80/50 $500 CSR 0002-05","87% AV Level Silver Plan","86.27%","0.860322033678768","Yes","Yes","No","100%",,"$500","$40","$1,700","$60","$500","$160","$1,790","$90","$200","$370","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$14,700","$14700 per person","$29400 per group","$17,150","$17150 per person","$34300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20.00%",,,,,"$4,200","$4200 per person","$12600 per group","$4,700","$4700 per person","$14100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0590002-05&Year=2018","http://www.bcbsla.com/individual-signatureblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0590002","Signature Blue Copay 70/50 $2100","19636LA059",,"LAN008","LAS009","LAF003","New","POS","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","19636LA0590002-06","Signature Blue copay 95/50 $200 CSR 0002-06","94% AV Level Silver Plan","93.03%","0.928764602616934","Yes","Yes","No","100%",,"$200","$30","$440","$60","$200","$120","$890","$90","$200","$320","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$14,700","$14700 per person","$29400 per group","$15,900","$15900 per person","$31800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","5.00%",,,,,"$4,200","$4200 per person","$12600 per group","$4,400","$4400 per person","$13200 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0590002-06&Year=2018","http://www.bcbsla.com/individual-signatureblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220005","Blue POS Copay 80/60 $1000","19636LA022",,"LAN005","LAS007","LAF009","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0220005-00","Blue POS Copay 80/60 $1000","Standard Gold Off Exchange Plan",,"0.762512855533808","No","Yes","No","100%",,"$1,040","$60","$1,590","$60","$560","$610","$990","$90","$200","$560","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$9000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-00&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0220007","Blue POS Copay 60/40 $3300","19636LA022",,"LAN005","LAS007","LAF010","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0220007-04","Blue POS copay 60/40 $2900 CSR 0007-04","73% AV Level Silver Plan",,"0.730602697841561","No","Yes","No","100%",,"$2,940","$60","$2,420","$60","$560","$770","$990","$90","$200","$560","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$14,700","$14700 per person","$29400 per group","$20,050","$20550 per person","$41100 per group","$2,900","$2900 per person","$8700 per group","40.00%",,,,,"$6,600","$6600 per person","$19800 per group","$9,500","$9500 per person","$28500 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-04&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0230002","Community Blue Copay 80/60 $1000","19636LA023",,"LAN007","LAS006","LAF009","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0230002-01","Community Blue Copay 80/60 $1000","Standard Gold On Exchange Plan",,"0.770848543005262","No","Yes","No","100%",,"$1,040","$60","$1,590","$60","$560","$530","$990","$90","$200","$560","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-01&Year=2018","http://www.bcbsla.com/individual-communityblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0230002","Community Blue Copay 80/60 $1000","19636LA023",,"LAN007","LAS006","LAF009","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0230002-02","Community Blue copay 100/100 $0 CSR 0002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-02&Year=2018","http://www.bcbsla.com/individual-communityblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0230002","Community Blue Copay 80/60 $1000","19636LA023",,"LAN007","LAS006","LAF009","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0230002-03","Community Blue copay 80/60 $1000 CSR 0002-03","Limited Cost Sharing Plan Variation",,"0.770848543005262","No","Yes","No","100%",,"$1,040","$60","$1,590","$60","$560","$530","$990","$90","$200","$560","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-03&Year=2018","http://www.bcbsla.com/individual-communityblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240002","Blue Connect Copay 80/60 $1000 (N)","19636LA024",,"LAN006","LAS005","LAF009","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0240002-00","Blue Connect Copay 80/60 $1000 (N)","Standard Gold Off Exchange Plan",,"0.770848543005262","No","Yes","No","100%",,"$1,040","$60","$1,590","$60","$560","$530","$990","$90","$200","$560","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-00&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240002","Blue Connect Copay 80/60 $1000 (N)","19636LA024",,"LAN006","LAS005","LAF009","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0240002-01","Blue Connect Copay 80/60 $1000 (N)","Standard Gold On Exchange Plan",,"0.770848543005262","No","Yes","No","100%",,"$1,040","$60","$1,590","$60","$560","$530","$990","$90","$200","$560","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-01&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240002","Blue Connect Copay 80/60 $1000 (N)","19636LA024",,"LAN006","LAS005","LAF009","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0240002-02","Blue Connect copay 100/100 $0 CSR 0002-02 (N)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-02&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100002","Vantage Group Freedom Gold 750","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.984",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100002-00","Vantage Group Freedom Gold 750","Standard Gold Off Exchange Plan","80.17%","0.802905685986985","No","Yes","No","100%",,"$750","$840","$767","$60","$750","$1,920","$518","$55","$750","$510","$414","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGFreedomGold750SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090001","Freedom Individual Platinum","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.994",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090001-03","Freedom Individual Platinum Limited","Limited Cost Sharing Plan Variation","90.31%","0.90840684034997","No","Yes","No","100%",,"$0","$600","$767","$60","$0","$1,220","$280","$55","$0","$415","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomPlatinumSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090002","Freedom Individual Gold 1000","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090002-00","Freedom Individual Gold 1000","Standard Gold Off Exchange Plan","79.05%","0.793113642538019","No","Yes","No","100%",,"$1,000","$1,110","$767","$60","$1,000","$2,140","$518","$55","$1,000","$510","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomGold1000SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0240002","Blue Connect Copay 80/60 $1000 (N)","19636LA024",,"LAN006","LAS005","LAF009","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0240002-03","Blue Connect copay 80/60 $1000 CSR 0002-03 (N)","Limited Cost Sharing Plan Variation",,"0.770848543005262","No","Yes","No","100%",,"$1,040","$60","$1,590","$60","$560","$530","$990","$90","$200","$560","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-03&Year=2018","http://www.bcbsla.com/individual-blueconnect-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0590001","Signature Blue Copay 80/60 $1000","19636LA059",,"LAN008","LAS009","LAF009","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0590001-00","Signature Blue Copay 80/60 $1000","Standard Gold Off Exchange Plan",,"0.770848543005262","No","Yes","No","100%",,"$1,040","$60","$1,590","$60","$560","$530","$990","$90","$200","$560","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0590001-00&Year=2018","http://www.bcbsla.com/individual-signatureblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0590001","Signature Blue Copay 80/60 $1000","19636LA059",,"LAN008","LAS009","LAF009","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0590001-01","Signature Blue Copay 80/60 $1000","Standard Gold On Exchange Plan",,"0.770848543005262","No","Yes","No","100%",,"$1,040","$60","$1,590","$60","$560","$530","$990","$90","$200","$560","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0590001-01&Year=2018","http://www.bcbsla.com/individual-signatureblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0590001","Signature Blue Copay 80/60 $1000","19636LA059",,"LAN008","LAS009","LAF009","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0590001-02","Signature Blue copay 100/100 $0 CSR 0001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0590001-02&Year=2018","http://www.bcbsla.com/individual-signatureblue-brochure2018"
"2018","LA","19636","HIOS","2017-09-27 03:20:22","Individual","No","72-1071369","19636LA0590001","Signature Blue Copay 80/60 $1000","19636LA059",,"LAN008","LAS009","LAF009","New","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","19636LA0590001-03","Signature Blue copay 80/60 $1000 CSR 0001-03","Limited Cost Sharing Plan Variation",,"0.770848543005262","No","Yes","No","100%",,"$1,040","$60","$1,590","$60","$560","$530","$990","$90","$200","$560","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0590001-03&Year=2018","http://www.bcbsla.com/individual-signatureblue-brochure2018"
"2018","LA","28419","HIOS","2017-05-27 02:20:34","Individual","Yes","47-0397286","28419LA0020003","Renaissance Individual Dental PPO, EHB Certified","28419LA002",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28419LA0020003-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","LA","28419","HIOS","2017-05-27 02:20:34","Individual","Yes","47-0397286","28419LA0020004","Renaissance Individual Dental PPO, EHB Certified","28419LA002",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28419LA0020004-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","LA","28419","HIOS","2017-05-27 02:20:34","Individual","Yes","47-0397286","28419LA0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","28419LA004",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28419","","28419LA0040001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/LA_EHB_High_2018","http://www.renaissancedental.com/LA_EHB_High_2018"
"2018","LA","28419","HIOS","2017-05-27 02:20:34","Individual","Yes","47-0397286","28419LA0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","28419LA004",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28419","","28419LA0040002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/LA_EHB_Low_2018","http://www.renaissancedental.com/LA_EHB_Low_2018"
"2018","LA","28419","HIOS","2017-05-27 02:20:34","Individual","Yes","47-0397286","28419LA0060001","Renaissance Individual Dental Pediatric-Only, EHB Certified","28419LA006",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28419LA0060001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","LA","28419","HIOS","2017-05-27 02:20:34","Individual","Yes","47-0397286","28419LA0060002","Renaissance Individual Dental Pediatric-Only, EHB Certified","28419LA006",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","28419LA0060002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","LA","28419","HIOS","2017-05-27 02:20:34","Individual","Yes","47-0397286","28419LA0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","28419LA005",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28419","","28419LA0050001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/LA_Ped_High_2018","http://www.renaissancedental.com/LA_Ped_High_2018"
"2018","LA","28419","HIOS","2017-05-27 02:20:34","Individual","Yes","47-0397286","28419LA0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","28419LA005",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28419","","28419LA0050002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/LA_Ped_Low_2018","http://www.renaissancedental.com/LA_Ped_Low_2018"
"2018","LA","44965","HIOS","2017-08-08 02:20:26","Individual","Yes","72-1279235","44965LA0590001","Humana Dental Smart Choice","44965LA059",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9846","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","44965LA0590001-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110341"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090001","Freedom Individual Platinum","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.994",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090001-00","Freedom Individual Platinum","Standard Platinum Off Exchange Plan","90.31%","0.90840684034997","No","Yes","No","100%",,"$0","$600","$767","$60","$0","$1,220","$280","$55","$0","$415","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomPlatinumSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100001","Vantage Group Freedom Platinum","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9844",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100001-00","Vantage Group Freedom Platinum","Standard Platinum Off Exchange Plan","89.95%","0.903325742297741","No","Yes","No","100%",,"$0","$480","$767","$60","$0","$1,319","$381","$55","$0","$415","$414","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGFreedomPlatinumSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100001","Vantage Group Freedom Platinum","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9844",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100001-01","Vantage Group Freedom Platinum","Standard Platinum On Exchange Plan","89.95%","0.903325742297741","No","Yes","No","100%",,"$0","$480","$767","$60","$0","$1,319","$381","$55","$0","$415","$414","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGFreedomPlatinumSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090001","Freedom Individual Platinum","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.994",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090001-01","Freedom Individual Platinum","Standard Platinum On Exchange Plan","90.31%","0.90840684034997","No","Yes","No","100%",,"$0","$600","$767","$60","$0","$1,220","$280","$55","$0","$415","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomPlatinumSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090001","Freedom Individual Platinum","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.994",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090001-02","Freedom Individual Platinum Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomPlatinumZeroSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100002","Vantage Group Freedom Gold 750","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.984",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100002-01","Vantage Group Freedom Gold 750","Standard Gold On Exchange Plan","80.17%","0.802905685986985","No","Yes","No","100%",,"$750","$840","$767","$60","$750","$1,920","$518","$55","$750","$510","$414","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGFreedomGold750SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100003","Vantage Group Freedom Silver 2400","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.984",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100003-00","Vantage Group Freedom Silver 2400","Standard Silver Off Exchange Plan","71.95%","0.723483951268629","No","Yes","No","100%",,"$2,400","$1,610","$767","$60","$1,310","$2,050","$518","$55","$1,021","$685","$414","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGFreedomSilver2400SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090003","Freedom Individual Silver 2500","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090003-03","Freedom Individual Silver 2500 Limited","Limited Cost Sharing Plan Variation","70.72%","0.718406660348155","No","Yes","No","100%",,"$2,500","$1,630","$767","$60","$1,710","$2,270","$518","$55","$1,021","$685","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomSilver2500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090004","Essential Individual Bronze 6500","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090004-01","Essential Individual Bronze 6500","Standard Bronze On Exchange Plan","64.85%","0.658333735990924","No","Yes","No","100%",,"$1,720","$0","$5,630","$60","$1,781","$1,160","$2,722","$55","$816","$270","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialBronze6500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090004","Essential Individual Bronze 6500","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090004-02","Essential Individual Bronze 6500 Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialBronze6500ZeroSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","87390","HIOS","2017-05-19 02:20:17","Individual","Yes","13-5123390","87390LA0070003","Guardian Essentials for Families and Individuals","87390LA007",,"LAN001","LAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","87390LA0070003-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/louisiana/","https://dentalexchange.guardianlife.com/our-plans/louisiana/"
"2018","LA","87390","HIOS","2017-05-19 02:20:17","Individual","Yes","13-5123390","87390LA0080002","Guardian Basics for Families and Individuals","87390LA008",,"LAN001","LAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","87390LA0080002-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/louisiana/","https://dentalexchange.guardianlife.com/our-plans/louisiana/"
"2018","LA","87390","HIOS","2017-05-19 02:20:17","Individual","Yes","13-5123390","87390LA0080002","Guardian Basics for Families and Individuals","87390LA008",,"LAN001","LAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","87390LA0080002-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/louisiana/","https://dentalexchange.guardianlife.com/our-plans/louisiana/"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090005","Freedom Individual Platinum Plus","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090005-00","Freedom Individual Platinum Plus","Standard Platinum Off Exchange Plan","90.31%","0.90840684034997","No","Yes","No","100%",,"$0","$600","$767","$60","$0","$1,220","$280","$55","$0","$415","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomPlatinumPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090008","Essential Individual Bronze Plus 6500","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090008-02","Essential Individual Bronze Plus 6500 Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialBronze6500ZeroPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100009","Vantage Group Savings Bronze 6000","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.991766102",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100009-01","Vantage Group Savings Bronze 6000","Standard Bronze On Exchange Plan","60.70%","0.606999606219384","Yes","Yes","No","100%",,"$1,720","$0","$4,780","$60","$3,184","$0","$3,316","$55","$1,925","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGSavingsBronze6000SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090013","Essential Individual Silver 3500","67243LA009","7821091072","LAN001","LAS001","LAF001","New","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937337",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090013-01","Essential Individual Silver 3500","Standard Silver On Exchange Plan","70.04%","0.710431228146675","No","Yes","No","100%",,"$3,500","$130","$3,720","$60","$1,803","$970","$1,633","$55","$1,142","$225","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$10500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialSilver3500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100003","Vantage Group Freedom Silver 2400","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.984",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100003-01","Vantage Group Freedom Silver 2400","Standard Silver On Exchange Plan","71.95%","0.723483951268629","No","Yes","No","100%",,"$2,400","$1,610","$767","$60","$1,310","$2,050","$518","$55","$1,021","$685","$414","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGFreedomSilver2400SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090002","Freedom Individual Gold 1000","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090002-01","Freedom Individual Gold 1000","Standard Gold On Exchange Plan","79.05%","0.793113642538019","No","Yes","No","100%",,"$1,000","$1,110","$767","$60","$1,000","$2,140","$518","$55","$1,000","$510","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomGold1000SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090002","Freedom Individual Gold 1000","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090002-02","Freedom Individual Gold 1000 Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomGold1000ZeroSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100005","Vantage Plus Group Freedom Platinum","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.984",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100005-00","Vantage Plus Group Freedom Platinum","Standard Platinum Off Exchange Plan","89.95%","0.903325742297741","No","Yes","No","100%",,"$0","$480","$767","$60","$0","$1,319","$381","$55","$0","$415","$414","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGFreedomPlatinumPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100005","Vantage Plus Group Freedom Platinum","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.984",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100005-01","Vantage Plus Group Freedom Platinum","Standard Platinum On Exchange Plan","89.95%","0.903325742297741","No","Yes","No","100%",,"$0","$480","$767","$60","$0","$1,319","$381","$55","$0","$415","$414","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGFreedomPlatinumPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090002","Freedom Individual Gold 1000","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090002-03","Freedom Individual Gold 1000 Limited","Limited Cost Sharing Plan Variation","79.05%","0.793113642538019","No","Yes","No","100%",,"$1,000","$1,110","$767","$60","$1,000","$2,140","$518","$55","$1,000","$510","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomGold1000SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090003","Freedom Individual Silver 2500","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090003-00","Freedom Individual Silver 2500","Standard Silver Off Exchange Plan","70.72%","0.718406660348155","No","Yes","No","100%",,"$2,500","$1,630","$767","$60","$1,710","$2,270","$518","$55","$1,021","$685","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomSilver2500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100006","Vantage Plus Group Freedom Gold 750","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.984",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100006-00","Vantage Plus Group Freedom Gold 750","Standard Gold Off Exchange Plan","80.17%","0.802905685986985","No","Yes","No","100%",,"$750","$840","$767","$60","$750","$1,920","$518","$55","$750","$510","$414","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGFreedomGold750PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100006","Vantage Plus Group Freedom Gold 750","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.984",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100006-01","Vantage Plus Group Freedom Gold 750","Standard Gold On Exchange Plan","80.17%","0.802905685986985","No","Yes","No","100%",,"$750","$840","$767","$60","$750","$1,920","$518","$55","$750","$510","$414","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGFreedomGold750PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090003","Freedom Individual Silver 2500","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090003-01","Freedom Individual Silver 2500","Standard Silver On Exchange Plan","70.72%","0.718406660348155","No","Yes","No","100%",,"$2,500","$1,630","$767","$60","$1,710","$2,270","$518","$55","$1,021","$685","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomSilver2500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090003","Freedom Individual Silver 2500","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090003-02","Freedom Individual Silver 2500 Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomSilver2500ZeroSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100007","Vantage Plus Group Freedom Silver 2400","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.984",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100007-00","Vantage Plus Group Freedom Silver 2400","Standard Silver Off Exchange Plan","71.95%","0.723483951268629","No","Yes","No","100%",,"$2,400","$1,610","$767","$60","$1,310","$2,050","$518","$55","$1,021","$685","$414","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGFreedomSilver2400PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100007","Vantage Plus Group Freedom Silver 2400","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.984",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100007-01","Vantage Plus Group Freedom Silver 2400","Standard Silver On Exchange Plan","71.95%","0.723483951268629","No","Yes","No","100%",,"$2,400","$1,610","$767","$60","$1,310","$2,050","$518","$55","$1,021","$685","$414","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGFreedomSilver2400PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090003","Freedom Individual Silver 2500","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090003-04","Freedom Individual Silver Select 2000","73% AV Level Silver Plan","73.74%","0.747625065953603","No","Yes","No","100%",,"$2,000","$1,630","$767","$60","$1,460","$2,270","$518","$55","$1,021","$685","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$6000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedom73Silver2500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceCSRINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090003","Freedom Individual Silver 2500","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090003-05","Freedom Individual Silver Basic 700","87% AV Level Silver Plan","86.59%","0.866757621808871","No","Yes","No","100%",,"$700","$560","$512","$60","$700","$1,200","$300","$55","$700","$460","$276","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$2100 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedom87Silver2500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceCSRINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090003","Freedom Individual Silver 2500","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090003-06","Freedom Individual Silver Value 100","94% AV Level Silver Plan","94.11%","0.941767200479466","No","Yes","No","100%",,"$100","$138","$256","$60","$100","$573","$127","$55","$100","$225","$138","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedom94Silver2500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceCSRINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090005","Freedom Individual Platinum Plus","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090005-01","Freedom Individual Platinum Plus","Standard Platinum On Exchange Plan","90.31%","0.90840684034997","No","Yes","No","100%",,"$0","$600","$767","$60","$0","$1,220","$280","$55","$0","$415","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomPlatinumPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090005","Freedom Individual Platinum Plus","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090005-02","Freedom Individual Platinum Plus Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomPlatinumZeroPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090005","Freedom Individual Platinum Plus","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Platinum","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090005-03","Freedom Individual Platinum Plus Limited","Limited Cost Sharing Plan Variation","90.31%","0.90840684034997","No","Yes","No","100%",,"$0","$600","$767","$60","$0","$1,220","$280","$55","$0","$415","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomPlatinumPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090006","Freedom Individual Gold Plus 1000","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090006-00","Freedom Individual Gold Plus 1000","Standard Gold Off Exchange Plan","79.05%","0.793113642538019","No","Yes","No","100%",,"$1,000","$1,110","$767","$60","$1,000","$2,140","$518","$55","$1,000","$510","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomGold1000PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090006","Freedom Individual Gold Plus 1000","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090006-01","Freedom Individual Gold Plus 1000","Standard Gold On Exchange Plan","79.05%","0.793113642538019","No","Yes","No","100%",,"$1,000","$1,110","$767","$60","$1,000","$2,140","$518","$55","$1,000","$510","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomGold1000PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090006","Freedom Individual Gold Plus 1000","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090006-02","Freedom Individual Gold Plus 1000 Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomGold1000ZeroPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090006","Freedom Individual Gold Plus 1000","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090006-03","Freedom Individual Gold Plus 1000 Limited","Limited Cost Sharing Plan Variation","79.05%","0.793113642538019","No","Yes","No","100%",,"$1,000","$1,110","$767","$60","$1,000","$2,140","$518","$55","$1,000","$510","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomGold1000PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090007","Freedom Individual Silver Plus 2500","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090007-00","Freedom Individual Silver Plus 2500","Standard Silver Off Exchange Plan","70.72%","0.718406660348155","No","Yes","No","100%",,"$2,500","$1,630","$767","$60","$1,710","$2,270","$518","$55","$1,021","$685","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomSilver2500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090007","Freedom Individual Silver Plus 2500","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090007-01","Freedom Individual Silver Plus 2500","Standard Silver On Exchange Plan","70.72%","0.718406660348155","No","Yes","No","100%",,"$2,500","$1,630","$767","$60","$1,710","$2,270","$518","$55","$1,021","$685","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomSilver2500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090007","Freedom Individual Silver Plus 2500","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090007-02","Freedom Individual Silver Plus 2500 Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomSilver2500ZeroPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090007","Freedom Individual Silver Plus 2500","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090007-03","Freedom Individual Silver Plus 2500 Limited","Limited Cost Sharing Plan Variation","70.72%","0.718406660348155","No","Yes","No","100%",,"$2,500","$1,630","$767","$60","$1,710","$2,270","$518","$55","$1,021","$685","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$7500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedomSilver2500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090007","Freedom Individual Silver Plus 2500","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090007-04","Freedom Individual Silver Plus Select 2000","73% AV Level Silver Plan","73.74%","0.747625065953603","No","Yes","No","100%",,"$2,000","$1,630","$767","$60","$1,460","$2,270","$518","$55","$1,021","$685","$414","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$6000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedom73Silver2500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceCSRINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090007","Freedom Individual Silver Plus 2500","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090007-05","Freedom Individual Silver Plus Basic 700","87% AV Level Silver Plan","86.59%","0.866757621808871","No","Yes","No","100%",,"$700","$560","$512","$60","$700","$1,200","$300","$55","$700","$460","$276","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$2100 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedom87Silver2500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceCSRINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090007","Freedom Individual Silver Plus 2500","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090007-06","Freedom Individual Silver Plus Value 100","94% AV Level Silver Plan","94.11%","0.941767200479466","No","Yes","No","100%",,"$100","$138","$256","$60","$100","$573","$127","$55","$100","$225","$138","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDFreedom94Silver2500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceCSRINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100004","Vantage Group Essential Bronze 6500","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.984",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100004-00","Vantage Group Essential Bronze 6500","Standard Bronze Off Exchange Plan","64.85%","0.658333735990924","No","Yes","No","100%",,"$1,720","$0","$5,630","$60","$1,781","$1,160","$2,722","$55","$816","$270","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGEssentialBronze6500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100004","Vantage Group Essential Bronze 6500","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.984",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100004-01","Vantage Group Essential Bronze 6500","Standard Bronze On Exchange Plan","64.85%","0.658333735990924","No","Yes","No","100%",,"$1,720","$0","$5,630","$60","$1,781","$1,160","$2,722","$55","$816","$270","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGEssentialBronze6500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100008","Vantage Plus Group Essential Bronze 6500","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.984",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100008-00","Vantage Plus Group Essential Bronze 6500","Standard Bronze Off Exchange Plan","64.85%","0.658333735990924","No","Yes","No","100%",,"$1,720","$0","$5,630","$60","$1,781","$1,160","$2,722","$55","$816","$270","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGEssentialBronze6500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100008","Vantage Plus Group Essential Bronze 6500","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.984",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100008-01","Vantage Plus Group Essential Bronze 6500","Standard Bronze On Exchange Plan","64.85%","0.658333735990924","No","Yes","No","100%",,"$1,720","$0","$5,630","$60","$1,781","$1,160","$2,722","$55","$816","$270","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGEssentialBronze6500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090004","Essential Individual Bronze 6500","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090004-00","Essential Individual Bronze 6500","Standard Bronze Off Exchange Plan","64.85%","0.658333735990924","No","Yes","No","100%",,"$1,720","$0","$5,630","$60","$1,781","$1,160","$2,722","$55","$816","$270","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialBronze6500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090004","Essential Individual Bronze 6500","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090004-03","Essential Individual Bronze 6500 Limited","Limited Cost Sharing Plan Variation","64.85%","0.658333735990924","No","Yes","No","100%",,"$1,720","$0","$5,630","$60","$1,781","$1,160","$2,722","$55","$816","$270","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialBronze6500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090008","Essential Individual Bronze Plus 6500","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090008-00","Essential Individual Bronze Plus 6500","Standard Bronze Off Exchange Plan","64.85%","0.658333735990924","No","Yes","No","100%",,"$1,720","$0","$5,630","$60","$1,781","$1,160","$2,722","$55","$816","$270","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialBronze6500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090008","Essential Individual Bronze Plus 6500","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090008-01","Essential Individual Bronze Plus 6500","Standard Bronze On Exchange Plan","64.85%","0.658333735990924","No","Yes","No","100%",,"$1,720","$0","$5,630","$60","$1,781","$1,160","$2,722","$55","$816","$270","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialBronze6500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090008","Essential Individual Bronze Plus 6500","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090008-03","Essential Individual Bronze Plus 6500 Limited","Limited Cost Sharing Plan Variation","64.85%","0.658333735990924","No","Yes","No","100%",,"$1,720","$0","$5,630","$60","$1,781","$1,160","$2,722","$55","$816","$270","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialBronze6500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090009","Savings Individual Bronze 5000","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.996792103",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090009-00","Savings Individual Bronze 5000","Standard Bronze Off Exchange Plan","61.09%","0.610913955497998","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDSavingsBronze5000SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090009","Savings Individual Bronze 5000","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.996792103",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090009-01","Savings Individual Bronze 5000","Standard Bronze On Exchange Plan","61.09%","0.610913955497998","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDSavingsBronze5000SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090009","Savings Individual Bronze 5000","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.996792103",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090009-02","Savings Individual Bronze 5000 Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDSavingsBronze5000ZeroSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090009","Savings Individual Bronze 5000","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.996792103",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090009-03","Savings Individual Bronze 5000 Limited","Limited Cost Sharing Plan Variation","61.09%","0.610913955497998","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDSavingsBronze5000SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090010","Savings Individual Bronze Plus 5000","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.99679",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090010-00","Savings Individual Bronze Plus 5000","Standard Bronze Off Exchange Plan","61.09%","0.610913955497998","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDSavingsBronze5000PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090010","Savings Individual Bronze Plus 5000","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.99679",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090010-01","Savings Individual Bronze Plus 5000","Standard Bronze On Exchange Plan","61.09%","0.610913955497998","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDSavingsBronze5000PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090010","Savings Individual Bronze Plus 5000","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.99679",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090010-02","Savings Individual Bronze Plus 5000 Zero","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDSavingsBronze5000ZeroPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090010","Savings Individual Bronze Plus 5000","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.99679",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090010-03","Savings Individual Bronze Plus 5000 Limited","Limited Cost Sharing Plan Variation","61.09%","0.610913955497998","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDSavingsBronze5000PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090013","Essential Individual Silver 3500","67243LA009","7821091072","LAN001","LAS001","LAF001","New","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937337",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090013-00","Essential Individual Silver 3500","Standard Silver Off Exchange Plan","70.04%","0.710431228146675","No","Yes","No","100%",,"$3,500","$130","$3,720","$60","$1,803","$970","$1,633","$55","$1,142","$225","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$10500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialSilver3500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100009","Vantage Group Savings Bronze 6000","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.991766102",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100009-00","Vantage Group Savings Bronze 6000","Standard Bronze Off Exchange Plan","60.70%","0.606999606219384","Yes","Yes","No","100%",,"$1,720","$0","$4,780","$60","$3,184","$0","$3,316","$55","$1,925","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGSavingsBronze6000SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090013","Essential Individual Silver 3500","67243LA009","7821091072","LAN001","LAS001","LAF001","New","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937337",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090013-02","Essential Individual Silver 3500 Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialSilver2500ZeroSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100010","Vantage Plus Group Savings Bronze 6000","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9918",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100010-00","Vantage Plus Group Savings Bronze 6000","Standard Bronze Off Exchange Plan","60.70%","0.606999606219384","Yes","Yes","No","100%",,"$1,720","$0","$4,780","$60","$3,184","$0","$3,316","$55","$1,925","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGSavingsBronze6000PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","No","72-1285173","67243LA0100010","Vantage Plus Group Savings Bronze 6000","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage",,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9918",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0100010-01","Vantage Plus Group Savings Bronze 6000","Standard Bronze On Exchange Plan","60.70%","0.606999606219384","Yes","Yes","No","100%",,"$1,720","$0","$4,780","$60","$3,184","$0","$3,316","$55","$1,925","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.vantagehealthplan.com/documents/Marketplace/2018SGSavingsBronze6000PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceSGPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090013","Essential Individual Silver 3500","67243LA009","7821091072","LAN001","LAS001","LAF001","New","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937337",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090013-03","Essential Individual Silver 3500 Limited","Limited Cost Sharing Plan Variation","70.04%","0.710431228146675","No","Yes","No","100%",,"$3,500","$130","$3,720","$60","$1,803","$970","$1,633","$55","$1,142","$225","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$10500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialSilver3500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090013","Essential Individual Silver 3500","67243LA009","7821091072","LAN001","LAS001","LAF001","New","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937337",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090013-04","Essential Individual Silver Select 3500","73% AV Level Silver Plan","72.21%","0.730906024466883","No","Yes","No","100%",,"$2,408","$0","$3,442","$60","$1,603","$970","$1,633","$55","$1,142","$225","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$10500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$900 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssential73Silver2500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceCSRINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090013","Essential Individual Silver 3500","67243LA009","7821091072","LAN001","LAS001","LAF001","New","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937337",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090013-05","Essential Individual Silver Basic 1000","87% AV Level Silver Plan","86.12%","0.862920646571229","No","Yes","No","100%",,"$1,000","$0","$1,200","$60","$1,096","$310","$794","$55","$1,000","$90","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$450 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssential87Silver2500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceCSRINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090013","Essential Individual Silver 3500","67243LA009","7821091072","LAN001","LAS001","LAF001","New","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937337",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090013-06","Essential Individual Silver Value 100","94% AV Level Silver Plan","93.11%","0.932915312718315","No","Yes","No","100%",,"$100","$38","$1,240","$60","$150","$287","$544","$55","$100","$45","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssential94Silver2500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceCSRINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090014","Essential Individual Silver Plus 3500","67243LA009","7821091072","LAN002","LAS002","LAF001","New","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937337",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090014-00","Essential Individual Silver Plus 3500","Standard Silver Off Exchange Plan","70.04%","0.710431228146675","No","Yes","No","100%",,"$3,500","$130","$3,720","$60","$1,803","$970","$1,633","$55","$1,142","$225","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$10500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialSilver3500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090014","Essential Individual Silver Plus 3500","67243LA009","7821091072","LAN002","LAS002","LAF001","New","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937337",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090014-01","Essential Individual Silver Plus 3500","Standard Silver On Exchange Plan","70.04%","0.710431228146675","No","Yes","No","100%",,"$3,500","$130","$3,720","$60","$1,803","$970","$1,633","$55","$1,142","$225","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$10500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialSilver3500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090014","Essential Individual Silver Plus 3500","67243LA009","7821091072","LAN002","LAS002","LAF001","New","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937337",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090014-02","Essential Individual Silver Plus 3500 Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialSilver2500ZeroPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090014","Essential Individual Silver Plus 3500","67243LA009","7821091072","LAN002","LAS002","LAF001","New","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937337",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090014-03","Essential Individual Silver Plus 3500 Limited","Limited Cost Sharing Plan Variation","70.04%","0.710431228146675","No","Yes","No","100%",,"$3,500","$130","$3,720","$60","$1,803","$970","$1,633","$55","$1,142","$225","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$10500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialSilver3500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090014","Essential Individual Silver Plus 3500","67243LA009","7821091072","LAN002","LAS002","LAF001","New","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937337",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090014-04","Essential Individual Silver Plus Select 3500","73% AV Level Silver Plan","72.21%","0.730906024466883","No","Yes","No","100%",,"$2,408","$0","$3,442","$60","$1,603","$970","$1,633","$55","$1,142","$225","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$10500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$900 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssential73Silver2500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceCSRINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090014","Essential Individual Silver Plus 3500","67243LA009","7821091072","LAN002","LAS002","LAF001","New","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937337",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090014-05","Essential Individual Silver Plus Basic 1000","87% AV Level Silver Plan","86.12%","0.862920646571229","No","Yes","No","100%",,"$1,000","$0","$1,200","$60","$1,096","$310","$794","$55","$1,000","$90","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$450 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssential87Silver2500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceCSRINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090014","Essential Individual Silver Plus 3500","67243LA009","7821091072","LAN002","LAS002","LAF001","New","POS","Silver","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937337",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090014-06","Essential Individual Silver Plus Value 100","94% AV Level Silver Plan","93.11%","0.932915312718315","No","Yes","No","100%",,"$100","$38","$1,240","$60","$150","$287","$544","$55","$100","$45","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssential94Silver2500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceCSRINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090019","Essential Individual Gold 1500","67243LA009","7821091072","LAN001","LAS001","LAF001","New","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090019-00","Essential Individual Gold 1500","Standard Gold Off Exchange Plan","79.80%","0.804200175963498","No","Yes","No","100%",,"$1,500","$0","$2,500","$60","$1,403","$840","$1,633","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialGold1500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090019","Essential Individual Gold 1500","67243LA009","7821091072","LAN001","LAS001","LAF001","New","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090019-01","Essential Individual Gold 1500","Standard Gold On Exchange Plan","79.80%","0.804200175963498","No","Yes","No","100%",,"$1,500","$0","$2,500","$60","$1,403","$840","$1,633","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialGold1500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090019","Essential Individual Gold 1500","67243LA009","7821091072","LAN001","LAS001","LAF001","New","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090019-02","Essential Individual Gold 1500 Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialGold1500ZeroSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090019","Essential Individual Gold 1500","67243LA009","7821091072","LAN001","LAS001","LAF001","New","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090019-03","Essential Individual Gold 1500 Limited","Limited Cost Sharing Plan Variation","79.80%","0.804200175963498","No","Yes","No","100%",,"$1,500","$0","$2,500","$60","$1,403","$840","$1,633","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialGold1500SummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090020","Essential Individual Gold Plus 1500","67243LA009","7821091072","LAN002","LAS002","LAF001","New","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090020-00","Essential Individual Gold Plus 1500","Standard Gold Off Exchange Plan","79.80%","0.804200175963498","No","Yes","No","100%",,"$1,500","$0","$2,500","$60","$1,403","$840","$1,633","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialGold1500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090020","Essential Individual Gold Plus 1500","67243LA009","7821091072","LAN002","LAS002","LAF001","New","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090020-01","Essential Individual Gold Plus 1500","Standard Gold On Exchange Plan","79.80%","0.804200175963498","No","Yes","No","100%",,"$1,500","$0","$2,500","$60","$1,403","$840","$1,633","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialGold1500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090020","Essential Individual Gold Plus 1500","67243LA009","7821091072","LAN002","LAS002","LAF001","New","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090020-02","Essential Individual Gold Plus 1500 Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialGold1500ZeroPlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","67243","HIOS","2017-11-02 02:20:21","Individual","No","72-1285173","67243LA0090020","Essential Individual Gold Plus 1500","67243LA009","7821091072","LAN002","LAS002","LAF001","New","POS","Gold","Not Applicable","Yes","Both","Yes","No",,"Charges in excess of the Vantage Allowable; Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,"2018-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/2018CommercialAndExchangeMemberListOfCoveredDrugs(Formulary).pdf","67243LA0090020-03","Essential Individual Gold Plus 1500 Limited","Limited Cost Sharing Plan Variation","79.80%","0.804200175963498","No","Yes","No","100%",,"$1,500","$0","$2,500","$60","$1,403","$840","$1,633","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/2018INDEssentialGold1500PlusSummaryOfBenefitsAndCoverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2018MarketplaceINDPlusPlanFinder.pdf"
"2018","LA","74056","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","74056LA0010001","TruAssure Basic Adult or Child Dental Plan","74056LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74056LA0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","68.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$95","$95 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=LA","https://www.truassure.com/brochure?state=LA"
"2018","LA","74056","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","74056LA0030001","TruAssure Dental Small Group Basic Plan","74056LA003",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","74056LA0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","LA","74056","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","74056LA0040001","TruAssure Dental Small Group Preferred Plan","74056LA004",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","74056LA0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","LA","74056","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","74056LA0010001","TruAssure Basic Adult or Child Dental Plan","74056LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74056LA0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","68.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$95","$95 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=LA","https://www.truassure.com/brochure?state=LA"
"2018","LA","74056","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","74056LA0020001","TruAssure Preferred Adult or Child Dental Plan","74056LA002",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74056LA0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=LA","https://www.truassure.com/brochure?state=LA"
"2018","LA","74056","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","74056LA0020001","TruAssure Preferred Adult or Child Dental Plan","74056LA002",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74056LA0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=LA","https://www.truassure.com/brochure?state=LA"
"2018","LA","75409","HIOS","2017-06-07 02:20:25","SHOP (Small Group)","Yes","13-5581829","75409LA0150001","EHB Basic Dental Plan (Low)","75409LA015",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","75409LA0150001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","LA","78461","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","78461LA0020005","BESTOne Plus Silver","78461LA002",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/exchange/paybill.html","","78461LA0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/current/LA_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","LA","78461","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","78461LA0010007","BESTDental Premium","78461LA001",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010007-00","BESTDental Premium","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/current/LA_BESTDental_Premium_Plan.pdf"
"2018","LA","78461","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","78461LA0010007","BESTDental Premium","78461LA001",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010007-01","BESTDental Premium","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/current/LA_BESTDental_Premium_Plan.pdf"
"2018","LA","78461","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","78461LA0020005","BESTOne Plus Silver","78461LA002",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/exchange/paybill.html","","78461LA0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/current/LA_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","LA","78461","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","78461LA0020006","BESTOne Basic Silver","78461LA002",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/exchange/paybill.html","","78461LA0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/current/LA_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","LA","78461","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","78461LA0010008","BESTDental Standard - H","78461LA001",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/current/LA_BESTDental_Standard-H_Plan.pdf"
"2018","LA","78461","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","78461LA0010008","BESTDental Standard - H","78461LA001",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/current/LA_BESTDental_Standard-H_Plan.pdf"
"2018","LA","78461","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","78461LA0020006","BESTOne Basic Silver","78461LA002",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/exchange/paybill.html","","78461LA0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/2017/LA_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","LA","78461","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","78461LA0010010","BESTDental Choice - H","78461LA001",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/current/LA_BESTDental_Choice-H_Plan.pdf"
"2018","LA","78461","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","78461LA0010010","BESTDental Choice - H","78461LA001",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/current/LA_BESTDental_Choice-H_Plan.pdf"
"2018","LA","78461","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","78461LA0010009","BESTDental Standard - L","78461LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/current/LA_BESTDental_Standard-L_Plan.pdf"
"2018","LA","78461","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","78461LA0020003","BESTOne Dental Advantage - Gold","78461LA002",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/exchange/paybill.html","","78461LA0020003-00","BESTOne Dental Advantage - Gold","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/current/LA_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","LA","78461","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","78461LA0020003","BESTOne Dental Advantage - Gold","78461LA002",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/exchange/paybill.html","","78461LA0020003-01","BESTOne Dental Advantage - Gold","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/current/LA_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","LA","78461","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","78461LA0010009","BESTDental Standard - L","78461LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/current/LA_BESTDental_Standard-L_Plan.pdf"
"2018","LA","78461","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","78461LA0010011","BESTDental Choice - L","78461LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/current/LA_BESTDental_Choice-L_Plan.pdf"
"2018","LA","78461","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","78461LA0020004","BESTOne Dental Plus - Gold","78461LA002",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/exchange/paybill.html","","78461LA0020004-00","BESTOne Dental Plus - Gold","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/current/LA_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","LA","78461","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","78461LA0020004","BESTOne Dental Plus - Gold","78461LA002",,"LAN001","LAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/exchange/paybill.html","","78461LA0020004-01","BESTOne Dental Plus - Gold","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/current/LA_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","LA","78461","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","78461LA0010011","BESTDental Choice - L","78461LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/current/LA_BESTDental_Choice-L_Plan.pdf"
"2018","LA","78461","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","78461LA0010012","BESTDental Value","78461LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/current/LA_BESTDental_Value_Plan.pdf"
"2018","LA","78461","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","78461LA0010012","BESTDental Value","78461LA001",,"LAN001","LAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/la/current/LA_BESTDental_Value_Plan.pdf"
"2018","LA","87390","HIOS","2017-05-19 02:20:17","Individual","Yes","13-5123390","87390LA0070003","Guardian Essentials for Families and Individuals","87390LA007",,"LAN001","LAS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","87390LA0070003-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/louisiana/","https://dentalexchange.guardianlife.com/our-plans/louisiana/"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","Yes","23-7384555","97176LA0400001","Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50% coinsurance, $75 deductible","97176LA040",,"LAN002","LAS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.84","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"","97176LA0400001-00","Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50% coinsurance, $75 deductible","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/group-bluedental-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0350003","Blue Saver 90/70 $3000","97176LA035",,"LAN001","LAS001","LAF012","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","97176LA0350003-00","Blue Saver 90/70 $3000","Standard Silver Off Exchange Plan",,"0.700327562604033","Yes","Yes","No","100%",,"$3,000","$0","$940","$60","$3,000","$0","$380","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"$13,100","$26200 per person","$26200 per group","$19,650","$33550 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","10.00%",,,,,"$6,000","$12000 per person","$12000 per group","$9,000","$18000 per person","$18000 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-00&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","Yes","23-7384555","97176LA0390001","Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible","97176LA039",,"LAN002","LAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"","97176LA0390001-00","Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/individual-bluedental-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","Yes","23-7384555","97176LA0390001","Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible","97176LA039",,"LAN002","LAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"","97176LA0390001-01","Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/individual-bluedental-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0350003","Blue Saver 90/70 $3000","97176LA035",,"LAN001","LAS001","LAF012","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","97176LA0350003-01","Blue Saver 90/70 $3000","Standard Silver On Exchange Plan",,"0.700327562604033","Yes","Yes","No","100%",,"$3,000","$0","$940","$60","$3,000","$0","$380","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"$13,100","$26200 per person","$26200 per group","$19,650","$33550 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","10.00%",,,,,"$6,000","$12000 per person","$12000 per group","$9,000","$18000 per person","$18000 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-01&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","Yes","23-7384555","97176LA0400002","Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","97176LA040",,"LAN002","LAS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.84","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"","97176LA0400002-00","Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/group-bluedental-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","Yes","23-7384555","97176LA0400003","Blue Dental Preferred Plus Certified- $1,500 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","97176LA040",,"LAN002","LAS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.84","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"","97176LA0400003-00","Blue Dental Preferred Plus Certified- $1,500 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/group-bluedental-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0350003","Blue Saver 90/70 $3000","97176LA035",,"LAN001","LAS001","LAF012","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","97176LA0350003-02","Blue Saver 100/100 $0 CSR 0003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-02&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","Yes","23-7384555","97176LA0390002","Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","97176LA039",,"LAN002","LAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"","97176LA0390002-00","Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/individual-bluedental-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","Yes","23-7384555","97176LA0390002","Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","97176LA039",,"LAN002","LAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"","97176LA0390002-01","Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/individual-bluedental-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0350003","Blue Saver 90/70 $3000","97176LA035",,"LAN001","LAS001","LAF012","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","97176LA0350003-03","Blue Saver 90/70 $3000 CSR 0003-03","Limited Cost Sharing Plan Variation",,"0.700327562604033","Yes","Yes","No","100%",,"$3,000","$0","$940","$60","$3,000","$0","$380","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"$13,100","$26200 per person","$26200 per group","$19,650","$33550 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","10.00%",,,,,"$6,000","$12000 per person","$12000 per group","$9,000","$18000 per person","$18000 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-03&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0350003","Blue Saver 90/70 $3000","97176LA035",,"LAN001","LAS001","LAF012","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","97176LA0350003-04","Blue Saver 90/70 $2300 CSR 0003-04","73% AV Level Silver Plan",,"0.736473601511844","Yes","Yes","No","100%",,"$2,300","$0","$1,010","$60","$2,300","$0","$450","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5850 per person","$11200 per group",,,,"$13,100","$26200 per person","$26200 per group","$18,700","$32050 per person","$37400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group","10.00%",,,,,"$6,000","$12000 per person","$12000 per group","$8,300","$16600 per person","$16600 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-04&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0350003","Blue Saver 90/70 $3000","97176LA035",,"LAN001","LAS001","LAF012","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","97176LA0350003-05","Blue Saver 90/70 $700 CSR 0003-05","87% AV Level Silver Plan",,"0.865715201475744","Yes","Yes","No","100%",,"$700","$0","$1,170","$60","$700","$0","$610","$90","$700","$0","$120","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2450 per person","$4500 per group",,,,"$13,100","$26200 per person","$26200 per group","$15,350","$28650 per person","$30700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group","10.00%",,,,,"$6,000","$12000 per person","$12000 per group","$6,700","$13400 per person","$13400 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-05&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0350003","Blue Saver 90/70 $3000","97176LA035",,"LAN001","LAS001","LAF012","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","97176LA0350003-06","Blue Saver 95/70 $200 CSR 0003-06","94% AV Level Silver Plan",,"0.944277421094613","Yes","Yes","No","100%",,"$200","$0","$610","$60","$200","$0","$330","$90","$200","$0","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2400 per person","$2400 per group",,,,"$13,100","$26200 per person","$26200 per group","$14,300","$28600 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$400 per person","$400 per group","5.00%",,,,,"$6,000","$12000 per person","$12000 per group","$6,200","$12400 per person","$12400 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-06&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0350004","Blue Saver 60/40 $4500","97176LA035",,"LAN001","LAS001","LAF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","97176LA0350004-00","Blue Saver 60/40 $4500","Standard Bronze Off Exchange Plan",,"0.615341363507729","Yes","Yes","No","100%",,"$4,500","$0","$2,050","$60","$4,500","$0","$1,370","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"$13,100","$26200 per person","$26200 per group","$19,650","$33550 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$7350 per person","$9000 per group","40.00%",,,,,"$9,000","$18000 per person","$18000 per group","$13,500","$25350 per person","$27000 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-00&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0350004","Blue Saver 60/40 $4500","97176LA035",,"LAN001","LAS001","LAF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","97176LA0350004-01","Blue Saver 60/40 $4500","Standard Bronze On Exchange Plan",,"0.615341363507729","Yes","Yes","No","100%",,"$4,500","$0","$2,050","$60","$4,500","$0","$1,370","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"$13,100","$26200 per person","$26200 per group","$19,650","$33550 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$7350 per person","$9000 per group","40.00%",,,,,"$9,000","$18000 per person","$18000 per group","$13,500","$25350 per person","$27000 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-01&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0350004","Blue Saver 60/40 $4500","97176LA035",,"LAN001","LAS001","LAF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","97176LA0350004-02","Blue Saver 100/100 $0 CSR 0004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-02&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0350004","Blue Saver 60/40 $4500","97176LA035",,"LAN001","LAS001","LAF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","97176LA0350004-03","Blue Saver 60/40 $4500 CSR 0004-03","Limited Cost Sharing Plan Variation",,"0.615341363507729","Yes","Yes","No","100%",,"$4,500","$0","$2,050","$60","$4,500","$0","$1,370","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"$13,100","$26200 per person","$26200 per group","$19,650","$33550 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$7350 per person","$9000 per group","40.00%",,,,,"$9,000","$18000 per person","$18000 per group","$13,500","$25350 per person","$27000 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-03&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0340017","Blue Max 80/60 $5000","97176LA034",,"LAN001","LAS001","LAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","97176LA0340017-00","Blue Max 80/60 $5000","Standard Bronze Off Exchange Plan",,"0.604893911722759","Yes","Yes","No","100%",,"$5,000","$0","$1,490","$60","$5,000","$0","$700","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$14700 per group","20.00%",,,,,"$10,000","$10000 per person","$29400 per group","$15,000","$15000 per person","$44100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340017-00&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0340017","Blue Max 80/60 $5000","97176LA034",,"LAN001","LAS001","LAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","97176LA0340017-01","Blue Max 80/60 $5000","Standard Bronze On Exchange Plan",,"0.604893911722759","Yes","Yes","No","100%",,"$5,000","$0","$1,490","$60","$5,000","$0","$700","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$14700 per group","20.00%",,,,,"$10,000","$10000 per person","$29400 per group","$15,000","$15000 per person","$44100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340017-01&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0340017","Blue Max 80/60 $5000","97176LA034",,"LAN001","LAS001","LAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","97176LA0340017-02","Blue Max 100/100 $0 CSR 0017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340017-02&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0340017","Blue Max 80/60 $5000","97176LA034",,"LAN001","LAS001","LAF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","97176LA0340017-03","Blue Max 80/60 $5000 CSR 0017-03","Limited Cost Sharing Plan Variation",,"0.604893911722759","Yes","Yes","No","100%",,"$5,000","$0","$1,490","$60","$5,000","$0","$700","$90","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$14700 per group","20.00%",,,,,"$10,000","$10000 per person","$29400 per group","$15,000","$15000 per person","$44100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340017-03&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0340015","Blue Max 90/70 $1500","97176LA034",,"LAN001","LAS001","LAF012","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","97176LA0340015-00","Blue Max 90/70 $1500","Standard Gold Off Exchange Plan",,"0.78070615207381","Yes","Yes","No","100%",,"$1,500","$0","$1,090","$60","$1,500","$0","$530","$90","$1,500","$0","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","10.00%",,,,,"$3,000","$3000 per person","$9000 per group","$4,500","$4500 per person","$13500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340015-00&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0340015","Blue Max 90/70 $1500","97176LA034",,"LAN001","LAS001","LAF012","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","97176LA0340015-01","Blue Max 90/70 $1500","Standard Gold On Exchange Plan",,"0.78070615207381","Yes","Yes","No","100%",,"$1,500","$0","$1,090","$60","$1,500","$0","$530","$90","$1,500","$0","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","10.00%",,,,,"$3,000","$3000 per person","$9000 per group","$4,500","$4500 per person","$13500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340015-01&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","29416MO0010010","BESTDental Choice - H","29416MO001",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTDental_Choice-H_Plan.pdf"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","29416MO0010010","BESTDental Choice - H","29416MO001",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTDental_Choice-H_Plan.pdf"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","29416MO0010009","BESTDental Standard - L","29416MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTDental_Standard-L_Plan.pdf"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","29416MO0020005","BESTOne Plus Silver","29416MO002",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","29416MO0020005","BESTOne Plus Silver","29416MO002",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","29416MO0010009","BESTDental Standard - L","29416MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTDental_Standard-L_Plan.pdf"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","29416MO0010011","BESTDental Choice - L","29416MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTDental_Choice-L_Plan.pdf"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","29416MO0020006","BESTOne Basic Silver","29416MO002",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","29416MO0020006","BESTOne Basic Silver","29416MO002",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","29416MO0010011","BESTDental Choice - L","29416MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTDental_Choice-L_Plan.pdf"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","29416MO0010012","BESTDental Value","29416MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTDental_Value_Plan.pdf"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","29416MO0010012","BESTDental Value","29416MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTDental_Value_Plan.pdf"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950006","Anthem Silver Pathway X 3850","32753MO095",,"MON001","MOS001","MOF010","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950006-05","Anthem Silver Pathway X 3850 S05","87% AV Level Silver Plan","86.00%","0.862466001480047","Yes","Yes","Yes","47%","53%","$950","$0","$1,000","$60","$950","$300","$700","$55","$950","$195","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","$1,950","$1950 per person","$3900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","0.00%","$950","$950 per person","$1900 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VH2","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0340015","Blue Max 90/70 $1500","97176LA034",,"LAN001","LAS001","LAF012","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","97176LA0340015-02","Blue Max 100/100 $0 CSR 0015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340015-02&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0340015","Blue Max 90/70 $1500","97176LA034",,"LAN001","LAS001","LAF012","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2018","97176LA0340015-03","Blue Max 90/70 $1500 CSR 0015-03","Limited Cost Sharing Plan Variation",,"0.78070615207381","Yes","Yes","No","100%",,"$1,500","$0","$1,090","$60","$1,500","$0","$530","$90","$1,500","$0","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","10.00%",,,,,"$3,000","$3000 per person","$9000 per group","$4,500","$4500 per person","$13500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340015-03&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950001","Anthem Gold Pathway X 1250","32753MO095",,"MON001","MOS001","MOF007","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950001-03","Anthem Gold Pathway X 1250","Limited Cost Sharing Plan Variation","76.17%","0.774895523785152","Yes","Yes","Yes","47%","53%","$1,250","$90","$3,928","$60","$1,250","$510","$1,646","$55","$1,250","$100","$171","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","10.00%","$1,250","$1250 per person","$3750 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VGF","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950004","Anthem Bronze Pathway X 0 for HSA","32753MO095",,"MON001","MOS001","MOF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950004-00","Anthem Bronze Pathway 0 for HSA","Standard Bronze Off Exchange Plan","60.22%","0.602242886076114","Yes","Yes","Yes","47%","53%","$6,650","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%","$6,650","$6650 per person","$13300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2VGS","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950004","Anthem Bronze Pathway X 0 for HSA","32753MO095",,"MON001","MOS001","MOF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950004-01","Anthem Bronze Pathway X 0 for HSA","Standard Bronze On Exchange Plan","60.22%","0.602242886076114","Yes","Yes","Yes","47%","53%","$6,650","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%","$6,650","$6650 per person","$13300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2VGT","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0340010","Blue Max Copay 70/50 $2800","97176LA034",,"LAN001","LAS001","LAF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","97176LA0340010-00","Blue Max Copay 70/50 $2800","Standard Silver Off Exchange Plan","71.40%","0.706672914836139","No","Yes","No","100%",,"$2,840","$0","$2,570","$60","$560","$860","$990","$90","$1,560","$110","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$2,800","$2800 per person","$8400 per group","30.00%",,,,,"$5,600","$5600 per person","$16800 per group","$8,400","$8400 per person","$25200 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-00&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","Yes","23-7384555","97176LA0390003","Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/60%/50% coinsurance, $0 deductible","97176LA039",,"LAN002","LAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"","97176LA0390003-00","Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/60%/50% coinsurance, $0 deductible","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/individual-bluedental-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","Yes","23-7384555","97176LA0390003","Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/60%/50% coinsurance, $0 deductible","97176LA039",,"LAN002","LAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"","97176LA0390003-01","Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/60%/50% coinsurance, $0 deductible","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/individual-bluedental-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0340010","Blue Max Copay 70/50 $2800","97176LA034",,"LAN001","LAS001","LAF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","97176LA0340010-01","Blue Max Copay 70/50 $2800","Standard Silver On Exchange Plan","71.40%","0.706672914836139","No","Yes","No","100%",,"$2,840","$0","$2,570","$60","$560","$860","$990","$90","$1,560","$110","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$2,800","$2800 per person","$8400 per group","30.00%",,,,,"$5,600","$5600 per person","$16800 per group","$8,400","$8400 per person","$25200 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-01&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0340010","Blue Max Copay 70/50 $2800","97176LA034",,"LAN001","LAS001","LAF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","97176LA0340010-02","Blue Max copay 100/100 $0 CSR 0010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$90","$0","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-02&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0340010","Blue Max Copay 70/50 $2800","97176LA034",,"LAN001","LAS001","LAF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","97176LA0340010-03","Blue Max copay 70/50 $2800 CSR 0010-03","Limited Cost Sharing Plan Variation","71.40%","0.706672914836139","No","Yes","No","100%",,"$2,840","$0","$2,570","$60","$560","$860","$990","$90","$1,560","$110","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$2,800","$2800 per person","$8400 per group","30.00%",,,,,"$5,600","$5600 per person","$16800 per group","$8,400","$8400 per person","$25200 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-03&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0340010","Blue Max Copay 70/50 $2800","97176LA034",,"LAN001","LAS001","LAF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","97176LA0340010-04","Blue Max copay 70/50 $2700 CSR 0010-04","73% AV Level Silver Plan","73.49%","0.728351727100104","No","Yes","No","100%",,"$2,740","$0","$2,600","$60","$560","$860","$990","$90","$1,560","$110","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"$14,700","$14700 per person","$29400 per group","$20,300","$20300 per person","$40600 per group","$2,700","$2700 per person","$8100 per group","30.00%",,,,,"$5,600","$5600 per person","$16800 per group","$8,300","$8300 per person","$24900 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-04&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0340010","Blue Max Copay 70/50 $2800","97176LA034",,"LAN001","LAS001","LAF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","97176LA0340010-05","Blue Max copay 80/50 $400 CSR 0010-05","87% AV Level Silver Plan","86.04%","0.857266352337203","No","Yes","No","100%",,"$400","$0","$1,750","$60","$560","$640","$950","$90","$400","$70","$230","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"$14,700","$14700 per person","$29400 per group","$16,850","$16850 per person","$33700 per group","$400","$400 per person","$1200 per group","20.00%",,,,,"$5,600","$5600 per person","$16800 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-05&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","LA","97176","HIOS","2017-11-01 02:20:20","Individual","No","23-7384555","97176LA0340010","Blue Max Copay 70/50 $2800","97176LA034",,"LAN001","LAS001","LAF010","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency and non-emergency coverage subject to Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-3tier-formulary2018","97176LA0340010-06","Blue Max copay 100/50 $75 CSR 0010-06","94% AV Level Silver Plan","93.24%","0.931590650938215","No","Yes","No","100%",,"$110","$0","$0","$60","$560","$100","$40","$90","$80","$40","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$14,700","$14700 per person","$29400 per group","$15,400","$15400 per person","$30800 per group","$75","$75 per person","$225 per group","0.00%",,,,,"$5,600","$5600 per person","$16800 per group","$5,675","$5675 per person","$17025 per group","$500","$500 per person","per group not applicable","20.00%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-06&Year=2018","http://www.bcbsla.com/individual-solutions-brochure2018"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","29416MO0010007","BESTDental Premium","29416MO001",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010007-00","BESTDental Premium","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTDental_Premium_Plan.pdf"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","29416MO0020003","BESTOne Advantage Gold","29416MO002",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full Covreage","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","29416MO0020003","BESTOne Advantage Gold","29416MO002",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full Covreage","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","29416MO0010007","BESTDental Premium","29416MO001",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010007-01","BESTDental Premium","Standard High On Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTDental_Premium_Plan.pdf"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","29416MO0010008","BESTDental Standard - H","29416MO001",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTDental_Standard-H_Plan.pdf"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","29416MO0020004","BESTOne Plus Gold","29416MO002",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full Coverage","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","29416MO0020004","BESTOne Plus Gold","29416MO002",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full Coverage","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","MO","29416","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","29416MO0010008","BESTDental Standard - H","29416MO001",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mo/current/MO_BESTDental_Standard-H_Plan.pdf"
"2018","MO","30613","HIOS","2017-08-08 02:20:26","Individual","Yes","39-1263473","30613MO0560001","Humana Dental Smart Choice","30613MO056",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9898","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","30613MO0560001-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110367"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","86-0257201","32753MO0890003","Anthem Dental Family","32753MO089",,"MON002","MOS009",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","32753MO0890003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/mo/f0/s0/t0/pw_e215729.pdf",
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950002","Anthem Silver Pathway X 1850","32753MO095",,"MON001","MOS001","MOF010","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950002-00","Anthem Silver Pathway 1850","Standard Silver Off Exchange Plan","69.83%","0.720973219307658","Yes","Yes","Yes","47%","53%","$1,850","$40","$4,311","$60","$1,850","$310","$2,018","$55","$1,540","$0","$385","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20.00%","$1,850","$1850 per person","$3700 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VGH","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","Yes","86-0257201","32753MO0860005","Anthem Dental Family Value","32753MO086",,"MON002","MOS009",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","32753MO0860005-01","Anthem Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/mo/f0/s0/t0/pw_e215731.pdf",
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","Yes","86-0257201","32753MO0920005","Anthem Dental Family Value","32753MO092",,"MON002","MOS009",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","32753MO0920005-00","Anthem Dental Family Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/mo/f0/s0/t0/pw_e215731.pdf",
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950002","Anthem Silver Pathway X 1850","32753MO095",,"MON001","MOS001","MOF010","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950002-01","Anthem Silver Pathway X 1850","Standard Silver On Exchange Plan","69.83%","0.720973219307658","Yes","Yes","Yes","47%","53%","$1,850","$40","$4,311","$60","$1,850","$310","$2,018","$55","$1,540","$0","$385","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20.00%","$1,850","$1850 per person","$3700 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VGJ","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950002","Anthem Silver Pathway X 1850","32753MO095",,"MON001","MOS001","MOF010","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950002-02","Anthem Silver Pathway X 1850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","47%","53%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VGK","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950002","Anthem Silver Pathway X 1850","32753MO095",,"MON001","MOS001","MOF010","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950002-03","Anthem Silver Pathway X 1850","Limited Cost Sharing Plan Variation","69.83%","0.720973219307658","Yes","Yes","Yes","47%","53%","$1,850","$40","$4,311","$60","$1,850","$310","$2,018","$55","$1,540","$0","$385","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20.00%","$1,850","$1850 per person","$3700 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VGJ","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950002","Anthem Silver Pathway X 1850","32753MO095",,"MON001","MOS001","MOF010","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950002-04","Anthem Silver Pathway X 1850 S04","73% AV Level Silver Plan","72.19%","0.742530709314364","Yes","Yes","Yes","47%","53%","$1,700","$0","$3,900","$60","$1,700","$310","$2,018","$55","$1,540","$0","$385","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","20.00%","$1,700","$1700 per person","$3400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VGL","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950002","Anthem Silver Pathway X 1850","32753MO095",,"MON001","MOS001","MOF010","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950002-05","Anthem Silver Pathway X 1850 S05","87% AV Level Silver Plan","86.17%","0.872225751181496","Yes","Yes","Yes","47%","53%","$750","$0","$700","$60","$750","$80","$620","$55","$750","$0","$385","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group","$1,450","$1450 per person","$2900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VGM","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950002","Anthem Silver Pathway X 1850","32753MO095",,"MON001","MOS001","MOF010","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950002-06","Anthem Silver Pathway X 1850 S06","94% AV Level Silver Plan","93.00%","0.932636252800453","Yes","Yes","Yes","47%","53%","$100","$0","$700","$60","$100","$80","$620","$55","$100","$0","$385","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%","$100","$100 per person","$200 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VGN","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950016","Anthem Catastrophic Pathway X 7350","32753MO095",,"MON001","MOS001","MOF001","New","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950016-00","Anthem Catastrophic Pathway 7350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","47%","53%","$7,350","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%","$7,350","$7350 per person","$14700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2Z6H","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950016","Anthem Catastrophic Pathway X 7350","32753MO095",,"MON001","MOS001","MOF001","New","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950016-01","Anthem Catastrophic Pathway X 7350","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","47%","53%","$7,350","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%","$7,350","$7350 per person","$14700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2Z6G","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950001","Anthem Gold Pathway X 1250","32753MO095",,"MON001","MOS001","MOF007","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950001-00","Anthem Gold Pathway 1250","Standard Gold Off Exchange Plan","76.17%","0.774895523785152","Yes","Yes","Yes","47%","53%","$1,250","$90","$3,928","$60","$1,250","$510","$1,646","$55","$1,250","$100","$171","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","10.00%","$1,250","$1250 per person","$3750 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VGE","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","86-0257201","32753MO0890004","Anthem Dental Family Enhanced","32753MO089",,"MON002","MOS009",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.824","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","32753MO0890004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/mo/f0/s0/t0/pw_e215730.pdf",
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","Yes","86-0257201","32753MO0860003","Anthem Dental Family","32753MO086",,"MON002","MOS009",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","32753MO0860003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/mo/f0/s0/t0/pw_e215729.pdf",
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","Yes","86-0257201","32753MO0920003","Anthem Dental Family","32753MO092",,"MON002","MOS009",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","32753MO0920003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/mo/f0/s0/t0/pw_e215729.pdf",
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950001","Anthem Gold Pathway X 1250","32753MO095",,"MON001","MOS001","MOF007","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950001-01","Anthem Gold Pathway X 1250","Standard Gold On Exchange Plan","76.17%","0.774895523785152","Yes","Yes","Yes","47%","53%","$1,250","$90","$3,928","$60","$1,250","$510","$1,646","$55","$1,250","$100","$171","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","10.00%","$1,250","$1250 per person","$3750 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VGF","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950001","Anthem Gold Pathway X 1250","32753MO095",,"MON001","MOS001","MOF007","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950001-02","Anthem Gold Pathway X 1250 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","47%","53%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VGG","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950004","Anthem Bronze Pathway X 0 for HSA","32753MO095",,"MON001","MOS001","MOF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950004-02","Anthem Bronze Pathway X 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","47%","53%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VGU","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950004","Anthem Bronze Pathway X 0 for HSA","32753MO095",,"MON001","MOS001","MOF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950004-03","Anthem Bronze Pathway X 0 for HSA","Limited Cost Sharing Plan Variation","60.22%","0.602242886076114","Yes","Yes","Yes","47%","53%","$6,650","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%","$6,650","$6650 per person","$13300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2VGT","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950005","Anthem Bronze Pathway X 20 for HSA","32753MO095",,"MON001","MOS001","MOF003","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950005-00","Anthem Bronze Pathway 20 for HSA","Standard Bronze Off Exchange Plan","61.02%","0.612503953377632","Yes","Yes","Yes","47%","53%","$4,170","$0","$2,480","$60","$4,654","$0","$1,996","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","20.00%","$5,250","$5250 per person","$10500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2VGV","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950005","Anthem Bronze Pathway X 20 for HSA","32753MO095",,"MON001","MOS001","MOF003","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950005-01","Anthem Bronze Pathway X 20 for HSA","Standard Bronze On Exchange Plan","61.02%","0.612503953377632","Yes","Yes","Yes","47%","53%","$4,170","$0","$2,480","$60","$4,654","$0","$1,996","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","20.00%","$5,250","$5250 per person","$10500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2VGW","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950005","Anthem Bronze Pathway X 20 for HSA","32753MO095",,"MON001","MOS001","MOF003","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950005-02","Anthem Bronze Pathway X 20 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","47%","53%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VGX","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950005","Anthem Bronze Pathway X 20 for HSA","32753MO095",,"MON001","MOS001","MOF003","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950005-03","Anthem Bronze Pathway X 20 for HSA","Limited Cost Sharing Plan Variation","61.02%","0.612503953377632","Yes","Yes","Yes","47%","53%","$4,170","$0","$2,480","$60","$4,654","$0","$1,996","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","20.00%","$5,250","$5250 per person","$10500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2VGW","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950006","Anthem Silver Pathway X 3850","32753MO095",,"MON001","MOS001","MOF010","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950006-00","Anthem Silver Pathway 3850","Standard Silver Off Exchange Plan","70.84%","0.711247363762771","Yes","Yes","Yes","47%","53%","$3,440","$0","$2,460","$60","$3,667","$800","$1,433","$55","$1,416","$405","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","$5,900","$5900 per person","$11800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group","0.00%","$3,850","$3850 per person","$7700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VGY","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950006","Anthem Silver Pathway X 3850","32753MO095",,"MON001","MOS001","MOF010","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950006-01","Anthem Silver Pathway X 3850","Standard Silver On Exchange Plan","70.84%","0.711247363762771","Yes","Yes","Yes","47%","53%","$3,440","$0","$2,460","$60","$3,667","$800","$1,433","$55","$1,416","$405","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","$5,900","$5900 per person","$11800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group","0.00%","$3,850","$3850 per person","$7700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VGZ","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950006","Anthem Silver Pathway X 3850","32753MO095",,"MON001","MOS001","MOF010","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950006-02","Anthem Silver Pathway X 3850 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","47%","53%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VH0","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950006","Anthem Silver Pathway X 3850","32753MO095",,"MON001","MOS001","MOF010","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950006-03","Anthem Silver Pathway X 3850","Limited Cost Sharing Plan Variation","70.84%","0.711247363762771","Yes","Yes","Yes","47%","53%","$3,440","$0","$2,460","$60","$3,667","$800","$1,433","$55","$1,416","$405","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","$5,900","$5900 per person","$11800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group","0.00%","$3,850","$3850 per person","$7700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VGZ","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950006","Anthem Silver Pathway X 3850","32753MO095",,"MON001","MOS001","MOF010","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950006-04","Anthem Silver Pathway X 3850 S04","73% AV Level Silver Plan","72.90%","0.730527591316464","Yes","Yes","Yes","47%","53%","$3,440","$0","$2,260","$60","$3,450","$670","$1,433","$55","$1,416","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,450","$3450 per person","$6900 per group","0.00%","$3,450","$3450 per person","$6900 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VH1","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950006","Anthem Silver Pathway X 3850","32753MO095",,"MON001","MOS001","MOF010","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950006-06","Anthem Silver Pathway X 3850 S06","94% AV Level Silver Plan","93.13%","0.933925602414828","Yes","Yes","Yes","47%","53%","$200","$0","$600","$60","$200","$190","$410","$55","$200","$160","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","0.00%","$200","$200 per person","$400 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VH3","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950007","Anthem Silver Pathway X for HSA","32753MO095",,"MON001","MOS001","MOF002","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950007-00","Anthem Silver Pathway for HSA","Standard Silver Off Exchange Plan","68.04%","0.688069401237282","Yes","Yes","Yes","47%","53%","$2,950","$0","$3,050","$60","$2,950","$0","$1,793","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,950","$2950 per person","$5900 per group","10.00%","$2,950","$2950 per person","$5900 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2VH4","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950007","Anthem Silver Pathway X for HSA","32753MO095",,"MON001","MOS001","MOF002","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950007-01","Anthem Silver Pathway X for HSA","Standard Silver On Exchange Plan","68.04%","0.688069401237282","Yes","Yes","Yes","47%","53%","$2,950","$0","$3,050","$60","$2,950","$0","$1,793","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,950","$2950 per person","$5900 per group","10.00%","$2,950","$2950 per person","$5900 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2VH5","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950009","Anthem Silver Pathway X 2900","32753MO095",,"MON001","MOS001","MOF006","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950009-03","Anthem Silver Pathway X 2900","Limited Cost Sharing Plan Variation","70.63%","0.714497972127711","No","Yes","Yes","47%","53%","$2,580","$0","$2,920","$60","$2,601","$470","$1,966","$55","$1,282","$80","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","25.00%","$2,900","$2900 per person","$5800 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2VHE","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950009","Anthem Silver Pathway X 2900","32753MO095",,"MON001","MOS001","MOF006","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950009-04","Anthem Silver Pathway X 2900 S04","73% AV Level Silver Plan","73.38%","0.741184500064732","No","Yes","Yes","47%","53%","$2,300","$0","$2,300","$60","$2,314","$450","$1,836","$55","$1,282","$80","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","$4,600","$4600 per person","$9200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group","25.00%","$2,300","$2300 per person","$4600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","40.00%","$850","$850 per person","$1700 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2VHG","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950007","Anthem Silver Pathway X for HSA","32753MO095",,"MON001","MOS001","MOF002","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950007-02","Anthem Silver Pathway X AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","47%","53%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VH6","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950007","Anthem Silver Pathway X for HSA","32753MO095",,"MON001","MOS001","MOF002","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950007-03","Anthem Silver Pathway X for HSA","Limited Cost Sharing Plan Variation","68.04%","0.688069401237282","Yes","Yes","Yes","47%","53%","$2,950","$0","$3,050","$60","$2,950","$0","$1,793","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,950","$2950 per person","$5900 per group","10.00%","$2,950","$2950 per person","$5900 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2VH5","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950011","Anthem Silver Pathway X 2250","32753MO095",,"MON001","MOS001","MOF009","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950011-04","Anthem Silver Pathway X 2250 S04","73% AV Level Silver Plan","73.79%","0.741471248955743","Yes","Yes","Yes","47%","53%","$1,720","$0","$3,080","$60","$2,161","$360","$2,279","$55","$855","$80","$855","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","50.00%","$2,200","$2200 per person","$4400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VHR","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950011","Anthem Silver Pathway X 2250","32753MO095",,"MON001","MOS001","MOF009","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950011-05","Anthem Silver Pathway X 2250 S05","87% AV Level Silver Plan","87.29%","0.87400477447797","Yes","Yes","Yes","47%","53%","$89","$0","$1,261","$60","$605","$120","$625","$55","$674","$0","$676","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","$1,350","$1350 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","50.00%","$850","$850 per person","$1700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VHS","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950011","Anthem Silver Pathway X 2250","32753MO095",,"MON001","MOS001","MOF009","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950011-06","Anthem Silver Pathway X 2250 S06","94% AV Level Silver Plan","93.59%","0.936595243403063","Yes","Yes","Yes","47%","53%","$89","$0","$511","$60","$150","$85","$365","$55","$150","$0","$450","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","50.00%","$150","$150 per person","$300 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VHT","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950007","Anthem Silver Pathway X for HSA","32753MO095",,"MON001","MOS001","MOF002","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950007-04","Anthem Silver Pathway X for HSA S04","73% AV Level Silver Plan","72.07%","0.725186162079275","Yes","Yes","Yes","47%","53%","$2,700","$0","$1,250","$60","$2,700","$0","$1,250","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,950","$3950 per person","$7900 per group","$3,950","$3950 per person","$7900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%","$2,700","$2700 per person","$5400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2VH7","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950007","Anthem Silver Pathway X for HSA","32753MO095",,"MON001","MOS001","MOF002","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950007-05","Anthem Silver Pathway X S05","87% AV Level Silver Plan","86.71%","0.867137005624073","Yes","Yes","Yes","47%","53%","$1,200","$0","$0","$60","$1,200","$0","$0","$55","$1,200","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","$1,200","$1200 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","0.00%","$1,200","$1200 per person","$2400 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VH8","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950007","Anthem Silver Pathway X for HSA","32753MO095",,"MON001","MOS001","MOF002","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950007-06","Anthem Silver Pathway X S06","94% AV Level Silver Plan","93.79%","0.937977340786209","Yes","Yes","Yes","47%","53%","$500","$0","$0","$60","$500","$0","$0","$55","$500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VH9","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950008","Anthem Bronze Pathway X 5450","32753MO095",,"MON001","MOS001","MOF004","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950008-00","Anthem Bronze Pathway 5450","Standard Bronze Off Exchange Plan","59.40%","0.596075195405814","Yes","Yes","Yes","47%","53%","$3,630","$0","$3,720","$60","$4,671","$0","$2,513","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","30.00%","$5,450","$5450 per person","$10900 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VHA","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950008","Anthem Bronze Pathway X 5450","32753MO095",,"MON001","MOS001","MOF004","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950008-01","Anthem Bronze Pathway X 5450","Standard Bronze On Exchange Plan","59.40%","0.596075195405814","Yes","Yes","Yes","47%","53%","$3,630","$0","$3,720","$60","$4,671","$0","$2,513","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","30.00%","$5,450","$5450 per person","$10900 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VHB","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950008","Anthem Bronze Pathway X 5450","32753MO095",,"MON001","MOS001","MOF004","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950008-02","Anthem Bronze Pathway X 5450 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","47%","53%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VHC","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950008","Anthem Bronze Pathway X 5450","32753MO095",,"MON001","MOS001","MOF004","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950008-03","Anthem Bronze Pathway X 5450","Limited Cost Sharing Plan Variation","59.40%","0.596075195405814","Yes","Yes","Yes","47%","53%","$3,630","$0","$3,720","$60","$4,671","$0","$2,513","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","30.00%","$5,450","$5450 per person","$10900 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VHB","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950009","Anthem Silver Pathway X 2900","32753MO095",,"MON001","MOS001","MOF006","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950009-00","Anthem Silver Pathway 2900","Standard Silver Off Exchange Plan","70.63%","0.714497972127711","No","Yes","Yes","47%","53%","$2,580","$0","$2,920","$60","$2,601","$470","$1,966","$55","$1,282","$80","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","25.00%","$2,900","$2900 per person","$5800 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2VHD","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950009","Anthem Silver Pathway X 2900","32753MO095",,"MON001","MOS001","MOF006","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950009-01","Anthem Silver Pathway X 2900","Standard Silver On Exchange Plan","70.63%","0.714497972127711","No","Yes","Yes","47%","53%","$2,580","$0","$2,920","$60","$2,601","$470","$1,966","$55","$1,282","$80","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","25.00%","$2,900","$2900 per person","$5800 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2VHE","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950009","Anthem Silver Pathway X 2900","32753MO095",,"MON001","MOS001","MOF006","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950009-02","Anthem Silver Pathway X 2900 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","47%","53%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2VHF","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950009","Anthem Silver Pathway X 2900","32753MO095",,"MON001","MOS001","MOF006","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950009-05","Anthem Silver Pathway X 2900 S05","87% AV Level Silver Plan","86.58%","0.867628787885581","No","Yes","Yes","47%","53%","$750","$0","$750","$60","$888","$120","$492","$55","$750","$80","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2VHH","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950009","Anthem Silver Pathway X 2900","32753MO095",,"MON001","MOS001","MOF006","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950009-06","Anthem Silver Pathway X 2900 S06","94% AV Level Silver Plan","93.56%","0.935283100540672","No","Yes","Yes","47%","53%","$134","$0","$466","$60","$350","$57","$193","$55","$250","$0","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd2VHJ","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950010","Anthem Bronze Pathway X 4950","32753MO095",,"MON001","MOS001","MOF005","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950010-00","Anthem Bronze Pathway 4950","Standard Bronze Off Exchange Plan","59.36%","0.595053219447109","Yes","Yes","Yes","47%","53%","$1,720","$0","$5,630","$60","$3,592","$0","$3,592","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50.00%","$4,950","$4950 per person","$9900 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VHK","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950003","Anthem Bronze Pathway X 6350","32753MO095",,"MON001","MOS001","MOF012","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950003-01","Anthem Bronze Pathway X 6350","Standard Bronze On Exchange Plan","61.34%","0.628030969733752","Yes","Yes","Yes","47%","53%","$4,870","$0","$2,480","$60","$4,490","$620","$2,018","$55","$1,540","$0","$385","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","20.00%","$6,350","$6350 per person","$12700 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VGQ","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950014","Anthem Silver Pathway X 3250","32753MO095",,"MON001","MOS001","MOF011","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950014-01","Anthem Silver Pathway X 3250","Standard Silver On Exchange Plan","69.13%","0.694492262905982","Yes","Yes","Yes","47%","53%","$1,720","$0","$4,730","$60","$2,858","$550","$2,858","$55","$855","$120","$855","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","50.00%","$3,250","$3250 per person","$6500 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VJ7","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950014","Anthem Silver Pathway X 3250","32753MO095",,"MON001","MOS001","MOF011","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950014-02","Anthem Silver Pathway X 3250 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","47%","53%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VJ8","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950014","Anthem Silver Pathway X 3250","32753MO095",,"MON001","MOS001","MOF011","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950014-03","Anthem Silver Pathway X 3250","Limited Cost Sharing Plan Variation","69.13%","0.694492262905982","Yes","Yes","Yes","47%","53%","$1,720","$0","$4,730","$60","$2,858","$550","$2,858","$55","$855","$120","$855","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","50.00%","$3,250","$3250 per person","$6500 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VJ7","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950014","Anthem Silver Pathway X 3250","32753MO095",,"MON001","MOS001","MOF011","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950014-04","Anthem Silver Pathway X 3250 S04","73% AV Level Silver Plan","73.05%","0.732824708019499","Yes","Yes","Yes","47%","53%","$1,720","$0","$3,080","$60","$2,161","$360","$2,279","$55","$855","$80","$855","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50.00%","$3,000","$3000 per person","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VJ9","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950010","Anthem Bronze Pathway X 4950","32753MO095",,"MON001","MOS001","MOF005","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950010-01","Anthem Bronze Pathway X 4950","Standard Bronze On Exchange Plan","59.36%","0.595053219447109","Yes","Yes","Yes","47%","53%","$1,720","$0","$5,630","$60","$3,592","$0","$3,592","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50.00%","$4,950","$4950 per person","$9900 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VHL","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950010","Anthem Bronze Pathway X 4950","32753MO095",,"MON001","MOS001","MOF005","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950010-02","Anthem Bronze Pathway X 4950 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","47%","53%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VHM","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950010","Anthem Bronze Pathway X 4950","32753MO095",,"MON001","MOS001","MOF005","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950010-03","Anthem Bronze Pathway X 4950","Limited Cost Sharing Plan Variation","59.36%","0.595053219447109","Yes","Yes","Yes","47%","53%","$1,720","$0","$5,630","$60","$3,592","$0","$3,592","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50.00%","$4,950","$4950 per person","$9900 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VHL","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950011","Anthem Silver Pathway X 2250","32753MO095",,"MON001","MOS001","MOF009","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950011-00","Anthem Silver Pathway 2250","Standard Silver Off Exchange Plan","69.53%","0.700599413498461","Yes","Yes","Yes","47%","53%","$1,720","$0","$5,630","$60","$2,250","$470","$2,858","$55","$855","$80","$855","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50.00%","$2,250","$2250 per person","$4500 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VHN","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950011","Anthem Silver Pathway X 2250","32753MO095",,"MON001","MOS001","MOF009","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950011-01","Anthem Silver Pathway X 2250","Standard Silver On Exchange Plan","69.53%","0.700599413498461","Yes","Yes","Yes","47%","53%","$1,720","$0","$5,630","$60","$2,250","$470","$2,858","$55","$855","$80","$855","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50.00%","$2,250","$2250 per person","$4500 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VHP","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950011","Anthem Silver Pathway X 2250","32753MO095",,"MON001","MOS001","MOF009","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950011-02","Anthem Silver Pathway X 2250 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","47%","53%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VHQ","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950011","Anthem Silver Pathway X 2250","32753MO095",,"MON001","MOS001","MOF009","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950011-03","Anthem Silver Pathway X 2250","Limited Cost Sharing Plan Variation","69.53%","0.700599413498461","Yes","Yes","Yes","47%","53%","$1,720","$0","$5,630","$60","$2,250","$470","$2,858","$55","$855","$80","$855","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50.00%","$2,250","$2250 per person","$4500 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VHP","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950012","Anthem Silver Pathway X 4500","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950012-00","Anthem Silver Pathway 4500","Standard Silver Off Exchange Plan","68.01%","0.684366514040482","Yes","Yes","Yes","47%","53%","$2,752","$0","$4,048","$60","$3,857","$590","$1,860","$55","$1,367","$140","$342","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%","$4,500","$4500 per person","$9000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VHU","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950012","Anthem Silver Pathway X 4500","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950012-01","Anthem Silver Pathway X 4500","Standard Silver On Exchange Plan","68.01%","0.684366514040482","Yes","Yes","Yes","47%","53%","$2,752","$0","$4,048","$60","$3,857","$590","$1,860","$55","$1,367","$140","$342","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%","$4,500","$4500 per person","$9000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VHV","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950012","Anthem Silver Pathway X 4500","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950012-02","Anthem Silver Pathway X 4500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","47%","53%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VHW","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950012","Anthem Silver Pathway X 4500","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950012-03","Anthem Silver Pathway X 4500","Limited Cost Sharing Plan Variation","68.01%","0.684366514040482","Yes","Yes","Yes","47%","53%","$2,752","$0","$4,048","$60","$3,857","$590","$1,860","$55","$1,367","$140","$342","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%","$4,500","$4500 per person","$9000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VHV","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950012","Anthem Silver Pathway X 4500","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950012-04","Anthem Silver Pathway X 4500 S04","73% AV Level Silver Plan","72.00%","0.724138387866224","Yes","Yes","Yes","47%","53%","$2,752","$0","$2,248","$60","$3,073","$465","$1,463","$55","$1,367","$140","$342","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%","$3,500","$3500 per person","$7000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VHX","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950012","Anthem Silver Pathway X 4500","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950012-05","Anthem Silver Pathway X 4500 S05","87% AV Level Silver Plan","86.05%","0.862798619303714","Yes","Yes","Yes","47%","53%","$950","$0","$700","$60","$950","$125","$575","$55","$950","$60","$342","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","20.00%","$950","$950 per person","$1900 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VHY","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950012","Anthem Silver Pathway X 4500","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950012-06","Anthem Silver Pathway X 4500 S06","94% AV Level Silver Plan","93.02%","0.931568294538192","Yes","Yes","Yes","47%","53%","$186","$0","$514","$60","$250","$100","$350","$55","$250","$60","$342","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%","$250","$250 per person","$500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VHZ","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950013","Anthem Silver Pathway X 5500","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950013-00","Anthem Silver Pathway 5500","Standard Silver Off Exchange Plan","68.02%","0.682455844553058","Yes","Yes","Yes","47%","53%","$2,580","$0","$3,920","$60","$3,750","$550","$1,966","$55","$1,282","$120","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","25.00%","$5,500","$5500 per person","$11000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VJ0","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950013","Anthem Silver Pathway X 5500","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950013-01","Anthem Silver Pathway X 5500","Standard Silver On Exchange Plan","68.02%","0.682455844553058","Yes","Yes","Yes","47%","53%","$2,580","$0","$3,920","$60","$3,750","$550","$1,966","$55","$1,282","$120","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","25.00%","$5,500","$5500 per person","$11000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VJ1","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950013","Anthem Silver Pathway X 5500","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950013-02","Anthem Silver Pathway X 5500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","47%","53%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VJ2","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950013","Anthem Silver Pathway X 5500","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950013-03","Anthem Silver Pathway X 5500","Limited Cost Sharing Plan Variation","68.02%","0.682455844553058","Yes","Yes","Yes","47%","53%","$2,580","$0","$3,920","$60","$3,750","$550","$1,966","$55","$1,282","$120","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","25.00%","$5,500","$5500 per person","$11000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VJ1","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950013","Anthem Silver Pathway X 5500","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950013-04","Anthem Silver Pathway X 5500 S04","73% AV Level Silver Plan","72.00%","0.724396811604098","Yes","Yes","Yes","47%","53%","$2,580","$0","$2,770","$60","$3,100","$510","$1,740","$55","$1,282","$120","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group","$5,350","$5350 per person","$10700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","25.00%","$3,100","$3100 per person","$6200 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VJ3","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950013","Anthem Silver Pathway X 5500","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950013-05","Anthem Silver Pathway X 5500 S05","87% AV Level Silver Plan","86.33%","0.864804376936662","Yes","Yes","Yes","47%","53%","$857","$0","$643","$60","$919","$150","$431","$55","$1,000","$73","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VJ4","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950013","Anthem Silver Pathway X 5500","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950013-06","Anthem Silver Pathway X 5500 S06","94% AV Level Silver Plan","93.03%","0.931587432450548","Yes","Yes","Yes","47%","53%","$134","$0","$566","$60","$200","$117","$383","$55","$200","$73","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VJ5","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950014","Anthem Silver Pathway X 3250","32753MO095",,"MON001","MOS001","MOF011","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950014-00","Anthem Silver Pathway 3250","Standard Silver Off Exchange Plan","69.13%","0.694492262905982","Yes","Yes","Yes","47%","53%","$1,720","$0","$4,730","$60","$2,858","$550","$2,858","$55","$855","$120","$855","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","50.00%","$3,250","$3250 per person","$6500 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VJ6","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950014","Anthem Silver Pathway X 3250","32753MO095",,"MON001","MOS001","MOF011","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950014-05","Anthem Silver Pathway X 3250 S05","87% AV Level Silver Plan","87.24%","0.873502060936408","Yes","Yes","Yes","47%","53%","$89","$0","$1,261","$60","$605","$120","$625","$55","$674","$0","$676","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","$1,350","$1350 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","50.00%","$900","$900 per person","$1800 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VJA","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950014","Anthem Silver Pathway X 3250","32753MO095",,"MON001","MOS001","MOF011","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950014-06","Anthem Silver Pathway X 3250 S06","94% AV Level Silver Plan","93.52%","0.935931952114368","Yes","Yes","Yes","47%","53%","$89","$0","$511","$60","$200","$85","$315","$55","$200","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","50.00%","$200","$200 per person","$400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VJB","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950015","Anthem Silver Pathway X 6000","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950015-00","Anthem Silver Pathway 6000","Standard Silver Off Exchange Plan","66.03%","0.662125287756592","Yes","Yes","Yes","47%","53%","$3,010","$0","$4,340","$60","$3,537","$630","$2,180","$55","$1,111","$160","$598","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","35.00%","$6,000","$6000 per person","$12000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VJT","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950015","Anthem Silver Pathway X 6000","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950015-01","Anthem Silver Pathway X 6000","Standard Silver On Exchange Plan","66.03%","0.662125287756592","Yes","Yes","Yes","47%","53%","$3,010","$0","$4,340","$60","$3,537","$630","$2,180","$55","$1,111","$160","$598","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","35.00%","$6,000","$6000 per person","$12000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VJS","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950015","Anthem Silver Pathway X 6000","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950015-02","Anthem Silver Pathway X 6000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","47%","53%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VJU","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950015","Anthem Silver Pathway X 6000","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950015-03","Anthem Silver Pathway X 6000","Limited Cost Sharing Plan Variation","66.03%","0.662125287756592","Yes","Yes","Yes","47%","53%","$3,010","$0","$4,340","$60","$3,537","$630","$2,180","$55","$1,111","$160","$598","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","35.00%","$6,000","$6000 per person","$12000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VJS","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950015","Anthem Silver Pathway X 6000","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950015-04","Anthem Silver Pathway X 6000 S04","73% AV Level Silver Plan","72.04%","0.72301064054658","Yes","Yes","Yes","47%","53%","$2,236","$0","$2,764","$60","$2,825","$443","$1,733","$55","$1,111","$120","$598","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","35.00%","$3,500","$3500 per person","$7000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VJV","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950015","Anthem Silver Pathway X 6000","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950015-05","Anthem Silver Pathway X 6000 S05","87% AV Level Silver Plan","86.08%","0.862416254599632","Yes","Yes","Yes","47%","53%","$700","$0","$900","$60","$905","$90","$605","$55","$1,000","$2","$598","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","35.00%","$1,000","$1000 per person","$2000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VJW","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950015","Anthem Silver Pathway X 6000","32753MO095",,"MON001","MOS001","MOF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950015-06","Anthem Silver Pathway X 6000 S06","94% AV Level Silver Plan","93.10%","0.932210343907431","Yes","Yes","Yes","47%","53%","$116","$0","$584","$60","$150","$90","$460","$55","$150","$0","$550","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","35.00%","$150","$150 per person","$300 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VJX","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950003","Anthem Bronze Pathway X 6350","32753MO095",,"MON001","MOS001","MOF012","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950003-00","Anthem Bronze Pathway 6350","Standard Bronze Off Exchange Plan","61.34%","0.628030969733752","Yes","Yes","Yes","47%","53%","$4,870","$0","$2,480","$60","$4,490","$620","$2,018","$55","$1,540","$0","$385","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","20.00%","$6,350","$6350 per person","$12700 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VGP","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","Yes","86-0257201","32753MO0860004","Anthem Dental Family Enhanced","32753MO086",,"MON002","MOS009",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.824","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","32753MO0860004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/mo/f0/s0/t0/pw_e215730.pdf",
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","Yes","86-0257201","32753MO0920004","Anthem Dental Family Enhanced","32753MO092",,"MON002","MOS009",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.824","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","32753MO0920004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/mo/f0/s0/t0/pw_e215730.pdf",
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950003","Anthem Bronze Pathway X 6350","32753MO095",,"MON001","MOS001","MOF012","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950003-02","Anthem Bronze Pathway X 6350 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","47%","53%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VGR","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","48786","HIOS","2017-06-03 02:07:36","Individual","Yes","13-5123390","48786MO0150002","Guardian Basics for Families and Individuals","48786MO015",,"MON002","MOS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","48786MO0150002-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/missouri/","https://dentalexchange.guardianlife.com/our-plans/missouri/"
"2018","MO","48786","HIOS","2017-06-03 02:07:36","Individual","Yes","13-5123390","48786MO0150002","Guardian Basics for Families and Individuals","48786MO015",,"MON002","MOS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","48786MO0150002-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/missouri/","https://dentalexchange.guardianlife.com/our-plans/missouri/"
"2018","MO","58284","HIOS","2017-08-12 02:21:25","Individual","Yes","27-3347197","58284MO0010001","LIBERTY MO Family Value Dental Plan","58284MO001",,"MON001","MOS001",,"Existing","HMO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No",,"No","https://www.libertydentalplan.com/ExchangePayment","","58284MO0010001-01","LIBERTY MO Family Value Dental Plan","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.libertydentalplan.com/Resources/Documents/2018-LDP-MO-IND-Exchange.pdf"
"2018","MO","58883","HIOS","2017-08-10 02:20:26","Individual","Yes","59-0397210","58883MO0010001","DentaQuest PPO  Pediatric High","58883MO001",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58883MO0010001-00","DentaQuest PPO  Pediatric High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/mo/","http://www.dentaquest.com/marketplace/mo/"
"2018","MO","58883","HIOS","2017-08-10 02:20:26","Individual","Yes","59-0397210","58883MO0010001","DentaQuest PPO  Pediatric High","58883MO001",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58883MO0010001-01","DentaQuest PPO  Pediatric High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/mo/","http://www.dentaquest.com/marketplace/mo/"
"2018","MO","58883","HIOS","2017-08-10 02:20:26","Individual","Yes","59-0397210","58883MO0010003","DentaQuest PPO Family High","58883MO001",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58883MO0010003-00","DentaQuest PPO Family High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/mo/","http://www.dentaquest.com/marketplace/mo/"
"2018","MO","32753","HIOS","2017-08-15 02:20:31","Individual","No","86-0257201","32753MO0950003","Anthem Bronze Pathway X 6350","32753MO095",,"MON001","MOS001","MOF012","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","Yes","BlueCard PPO Basic Network, within MO full access, outside MO is Emergency and Urgent care only","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0950003-03","Anthem Bronze Pathway X 6350","Limited Cost Sharing Plan Variation","61.34%","0.628030969733752","Yes","Yes","Yes","47%","53%","$4,870","$0","$2,480","$60","$4,490","$620","$2,018","$55","$1,540","$0","$385","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","20.00%","$6,350","$6350 per person","$12700 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VGQ","http://editiondigital.net/view/IU65/2018/ON_HIX_MO_KIT_2018"
"2018","MO","35853","HIOS","2017-06-17 02:21:00","Individual","Yes","47-0397286","35853MO0020003","Renaissance Individual Dental PPO, EHB Certified","35853MO002",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","35853MO0020003-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MO","35853","HIOS","2017-06-17 02:21:00","Individual","Yes","47-0397286","35853MO0020004","Renaissance Individual Dental PPO, EHB Certified","35853MO002",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","35853MO0020004-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MO","35853","HIOS","2017-06-17 02:21:00","Individual","Yes","47-0397286","35853MO0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","35853MO004",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/35853","","35853MO0040001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/MO_EHB_High_2018","http://www.renaissancedental.com/MO_EHB_High_2018"
"2018","MO","35853","HIOS","2017-06-17 02:21:00","Individual","Yes","47-0397286","35853MO0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","35853MO004",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/35853","","35853MO0040002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/MO_EHB_Low_2018","http://www.renaissancedental.com/MO_EHB_Low_2018"
"2018","MO","35853","HIOS","2017-06-17 02:21:00","Individual","Yes","47-0397286","35853MO0060001","Renaissance Individual Dental Pediatric-Only, EHB Certified","35853MO006",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","35853MO0060001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MO","35853","HIOS","2017-06-17 02:21:00","Individual","Yes","47-0397286","35853MO0060002","Renaissance Individual Dental Pediatric-Only, EHB Certified","35853MO006",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","35853MO0060002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MO","35853","HIOS","2017-06-17 02:21:00","Individual","Yes","47-0397286","35853MO0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","35853MO005",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/35853","","35853MO0050001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/MO_Ped_High_2018","http://www.renaissancedental.com/MO_Ped_High_2018"
"2018","MO","35853","HIOS","2017-06-17 02:21:00","Individual","Yes","47-0397286","35853MO0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","35853MO005",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/35853","","35853MO0050002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/MO_Ped_Low_2018","http://www.renaissancedental.com/MO_Ped_Low_2018"
"2018","MO","48786","HIOS","2017-06-03 02:07:36","Individual","Yes","13-5123390","48786MO0160002","Guardian Essentials for Families and Individuals","48786MO016",,"MON002","MOS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","48786MO0160002-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/missouri/","https://dentalexchange.guardianlife.com/our-plans/missouri/"
"2018","MO","48786","HIOS","2017-06-03 02:07:36","SHOP (Small Group)","Yes","13-5123390","48786MO0090005","Guardian Pediatric Advantage","48786MO009",,"MON001","MOS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available outside of the Service Area.","Yes",,"","48786MO0090005-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MO","48786","HIOS","2017-06-03 02:07:36","SHOP (Small Group)","Yes","13-5123390","48786MO0100005","Guardian Pediatric Essentials","48786MO010",,"MON001","MOS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available outside of the Service Area.","Yes",,"","48786MO0100005-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040015","Cigna Connect 4500","74483MO004","7730182962","MON002","MOS002","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040015-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-0-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040015","Cigna Connect 4500","74483MO004","7730182962","MON002","MOS002","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040015-03","Cigna Connect 4500-1","Limited Cost Sharing Plan Variation","66.68%","0.674919980452162","Yes","Yes","No","100%",,"$4,500","$40","$2,400","$10","$130","$900","$0","$200","$1,380","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4500-1-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-4500-1-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040015","Cigna Connect 4500","74483MO004","7730182962","MON002","MOS002","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040015-04","Cigna Connect 3000-2","73% AV Level Silver Plan","72.05%","0.726949661491049","Yes","Yes","No","100%",,"$3,000","$30","$2,700","$10","$130","$700","$0","$200","$1,380","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-3000-2-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-3000-2-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040015","Cigna Connect 4500","74483MO004","7730182962","MON002","MOS002","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040015-05","Cigna Connect 900-3","87% AV Level Silver Plan","86.05%","0.862673262454987","Yes","Yes","No","100%",,"$900","$20","$1,200","$10","$130","$500","$0","$200","$900","$300","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-900-3-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-900-3-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040015","Cigna Connect 4500","74483MO004","7730182962","MON002","MOS002","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040015-06","Cigna Connect 100-4","94% AV Level Silver Plan","93.09%","0.934746566967962","Yes","Yes","No","100%",,"$100","$10","$1,100","$10","$100","$400","$0","$200","$100","$200","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-100-4-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-100-4-kc-mo"
"2018","MO","48786","HIOS","2017-06-03 02:07:36","Individual","Yes","13-5123390","48786MO0160002","Guardian Essentials for Families and Individuals","48786MO016",,"MON002","MOS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","48786MO0160002-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/missouri/","https://dentalexchange.guardianlife.com/our-plans/missouri/"
"2018","MO","58883","HIOS","2017-08-10 02:20:26","Individual","Yes","59-0397210","58883MO0010003","DentaQuest PPO Family High","58883MO001",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58883MO0010003-01","DentaQuest PPO Family High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/mo/","http://www.dentaquest.com/marketplace/mo/"
"2018","MO","58883","HIOS","2017-08-10 02:20:26","Individual","Yes","59-0397210","58883MO0010004","DentaQuest PPO Family Low","58883MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58883MO0010004-00","DentaQuest PPO Family Low","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/mo/","http://www.dentaquest.com/marketplace/mo/"
"2018","MO","58883","HIOS","2017-08-10 02:20:26","Individual","Yes","59-0397210","58883MO0010004","DentaQuest PPO Family Low","58883MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58883MO0010004-01","DentaQuest PPO Family Low","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/mo/","http://www.dentaquest.com/marketplace/mo/"
"2018","MO","68265","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","68265MO0010007","Dentegra Dental PPO Pediatric Basic Plan","68265MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","68265MO0010007-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mo/68265mo0010007-18"
"2018","MO","68265","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","68265MO0010012","Dentegra Dental PPO Family Preferred Plan","68265MO001",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","68265MO0010012-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","$45 per person","per group not applicable",,,,,,"$45","$45 per person","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mo/68265mo0010012-18"
"2018","MO","68265","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","68265MO0010011","Dentegra Dental PPO Family Basic Plan","68265MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","68265MO0010011-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mo/68265mo0010011-18"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040018","Cigna Connect 1000","74483MO004","7730182962","MON002","MOS002","MOF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040018-01","Cigna Connect 1000","Standard Gold On Exchange Plan","78.14%","0.787871580002755","Yes","Yes","No","100%",,"$1,000","$30","$2,300","$10","$130","$700","$0","$200","$1,000","$400","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1000-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-1000-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040018","Cigna Connect 1000","74483MO004","7730182962","MON002","MOS002","MOF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040018-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-0-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040018","Cigna Connect 1000","74483MO004","7730182962","MON002","MOS002","MOF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040018-03","Cigna Connect 1000-1","Limited Cost Sharing Plan Variation","78.14%","0.787871580002755","Yes","Yes","No","100%",,"$1,000","$30","$2,300","$10","$130","$700","$0","$200","$1,000","$400","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1000-1-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-1000-1-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040004","Cigna Connect 4500","74483MO004","7730182962","MON001","MOS001","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-00","Cigna Connect 4500","Standard Silver Off Exchange Plan","66.68%","0.674919980452162","Yes","Yes","No","100%",,"$4,500","$40","$2,400","$10","$130","$900","$0","$200","$1,380","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4500-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-4500-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040004","Cigna Connect 4500","74483MO004","7730182962","MON001","MOS001","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-01","Cigna Connect 4500","Standard Silver On Exchange Plan","66.68%","0.674919980452162","Yes","Yes","No","100%",,"$4,500","$40","$2,400","$10","$130","$900","$0","$200","$1,380","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4500-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-4500-stl-mo"
"2018","MO","68396","HIOS","2017-05-18 02:20:21","SHOP (Small Group)","Yes","13-5581829","68396MO0190001","Family Basic Dental Plan (Low)","68396MO019",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.9","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","68396MO0190001-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MO","69783","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","69783MO0010001","DentaTrust-PPO Pediatric High Option","69783MO001","7083617077","MON001","MOS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69783MO0010001-00","DentaTrust-PPO Pediatric High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtmo.dentalcareplus.com","http://hixpbdtmo.dentalcareplus.com"
"2018","MO","69783","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","69783MO0020003","DentaSpan Family High Option","69783MO002","7083617077","MON001","MOS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69783MO0020003-00","DentaSpan Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsmo.dentalcareplus.com","http://hiopbdsmo.dentalcareplus.com"
"2018","MO","69783","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","69783MO0020003","DentaSpan Family High Option","69783MO002","7083617077","MON001","MOS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69783MO0020003-01","DentaSpan Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsmo.dentalcareplus.com","http://hixpbdsmo.dentalcareplus.com"
"2018","MO","69783","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","69783MO0010001","DentaTrust-PPO Pediatric High Option","69783MO001","7083617077","MON001","MOS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69783MO0010001-01","DentaTrust-PPO Pediatric High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtmo.dentalcareplus.com","http://hixpbdtmo.dentalcareplus.com"
"2018","MO","69783","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","69783MO0010002","DentaTrust-PPO Pediatric Low Option","69783MO001","7083617077","MON001","MOS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69783MO0010002-00","DentaTrust-PPO Pediatric Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtmo.dentalcareplus.com","http://hixpbdtmo.dentalcareplus.com"
"2018","MO","69783","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","69783MO0020004","DentaSpan Family Low Option","69783MO002","7083617077","MON001","MOS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69783MO0020004-00","DentaSpan Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsmo.dentalcareplus.com","http://hiopbdsmo.dentalcareplus.com"
"2018","MO","69783","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","69783MO0020004","DentaSpan Family Low Option","69783MO002","7083617077","MON001","MOS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69783MO0020004-01","DentaSpan Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsmo.dentalcareplus.com","http://hixpbdsmo.dentalcareplus.com"
"2018","MO","69783","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","69783MO0010002","DentaTrust-PPO Pediatric Low Option","69783MO001","7083617077","MON001","MOS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69783MO0010002-01","DentaTrust-PPO Pediatric Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtmo.dentalcareplus.com","http://hixpbdtmo.dentalcareplus.com"
"2018","MO","69783","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","69783MO0030003","DentaSpan Dental-Family High Option-Off Exchange","69783MO003","7083617077","MON001","MOS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69783MO0030003-00","DentaSpan Dental-Family High Option-Off Exchange","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsmo.dentalcareplus.com","http://hiopbdsmo.dentalcareplus.com"
"2018","MO","69783","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","69783MO0030004","DentaSpan Dental-Family Low Option-Off Exchange","69783MO003","7083617077","MON001","MOS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69783MO0030004-00","DentaSpan Dental-Family Low Option-Off Exchange","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsmo.dentalcareplus.com","http://hiopbdsmo.dentalcareplus.com"
"2018","MO","69783","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","69783MO0030001","DentaSpan Pediatric High Option- Off Exchange","69783MO003","7083617077","MON001","MOS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69783MO0030001-00","DentaSpan Pediatric High Option- Off Exchange","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsmo.dentalcareplus.com","http://hiopbdsmo.dentalcareplus.com"
"2018","MO","69783","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","69783MO0010003","DentaTrust-PPO Family High Option","69783MO001","7083617077","MON001","MOS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69783MO0010003-00","DentaTrust-PPO Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtmo.dentalcareplus.com","http://hixpbdtmo.dentalcareplus.com"
"2018","MO","69783","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","69783MO0010003","DentaTrust-PPO Family High Option","69783MO001","7083617077","MON001","MOS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69783MO0010003-01","DentaTrust-PPO Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtmo.dentalcareplus.com","http://hixpbdtmo.dentalcareplus.com"
"2018","MO","69783","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","69783MO0030002","DentaSpan Pediatric Low Option- Off Exchange","69783MO003","7083617077","MON001","MOS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69783MO0030002-00","DentaSpan Pediatric Low Option- Off Exchange","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsmo.dentalcareplus.com","http://hiopbdsmo.dentalcareplus.com"
"2018","MO","69783","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","69783MO0010004","DentaTrust-PPO Family Low Option","69783MO001","7083617077","MON001","MOS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69783MO0010004-00","DentaTrust-PPO Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtmo.dentalcareplus.com","http://hixpbdtmo.dentalcareplus.com"
"2018","MO","69783","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","69783MO0010004","DentaTrust-PPO Family Low Option","69783MO001","7083617077","MON001","MOS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69783MO0010004-01","DentaTrust-PPO Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtmo.dentalcareplus.com","http://hixpbdtmo.dentalcareplus.com"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040019","Cigna Connect 7000","74483MO004","7730182962","MON001","MOS001","MOF001","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040019-00","Cigna Connect 7000","Standard Bronze Off Exchange Plan",,"0.585881021017815","Yes","Yes","No","100%",,"$7,000","$0","$400","$10","$6,910","$0","$0","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-7000-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-7000-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","Yes","59-1031071","74483MO0030001","Cigna Dental Pediatric","74483MO003","7730182962","MON003","MOS003",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","74483MO0030001-00","Cigna Dental Pediatric","Standard Low Off Exchange Plan","69.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2018/sob/cigna-dental-pediatric-fedvip"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040019","Cigna Connect 7000","74483MO004","7730182962","MON001","MOS001","MOF001","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040019-01","Cigna Connect 7000","Standard Bronze On Exchange Plan",,"0.585881021017815","Yes","Yes","No","100%",,"$7,000","$0","$400","$10","$6,910","$0","$0","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-7000-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-7000-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040019","Cigna Connect 7000","74483MO004","7730182962","MON001","MOS001","MOF001","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040019-02","Cigna Connect-0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-0-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040019","Cigna Connect 7000","74483MO004","7730182962","MON001","MOS001","MOF001","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040019-03","Cigna Connect 7000-1","Limited Cost Sharing Plan Variation",,"0.585881021017815","Yes","Yes","No","100%",,"$7,000","$0","$400","$10","$6,910","$0","$0","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-7000-1-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-7000-1-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040022","Cigna Connect 7000","74483MO004","7730182962","MON002","MOS002","MOF001","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040022-00","Cigna Connect 7000","Standard Bronze Off Exchange Plan",,"0.585881021017815","Yes","Yes","No","100%",,"$7,000","$0","$400","$10","$6,910","$0","$0","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-7000-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-7000-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040022","Cigna Connect 7000","74483MO004","7730182962","MON002","MOS002","MOF001","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040022-01","Cigna Connect 7000","Standard Bronze On Exchange Plan",,"0.585881021017815","Yes","Yes","No","100%",,"$7,000","$0","$400","$10","$6,910","$0","$0","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-7000-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-7000-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040022","Cigna Connect 7000","74483MO004","7730182962","MON002","MOS002","MOF001","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040022-02","Cigna Connect-0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-0-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040022","Cigna Connect 7000","74483MO004","7730182962","MON002","MOS002","MOF001","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040022-03","Cigna Connect 7000-1","Limited Cost Sharing Plan Variation",,"0.585881021017815","Yes","Yes","No","100%",,"$7,000","$0","$400","$10","$6,910","$0","$0","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-7000-1-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-7000-1-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040008","Cigna Connect 1000","74483MO004","7730182962","MON001","MOS001","MOF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040008-00","Cigna Connect 1000","Standard Gold Off Exchange Plan","78.14%","0.787871580002755","Yes","Yes","No","100%",,"$1,000","$30","$2,300","$10","$130","$700","$0","$200","$1,000","$400","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1000-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-1000-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040008","Cigna Connect 1000","74483MO004","7730182962","MON001","MOS001","MOF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040008-01","Cigna Connect 1000","Standard Gold On Exchange Plan","78.14%","0.787871580002755","Yes","Yes","No","100%",,"$1,000","$30","$2,300","$10","$130","$700","$0","$200","$1,000","$400","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1000-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-1000-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040008","Cigna Connect 1000","74483MO004","7730182962","MON001","MOS001","MOF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040008-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-0-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040008","Cigna Connect 1000","74483MO004","7730182962","MON001","MOS001","MOF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040008-03","Cigna Connect 1000-1","Limited Cost Sharing Plan Variation","78.14%","0.787871580002755","Yes","Yes","No","100%",,"$1,000","$30","$2,300","$10","$130","$700","$0","$200","$1,000","$400","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1000-1-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-1000-1-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040018","Cigna Connect 1000","74483MO004","7730182962","MON002","MOS002","MOF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040018-00","Cigna Connect 1000","Standard Gold Off Exchange Plan","78.14%","0.787871580002755","Yes","Yes","No","100%",,"$1,000","$30","$2,300","$10","$130","$700","$0","$200","$1,000","$400","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1000-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-1000-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040004","Cigna Connect 4500","74483MO004","7730182962","MON001","MOS001","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-0-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040004","Cigna Connect 4500","74483MO004","7730182962","MON001","MOS001","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-03","Cigna Connect 4500-1","Limited Cost Sharing Plan Variation","66.68%","0.674919980452162","Yes","Yes","No","100%",,"$4,500","$40","$2,400","$10","$130","$900","$0","$200","$1,380","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4500-1-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-4500-1-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040004","Cigna Connect 4500","74483MO004","7730182962","MON001","MOS001","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-04","Cigna Connect 3000-2","73% AV Level Silver Plan","72.05%","0.726949661491049","Yes","Yes","No","100%",,"$3,000","$30","$2,700","$10","$130","$700","$0","$200","$1,380","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-3000-2-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-3000-2-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040004","Cigna Connect 4500","74483MO004","7730182962","MON001","MOS001","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-05","Cigna Connect 900-3","87% AV Level Silver Plan","86.05%","0.862673262454987","Yes","Yes","No","100%",,"$900","$20","$1,200","$10","$130","$500","$0","$200","$900","$300","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-900-3-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-900-3-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040004","Cigna Connect 4500","74483MO004","7730182962","MON001","MOS001","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-06","Cigna Connect 100-4","94% AV Level Silver Plan","93.09%","0.934746566967962","Yes","Yes","No","100%",,"$100","$10","$1,100","$10","$100","$400","$0","$200","$100","$200","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-100-4-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-100-4-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040015","Cigna Connect 4500","74483MO004","7730182962","MON002","MOS002","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040015-00","Cigna Connect 4500","Standard Silver Off Exchange Plan","66.68%","0.674919980452162","Yes","Yes","No","100%",,"$4,500","$40","$2,400","$10","$130","$900","$0","$200","$1,380","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4500-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-4500-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040015","Cigna Connect 4500","74483MO004","7730182962","MON002","MOS002","MOF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040015-01","Cigna Connect 4500","Standard Silver On Exchange Plan","66.68%","0.674919980452162","Yes","Yes","No","100%",,"$4,500","$40","$2,400","$10","$130","$900","$0","$200","$1,380","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4500-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-4500-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040005","Cigna Connect 3700","74483MO004","7730182962","MON001","MOS001","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-00","Cigna Connect 3700","Standard Silver Off Exchange Plan","69.60%","0.700435408369265","Yes","Yes","No","100%",,"$3,700","$40","$1,800","$10","$130","$900","$0","$200","$1,380","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-3700-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-3700-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040005","Cigna Connect 3700","74483MO004","7730182962","MON001","MOS001","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-01","Cigna Connect 3700","Standard Silver On Exchange Plan","69.60%","0.700435408369265","Yes","Yes","No","100%",,"$3,700","$40","$1,800","$10","$130","$900","$0","$200","$1,380","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-3700-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-3700-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040005","Cigna Connect 3700","74483MO004","7730182962","MON001","MOS001","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-0-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040005","Cigna Connect 3700","74483MO004","7730182962","MON001","MOS001","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-03","Cigna Connect 3700-1","Limited Cost Sharing Plan Variation","69.60%","0.700435408369265","Yes","Yes","No","100%",,"$3,700","$40","$1,800","$10","$130","$900","$0","$200","$1,380","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-3700-1-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-3700-1-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040005","Cigna Connect 3700","74483MO004","7730182962","MON001","MOS001","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-04","Cigna Connect 2700-2A","73% AV Level Silver Plan","73.02%","0.735038002312946","Yes","Yes","No","100%",,"$2,700","$40","$2,000","$10","$130","$900","$0","$200","$1,380","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-2700-2a-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-2700-2a-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040005","Cigna Connect 3700","74483MO004","7730182962","MON001","MOS001","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-05","Cigna Connect 600-3","87% AV Level Silver Plan","86.02%","0.865034980716355","Yes","Yes","No","100%",,"$600","$10","$1,800","$10","$130","$500","$0","$200","$600","$50","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-600-3-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-600-3-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040005","Cigna Connect 3700","74483MO004","7730182962","MON001","MOS001","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-06","Cigna Connect 50-4A","94% AV Level Silver Plan","93.16%","0.935628296189335","Yes","Yes","No","100%",,"$50","$20","$1,300","$10","$50","$400","$10","$200","$50","$40","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-50-4a-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-50-4a-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040016","Cigna Connect 3700","74483MO004","7730182962","MON002","MOS002","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040016-00","Cigna Connect 3700","Standard Silver Off Exchange Plan","69.60%","0.700435408369265","Yes","Yes","No","100%",,"$3,700","$40","$1,800","$10","$130","$900","$0","$200","$1,380","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-3700-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-3700-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040016","Cigna Connect 3700","74483MO004","7730182962","MON002","MOS002","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040016-01","Cigna Connect 3700","Standard Silver On Exchange Plan","69.60%","0.700435408369265","Yes","Yes","No","100%",,"$3,700","$40","$1,800","$10","$130","$900","$0","$200","$1,380","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-3700-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-3700-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040016","Cigna Connect 3700","74483MO004","7730182962","MON002","MOS002","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040016-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-0-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040016","Cigna Connect 3700","74483MO004","7730182962","MON002","MOS002","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040016-03","Cigna Connect 3700-1","Limited Cost Sharing Plan Variation","69.60%","0.700435408369265","Yes","Yes","No","100%",,"$3,700","$40","$1,800","$10","$130","$900","$0","$200","$1,380","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-3700-1-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-3700-1-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040016","Cigna Connect 3700","74483MO004","7730182962","MON002","MOS002","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040016-04","Cigna Connect 2700-2A","73% AV Level Silver Plan","73.02%","0.735038002312946","Yes","Yes","No","100%",,"$2,700","$40","$2,000","$10","$130","$900","$0","$200","$1,380","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-2700-2a-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-2700-2a-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040016","Cigna Connect 3700","74483MO004","7730182962","MON002","MOS002","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040016-05","Cigna Connect 600-3","87% AV Level Silver Plan","86.02%","0.865034980716355","Yes","Yes","No","100%",,"$600","$10","$1,800","$10","$130","$500","$0","$200","$600","$50","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-600-3-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-600-3-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040016","Cigna Connect 3700","74483MO004","7730182962","MON002","MOS002","MOF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040016-06","Cigna Connect 50-4A","94% AV Level Silver Plan","93.16%","0.935628296189335","Yes","Yes","No","100%",,"$50","$20","$1,300","$10","$50","$400","$10","$200","$50","$40","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-50-4a-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-50-4a-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040002","Cigna Connect 6650","74483MO004","7730182962","MON001","MOS001","MOF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040002-00","Cigna Connect 6650","Standard Bronze Off Exchange Plan","61.39%","0.626925297707575","Yes","Yes","No","100%",,"$6,650","$30","$700","$10","$650","$800","$0","$200","$1,380","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6650-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-6650-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040002","Cigna Connect 6650","74483MO004","7730182962","MON001","MOS001","MOF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040002-01","Cigna Connect 6650","Standard Bronze On Exchange Plan","61.39%","0.626925297707575","Yes","Yes","No","100%",,"$6,650","$30","$700","$10","$650","$800","$0","$200","$1,380","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6650-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-6650-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040002","Cigna Connect 6650","74483MO004","7730182962","MON001","MOS001","MOF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040002-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-0-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040002","Cigna Connect 6650","74483MO004","7730182962","MON001","MOS001","MOF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040002-03","Cigna Connect 6650-1","Limited Cost Sharing Plan Variation","61.39%","0.626925297707575","Yes","Yes","No","100%",,"$6,650","$30","$700","$10","$650","$800","$0","$200","$1,380","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6650-1-stl-mo","http://www.cigna.com/2018/sob/cigna-connect-6650-1-stl-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040012","Cigna Connect 6650","74483MO004","7730182962","MON002","MOS002","MOF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040012-00","Cigna Connect 6650","Standard Bronze Off Exchange Plan","61.39%","0.626925297707575","Yes","Yes","No","100%",,"$6,650","$30","$700","$10","$650","$800","$0","$200","$1,380","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6650-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-6650-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040012","Cigna Connect 6650","74483MO004","7730182962","MON002","MOS002","MOF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040012-01","Cigna Connect 6650","Standard Bronze On Exchange Plan","61.39%","0.626925297707575","Yes","Yes","No","100%",,"$6,650","$30","$700","$10","$650","$800","$0","$200","$1,380","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6650-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-6650-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040012","Cigna Connect 6650","74483MO004","7730182962","MON002","MOS002","MOF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040012-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-0-kc-mo"
"2018","MO","74483","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","74483MO0040012","Cigna Connect 6650","74483MO004","7730182962","MON002","MOS002","MOF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040012-03","Cigna Connect 6650-1","Limited Cost Sharing Plan Variation","61.39%","0.626925297707575","Yes","Yes","No","100%",,"$6,650","$30","$700","$10","$650","$800","$0","$200","$1,380","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6650-1-kc-mo","http://www.cigna.com/2018/sob/cigna-connect-6650-1-kc-mo"
"2018","MO","82905","HIOS","2017-09-22 02:20:26","Individual","Yes","36-3757528","82905MO0010001","TruAssure Basic Adult or Child Dental Plan","82905MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82905MO0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$105","$105 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MO","https://www.truassure.com/brochure?state=MO"
"2018","MO","82905","HIOS","2017-09-22 02:20:26","SHOP (Small Group)","Yes","36-3757528","82905MO0030001","TruAssure Dental Small Group Basic Plan","82905MO003",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","82905MO0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MO","82905","HIOS","2017-09-22 02:20:26","SHOP (Small Group)","Yes","36-3757528","82905MO0040001","TruAssure Dental Small Group Preferred Plan","82905MO004",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","82905MO0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MO","82905","HIOS","2017-09-22 02:20:26","Individual","Yes","36-3757528","82905MO0010001","TruAssure Basic Adult or Child Dental Plan","82905MO001",,"MON001","MOS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82905MO0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$105","$105 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MO","https://www.truassure.com/brochure?state=MO"
"2018","MO","82905","HIOS","2017-09-22 02:20:26","Individual","Yes","36-3757528","82905MO0020001","TruAssure Preferred Adult or Child Dental Plan","82905MO002",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82905MO0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MO","https://www.truassure.com/brochure?state=MO"
"2018","MO","82905","HIOS","2017-09-22 02:20:26","Individual","Yes","36-3757528","82905MO0020001","TruAssure Preferred Adult or Child Dental Plan","82905MO002",,"MON001","MOS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82905MO0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MO","https://www.truassure.com/brochure?state=MO"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090001","Ambetter Essential Care 1 (2018)","99723MO009",,"MON001","MOS001","MOF001","New","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090001-00","Ambetter Essential Care 1 (2018)","Standard Bronze Off Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090001-00.pdf","https://api.centene.com/Brochures/2018/99723MO0090001-00.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090001","Ambetter Essential Care 1 (2018)","99723MO009",,"MON001","MOS001","MOF001","New","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090001-01","Ambetter Essential Care 1 (2018)","Standard Bronze On Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090001-01.pdf","https://api.centene.com/Brochures/2018/99723MO0090001-01.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090001","Ambetter Essential Care 1 (2018)","99723MO009",,"MON001","MOS001","MOF001","New","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090001-02","Ambetter Essential Care 1 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090001-02.pdf","https://api.centene.com/Brochures/2018/99723MO0090001-02.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090001","Ambetter Essential Care 1 (2018)","99723MO009",,"MON001","MOS001","MOF001","New","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090001-03","Ambetter Essential Care 1 (2018)","Limited Cost Sharing Plan Variation",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090001-03.pdf","https://api.centene.com/Brochures/2018/99723MO0090001-03.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090002","Ambetter Balanced Care 1 (2018)","99723MO009",,"MON001","MOS001","MOF002","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090002-00","Ambetter Balanced Care 1 (2018)","Standard Silver Off Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090002-00.pdf","https://api.centene.com/Brochures/2018/99723MO0090002-00.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090002","Ambetter Balanced Care 1 (2018)","99723MO009",,"MON001","MOS001","MOF002","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090002-01","Ambetter Balanced Care 1 (2018)","Standard Silver On Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090002-01.pdf","https://api.centene.com/Brochures/2018/99723MO0090002-01.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090002","Ambetter Balanced Care 1 (2018)","99723MO009",,"MON001","MOS001","MOF002","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090002-02","Ambetter Balanced Care 1 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090002-02.pdf","https://api.centene.com/Brochures/2018/99723MO0090002-02.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090002","Ambetter Balanced Care 1 (2018)","99723MO009",,"MON001","MOS001","MOF002","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090002-03","Ambetter Balanced Care 1 (2018)","Limited Cost Sharing Plan Variation",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090002-03.pdf","https://api.centene.com/Brochures/2018/99723MO0090002-03.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090002","Ambetter Balanced Care 1 (2018)","99723MO009",,"MON001","MOS001","MOF002","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090002-04","Ambetter Balanced Care 1 (2018)","73% AV Level Silver Plan",,"0.739812128349422","Yes","Yes","No","100%",,"$3,000","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090002-04.pdf","https://api.centene.com/Brochures/2018/99723MO0090002-04.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090002","Ambetter Balanced Care 1 (2018)","99723MO009",,"MON001","MOS001","MOF002","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090002-05","Ambetter Balanced Care 1 (2018)","87% AV Level Silver Plan",,"0.87931537568396","Yes","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$300","$400","$60","$750","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090002-05.pdf","https://api.centene.com/Brochures/2018/99723MO0090002-05.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090002","Ambetter Balanced Care 1 (2018)","99723MO009",,"MON001","MOS001","MOF002","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090002-06","Ambetter Balanced Care 1 (2018)","94% AV Level Silver Plan",,"0.949528260595198","Yes","Yes","No","100%",,"$0","$0","$950","$60","$0","$300","$400","$60","$0","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090002-06.pdf","https://api.centene.com/Brochures/2018/99723MO0090002-06.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090003","Ambetter Balanced Care 3 (2018)","99723MO009",,"MON001","MOS001","MOF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090003-00","Ambetter Balanced Care 3 (2018)","Standard Silver Off Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090003-00.pdf","https://api.centene.com/Brochures/2018/99723MO0090003-00.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090003","Ambetter Balanced Care 3 (2018)","99723MO009",,"MON001","MOS001","MOF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090003-01","Ambetter Balanced Care 3 (2018)","Standard Silver On Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090003-01.pdf","https://api.centene.com/Brochures/2018/99723MO0090003-01.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090003","Ambetter Balanced Care 3 (2018)","99723MO009",,"MON001","MOS001","MOF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090003-02","Ambetter Balanced Care 3 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090003-02.pdf","https://api.centene.com/Brochures/2018/99723MO0090003-02.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090003","Ambetter Balanced Care 3 (2018)","99723MO009",,"MON001","MOS001","MOF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090003-03","Ambetter Balanced Care 3 (2018)","Limited Cost Sharing Plan Variation",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090003-03.pdf","https://api.centene.com/Brochures/2018/99723MO0090003-03.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090003","Ambetter Balanced Care 3 (2018)","99723MO009",,"MON001","MOS001","MOF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090003-04","Ambetter Balanced Care 3 (2018)","73% AV Level Silver Plan",,"0.739635889295605","Yes","Yes","No","100%",,"$1,950","$1,300","$300","$60","$1,300","$1,700","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090003-04.pdf","https://api.centene.com/Brochures/2018/99723MO0090003-04.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090003","Ambetter Balanced Care 3 (2018)","99723MO009",,"MON001","MOS001","MOF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090003-05","Ambetter Balanced Care 3 (2018)","87% AV Level Silver Plan",,"0.879959544313859","Yes","Yes","No","100%",,"$675","$200","$300","$60","$675","$300","$600","$60","$675","$20","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090003-05.pdf","https://api.centene.com/Brochures/2018/99723MO0090003-05.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090003","Ambetter Balanced Care 3 (2018)","99723MO009",,"MON001","MOS001","MOF003","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090003-06","Ambetter Balanced Care 3 (2018)","94% AV Level Silver Plan",,"0.949879112635725","Yes","Yes","No","100%",,"$200","$90","$300","$60","$200","$200","$200","$60","$200","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090003-06.pdf","https://api.centene.com/Brochures/2018/99723MO0090003-06.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090004","Ambetter Balanced Care 4 (2018)","99723MO009",,"MON001","MOS001","MOF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090004-00","Ambetter Balanced Care 4 (2018)","Standard Silver Off Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090004-00.pdf","https://api.centene.com/Brochures/2018/99723MO0090004-00.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090004","Ambetter Balanced Care 4 (2018)","99723MO009",,"MON001","MOS001","MOF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090004-01","Ambetter Balanced Care 4 (2018)","Standard Silver On Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090004-01.pdf","https://api.centene.com/Brochures/2018/99723MO0090004-01.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090004","Ambetter Balanced Care 4 (2018)","99723MO009",,"MON001","MOS001","MOF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090004-02","Ambetter Balanced Care 4 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090004-02.pdf","https://api.centene.com/Brochures/2018/99723MO0090004-02.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090004","Ambetter Balanced Care 4 (2018)","99723MO009",,"MON001","MOS001","MOF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090004-03","Ambetter Balanced Care 4 (2018)","Limited Cost Sharing Plan Variation",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090004-03.pdf","https://api.centene.com/Brochures/2018/99723MO0090004-03.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090004","Ambetter Balanced Care 4 (2018)","99723MO009",,"MON001","MOS001","MOF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090004-04","Ambetter Balanced Care 4 (2018)","73% AV Level Silver Plan",,"0.727430168333116","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$1,800","$1,300","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090004-04.pdf","https://api.centene.com/Brochures/2018/99723MO0090004-04.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090004","Ambetter Balanced Care 4 (2018)","99723MO009",,"MON001","MOS001","MOF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090004-05","Ambetter Balanced Care 4 (2018)","87% AV Level Silver Plan",,"0.863154651499334","Yes","Yes","No","100%",,"$1,850","$0","$0","$60","$1,850","$0","$0","$60","$1,630","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090004-05.pdf","https://api.centene.com/Brochures/2018/99723MO0090004-05.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090004","Ambetter Balanced Care 4 (2018)","99723MO009",,"MON001","MOS001","MOF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090004-06","Ambetter Balanced Care 4 (2018)","94% AV Level Silver Plan",,"0.940719200046497","Yes","Yes","No","100%",,"$600","$0","$0","$60","$600","$0","$0","$60","$600","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/99723MO0090004-06.pdf","https://api.centene.com/Brochures/2018/99723MO0090004-06.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090005","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","99723MO009",,"MON001","MOS001","MOF005","New","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090005-00","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/99723MO0090005-00.pdf","https://api.centene.com/Brochures/2018/99723MO0090005-00.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090005","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","99723MO009",,"MON001","MOS001","MOF005","New","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090005-01","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/99723MO0090005-01.pdf","https://api.centene.com/Brochures/2018/99723MO0090005-01.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090005","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","99723MO009",,"MON001","MOS001","MOF005","New","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090005-02","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/99723MO0090005-02.pdf","https://api.centene.com/Brochures/2018/99723MO0090005-02.pdf"
"2018","MO","99723","HIOS","2017-11-04 03:16:05","Individual","No","06-0641618","99723MO0090005","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","99723MO009",,"MON001","MOS001","MOF005","New","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.homestatehealth.com/payments","http://ambetter.homestatehealth.com/resources/pharmacy-resources.html","99723MO0090005-03","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/99723MO0090005-03.pdf","https://api.centene.com/Brochures/2018/99723MO0090005-03.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","Yes","95-6042390","11324MS0010007","BESTDental Premium","11324MS001",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0010007-00","BESTDental Premium","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2017/MS_BESTDental_Premium_Plan.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","Individual","Yes","95-6042390","11324MS0020003","BESTOne Advantage Gold","11324MS002",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MS/2017/MS_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","Individual","Yes","95-6042390","11324MS0020003","BESTOne Advantage Gold","11324MS002",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MS/2017/MS_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","Yes","95-6042390","11324MS0010007","BESTDental Premium","11324MS001",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0010007-01","BESTDental Premium","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2017/MS_BESTDental_Premium_Plan.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","Yes","95-6042390","11324MS0010008","BESTDental Standard - H","11324MS001",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2017/MS_BESTDental_Standard-H_Plan.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","Individual","Yes","95-6042390","11324MS0020004","BESTOne Plus Gold","11324MS002",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MS/2017/MS_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","Individual","Yes","95-6042390","11324MS0020004","BESTOne Plus Gold","11324MS002",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MS/2017/MS_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","Yes","95-6042390","11324MS0010008","BESTDental Standard - H","11324MS001",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2017/MS_BESTDental_Standard-H_Plan.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","Yes","95-6042390","11324MS0010010","BESTDental Choice - H","11324MS001",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2017/MS_BESTDental_Choice-H_Plan.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","Yes","95-6042390","11324MS0010010","BESTDental Choice - H","11324MS001",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2017/MS_BESTDental_Choice-H_Plan.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","Yes","95-6042390","11324MS0010009","BESTDental Standard - L","11324MS001",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2017/MS_BESTDental_Standard-L_Plan.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","Individual","Yes","95-6042390","11324MS0020005","BESTOne Plus Silver","11324MS002",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/MS/2017/MS_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","Individual","Yes","95-6042390","11324MS0020005","BESTOne Plus Silver","11324MS002",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/MS/2017/MS_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","Yes","95-6042390","11324MS0010009","BESTDental Standard - L","11324MS001",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2017/MS_BESTDental_Standard-L_Plan.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","Yes","95-6042390","11324MS0010011","BESTDental Choice - L","11324MS001",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2017/MS_BESTDental_Choice-L_Plan.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","Individual","Yes","95-6042390","11324MS0020006","BESTOne Basic Silver","11324MS002",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/MS/2017/MS_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","Individual","Yes","95-6042390","11324MS0020006","BESTOne Basic Silver","11324MS002",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/MS/2017/MS_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","Yes","95-6042390","11324MS0010011","BESTDental Choice - L","11324MS001",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2017/MS_BESTDental_Choice-L_Plan.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","Yes","95-6042390","11324MS0010012","BESTDental Value","11324MS001",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2017/MS_BESTDental_Value_Plan.pdf"
"2018","MS","11324","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","Yes","95-6042390","11324MS0010012","BESTDental Value","11324MS001",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2017/MS_BESTDental_Value_Plan.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2018)","90714MS001",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010003-03","Ambetter Balanced Care 2 (2018)","Limited Cost Sharing Plan Variation",,"0.680910265893456","Yes","Yes","No","100%",,"$6,600","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0010003-03.pdf","https://api.centene.com/Brochures/2018/90714MS0010003-03.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2018)","90714MS001",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010003-04","Ambetter Balanced Care 2 (2018)","73% AV Level Silver Plan",,"0.729896135538709","Yes","Yes","No","100%",,"$4,600","$400","$0","$60","$1,900","$1,400","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0010003-04.pdf","https://api.centene.com/Brochures/2018/90714MS0010003-04.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010052","Ambetter Essential Care 2 HSA (2018)","90714MS001",,"MSN001","MSS001","MSF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010052-03","Ambetter Essential Care 2 HSA (2018)","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://api.centene.com/SBC/2018/90714MS0010052-03.pdf","https://api.centene.com/Brochures/2018/90714MS0010052-03.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","90714MS001",,"MSN001","MSS001","MSF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010001-00","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/90714MS0010001-00.pdf","https://api.centene.com/Brochures/2018/90714MS0010001-00.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","90714MS001",,"MSN001","MSS001","MSF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010001-01","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/90714MS0010001-01.pdf","https://api.centene.com/Brochures/2018/90714MS0010001-01.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","90714MS001",,"MSN001","MSS001","MSF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010001-02","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/90714MS0010001-02.pdf","https://api.centene.com/Brochures/2018/90714MS0010001-02.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","90714MS001",,"MSN001","MSS001","MSF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010001-03","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/90714MS0010001-03.pdf","https://api.centene.com/Brochures/2018/90714MS0010001-03.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2018)","90714MS001",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010003-00","Ambetter Balanced Care 2 (2018)","Standard Silver Off Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$6,600","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0010003-00.pdf","https://api.centene.com/Brochures/2018/90714MS0010003-00.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2018)","90714MS001",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010003-01","Ambetter Balanced Care 2 (2018)","Standard Silver On Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$6,600","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0010003-01.pdf","https://api.centene.com/Brochures/2018/90714MS0010003-01.pdf"
"2018","MS","48963","HIOS","2017-06-22 02:20:27","Individual","Yes","39-1263473","48963MS0510001","Humana Dental Smart Choice","48963MS051",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.973","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","48963MS0510001-00","Humana Dental Smart Choice","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110380"
"2018","MS","48963","HIOS","2017-06-22 02:20:27","Individual","Yes","39-1263473","48963MS0510001","Humana Dental Smart Choice","48963MS051",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.973","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","48963MS0510001-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110380"
"2018","MS","49374","HIOS","2017-08-11 02:20:28","Individual","Yes","94-2761537","49374MS0010002","Delta Dental PPO Pediatric Preferred Plan","49374MS001",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","49374MS0010002-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ms/49374ms0010002-18"
"2018","MS","49374","HIOS","2017-08-11 02:20:28","Individual","Yes","94-2761537","49374MS0010001","Delta Dental PPO Pediatric Basic Plan","49374MS001",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","49374MS0010001-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ms/49374ms0010001-18"
"2018","MS","49374","HIOS","2017-08-11 02:20:28","Individual","Yes","94-2761537","49374MS0010006","Delta Dental PPO Basic Plan for Families","49374MS001",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","49374MS0010006-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ms/49374ms0010006-18"
"2018","MS","49374","HIOS","2017-08-11 02:20:28","Individual","Yes","94-2761537","49374MS0010004","Delta Dental PPO Preferred Plan for Families","49374MS001",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","49374MS0010004-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ms/49374ms0010004-18"
"2018","MS","74718","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","74718MS0010001","TruAssure Basic Adult or Child Dental Plan","74718MS001",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits`","Yes","https://www.truassure.com/payment","","74718MS0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","69.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MS","https://www.truassure.com/brochure?state=MS"
"2018","MS","74718","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","74718MS0010001","TruAssure Basic Adult or Child Dental Plan","74718MS001",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits`","Yes","https://www.truassure.com/payment","","74718MS0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","69.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MS","https://www.truassure.com/brochure?state=MS"
"2018","MS","74718","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","74718MS0020001","TruAssure Preferred Adult or Child Dental Plan","74718MS002",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74718MS0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MS","https://www.truassure.com/brochure?state=MS"
"2018","MS","74718","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","74718MS0020001","TruAssure Preferred Adult or Child Dental Plan","74718MS002",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74718MS0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MS","https://www.truassure.com/brochure?state=MS"
"2018","MS","84254","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","84254MS0020003","Renaissance Individual Dental PPO, EHB Certified","84254MS002",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","84254MS0020003-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MS","84254","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","84254MS0020004","Renaissance Individual Dental PPO, EHB Certified","84254MS002",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","84254MS0020004-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MS","84254","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","84254MS0050001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","84254MS005",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/84254","","84254MS0050001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/MS_EHB_High_2018","http://www.renaissancedental.com/MS_EHB_High_2018"
"2018","MS","84254","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","84254MS0050002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","84254MS005",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/84254","","84254MS0050002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/MS_EHB_Low_2018","http://www.renaissancedental.com/MS_EHB_Low_2018"
"2018","MS","84254","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","84254MS0070001","Renaissance Individual Dental Pediatric-Only, EHB Certified","84254MS007",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","84254MS0070001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MS","84254","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","84254MS0070002","Renaissance Individual Dental Pediatric-Only, EHB Certified","84254MS007",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","84254MS0070002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MS","84254","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","84254MS0060001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","84254MS006",,"MSN001","MSS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/84254","","84254MS0060001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/MS_Ped_High_2018","http://www.renaissancedental.com/MS_Ped_High_2018"
"2018","MS","84254","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","84254MS0060002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","84254MS006",,"MSN001","MSS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/84254","","84254MS0060002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/MS_Ped_Low_2018","http://www.renaissancedental.com/MS_Ped_Low_2018"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010052","Ambetter Essential Care 2 HSA (2018)","90714MS001",,"MSN001","MSS001","MSF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010052-00","Ambetter Essential Care 2 HSA (2018)","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://api.centene.com/SBC/2018/90714MS0010052-00.pdf","https://api.centene.com/Brochures/2018/90714MS0010052-00.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010052","Ambetter Essential Care 2 HSA (2018)","90714MS001",,"MSN001","MSS001","MSF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010052-01","Ambetter Essential Care 2 HSA (2018)","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://api.centene.com/SBC/2018/90714MS0010052-01.pdf","https://api.centene.com/Brochures/2018/90714MS0010052-01.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010052","Ambetter Essential Care 2 HSA (2018)","90714MS001",,"MSN001","MSS001","MSF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010052-02","Ambetter Essential Care 2 HSA (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0010052-02.pdf","https://api.centene.com/Brochures/2018/90714MS0010052-02.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2018)","90714MS001",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010003-02","Ambetter Balanced Care 2 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0010003-02.pdf","https://api.centene.com/Brochures/2018/90714MS0010003-02.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2018)","90714MS001",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010003-05","Ambetter Balanced Care 2 (2018)","87% AV Level Silver Plan",,"0.867181007012531","Yes","Yes","No","100%",,"$1,700","$10","$0","$60","$1,500","$250","$0","$60","$1,600","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0010003-05.pdf","https://api.centene.com/Brochures/2018/90714MS0010003-05.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2018)","90714MS001",,"MSN001","MSS001","MSF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010003-06","Ambetter Balanced Care 2 (2018)","94% AV Level Silver Plan",,"0.942313720589882","Yes","Yes","No","100%",,"$572","$3","$0","$60","$500","$70","$0","$60","$575","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0010003-06.pdf","https://api.centene.com/Brochures/2018/90714MS0010003-06.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010008","Ambetter Balanced Care 3 (2018)","90714MS001",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010008-00","Ambetter Balanced Care 3 (2018)","Standard Silver Off Exchange Plan",,"0.71965401609266","Yes","Yes","No","100%",,"$2,350","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0010008-00.pdf","https://api.centene.com/Brochures/2018/90714MS0010008-00.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010008","Ambetter Balanced Care 3 (2018)","90714MS001",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010008-01","Ambetter Balanced Care 3 (2018)","Standard Silver On Exchange Plan",,"0.71965401609266","Yes","Yes","No","100%",,"$2,350","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0010008-01.pdf","https://api.centene.com/Brochures/2018/90714MS0010008-01.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010008","Ambetter Balanced Care 3 (2018)","90714MS001",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010008-02","Ambetter Balanced Care 3 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0010008-02.pdf","https://api.centene.com/Brochures/2018/90714MS0010008-02.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010008","Ambetter Balanced Care 3 (2018)","90714MS001",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010008-03","Ambetter Balanced Care 3 (2018)","Limited Cost Sharing Plan Variation",,"0.71965401609266","Yes","Yes","No","100%",,"$2,350","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0010008-03.pdf","https://api.centene.com/Brochures/2018/90714MS0010008-03.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010008","Ambetter Balanced Care 3 (2018)","90714MS001",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010008-04","Ambetter Balanced Care 3 (2018)","73% AV Level Silver Plan",,"0.739984676325012","Yes","Yes","No","100%",,"$1,950","$1,300","$300","$60","$1,300","$1,700","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0010008-04.pdf","https://api.centene.com/Brochures/2018/90714MS0010008-04.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010008","Ambetter Balanced Care 3 (2018)","90714MS001",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010008-05","Ambetter Balanced Care 3 (2018)","87% AV Level Silver Plan",,"0.879959544313859","Yes","Yes","No","100%",,"$675","$200","$300","$60","$675","$300","$600","$60","$675","$20","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0010008-05.pdf","https://api.centene.com/Brochures/2018/90714MS0010008-05.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0010008","Ambetter Balanced Care 3 (2018)","90714MS001",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0010008-06","Ambetter Balanced Care 3 (2018)","94% AV Level Silver Plan",,"0.949879112635725","Yes","Yes","No","100%",,"$200","$90","$300","$60","$200","$200","$200","$60","$200","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0010008-06.pdf","https://api.centene.com/Brochures/2018/90714MS0010008-06.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0030006","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9561",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0030006-00","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.71965401609266","Yes","Yes","No","100%",,"$2,350","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0030006-00.pdf","https://api.centene.com/Brochures/2018/90714MS0030006-00.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0030006","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9561",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0030006-01","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.71965401609266","Yes","Yes","No","100%",,"$2,350","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0030006-01.pdf","https://api.centene.com/Brochures/2018/90714MS0030006-01.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0030006","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9561",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0030006-02","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0030006-02.pdf","https://api.centene.com/Brochures/2018/90714MS0030006-02.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0030006","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9561",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0030006-03","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.71965401609266","Yes","Yes","No","100%",,"$2,350","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0030006-03.pdf","https://api.centene.com/Brochures/2018/90714MS0030006-03.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0030006","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9561",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0030006-04","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.739984676325012","Yes","Yes","No","100%",,"$1,950","$1,300","$300","$60","$1,300","$1,700","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0030006-04.pdf","https://api.centene.com/Brochures/2018/90714MS0030006-04.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0030006","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9561",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0030006-05","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.879959544313859","Yes","Yes","No","100%",,"$675","$200","$300","$60","$675","$300","$600","$60","$675","$20","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0030006-05.pdf","https://api.centene.com/Brochures/2018/90714MS0030006-05.pdf"
"2018","MS","90714","HIOS","2017-09-22 02:20:26","Individual","No","35-2525384","90714MS0030006","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9561",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","https://ambetter.magnoliahealthplan.com/resources/pharmacy-resources.html","90714MS0030006-06","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949879112635725","Yes","Yes","No","100%",,"$200","$90","$300","$60","$200","$200","$200","$60","$200","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/90714MS0030006-06.pdf","https://api.centene.com/Brochures/2018/90714MS0030006-06.pdf"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060018","Blue Advantage 2500 (broad network)","11512NC006",,"NCN001","NCS017","NCF004","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060018-00","Blue Advantage 2500 (broad network)","Standard Gold Off Exchange Plan",,"0.775197716450845","No","Yes","No","100%",,"$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_2500_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060018","Blue Advantage 2500 (broad network)","11512NC006",,"NCN001","NCS017","NCF004","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060018-01","Blue Advantage 2500 (broad network)","Standard Gold On Exchange Plan",,"0.775197716450845","No","Yes","No","100%",,"$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_2500_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060018","Blue Advantage 2500 (broad network)","11512NC006",,"NCN001","NCS017","NCF004","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060018-02","Blue Advantage 2500 (broad network)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_100_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060018","Blue Advantage 2500 (broad network)","11512NC006",,"NCN001","NCS017","NCF004","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060018-03","Blue Advantage 2500 (broad network)","Limited Cost Sharing Plan Variation",,"0.775197716450845","No","Yes","No","100%",,"$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_2500_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060020","Blue Advantage 4000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060020-00","Blue Advantage 4000 (broad network)","Standard Silver Off Exchange Plan",,"0.718064643847287","No","Yes","No","100%",,"$4,000","$30","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_4000_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060020","Blue Advantage 4000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060020-01","Blue Advantage 4000 (broad network)","Standard Silver On Exchange Plan",,"0.718064643847287","No","Yes","No","100%",,"$4,000","$30","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_4000_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060020","Blue Advantage 4000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060020-02","Blue Advantage 4000 (broad network)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_100_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060020","Blue Advantage 4000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060020-03","Blue Advantage 4000 (broad network)","Limited Cost Sharing Plan Variation",,"0.718064643847287","No","Yes","No","100%",,"$4,000","$30","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_4000_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060020","Blue Advantage 4000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060020-04","Blue Advantage 4000 (broad network)","73% AV Level Silver Plan",,"0.739094469641127","No","Yes","No","100%",,"$3,600","$0","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$11,700","$11700 per person","$23400 per group","$17,550","$17550 per person","$35100 per group","$3,600","$3600 per person","$7200 per group","30.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_3600_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060020","Blue Advantage 4000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060020-05","Blue Advantage 4000 (broad network)","87% AV Level Silver Plan",,"0.873897827171341","No","Yes","No","100%",,"$600","$0","$2,400","$60","$600","$200","$500","$60","$600","$60","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$4,900","$4900 per person","$9800 per group","$7,350","$7350 per person","$14700 per group","$600","$600 per person","$1200 per group","30.00%",,,,,"$1,200","$1200 per person","$2400 per group","$1,800","$1800 per person","$3600 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_600_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060020","Blue Advantage 4000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060020-06","Blue Advantage 4000 (broad network)","94% AV Level Silver Plan",,"0.939007913764171","No","Yes","No","100%",,"$300","$0","$800","$60","$300","$80","$300","$60","$300","$60","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$1,400","$1400 per person","$2800 per group","$2,100","$2100 per person","$4200 per group","$300","$300 per person","$600 per group","30.00%",,,,,"$600","$600 per person","$1200 per group","$900","$900 per person","$1800 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_300_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060028","Blue Advantage 7000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060028-00","Blue Advantage 7000 (broad network)","Standard Silver Off Exchange Plan",,"0.663928788449717","No","Yes","No","100%",,"$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","$400","$400 per person","per group not applicable","30.00%",,,,,"$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_7000_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060028","Blue Advantage 7000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060028-01","Blue Advantage 7000 (broad network)","Standard Silver On Exchange Plan",,"0.663928788449717","No","Yes","No","100%",,"$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","$400","$400 per person","per group not applicable","30.00%",,,,,"$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_7000_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060028","Blue Advantage 7000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060028-02","Blue Advantage 7000 (broad network)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_100_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060028","Blue Advantage 7000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060028-03","Blue Advantage 7000 (broad network)","Limited Cost Sharing Plan Variation",,"0.663928788449717","No","Yes","No","100%",,"$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","$400","$400 per person","per group not applicable","30.00%",,,,,"$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_7000_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060028","Blue Advantage 7000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060028-04","Blue Advantage 7000 (broad network)","73% AV Level Silver Plan",,"0.735345670401859","No","Yes","No","100%",,"$3,900","$0","$2,000","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$11,700","$11700 per person","$23400 per group","$17,550","$17550 per person","$35100 per group","$3,900","$3900 per person","$7800 per group","30.00%",,,,,"$7,800","$7800 per person","$15600 per group","$11,700","$11700 per person","$23400 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_3900_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060028","Blue Advantage 7000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060028-05","Blue Advantage 7000 (broad network)","87% AV Level Silver Plan",,"0.867671087038711","No","Yes","No","100%",,"$800","$0","$2,200","$60","$800","$200","$500","$60","$800","$60","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$4,900","$4900 per person","$9800 per group","$7,350","$7350 per person","$14700 per group","$800","$800 per person","$1600 per group","30.00%",,,,,"$1,600","$1600 per person","$3200 per group","$2,400","$2400 per person","$4800 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_800_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060028","Blue Advantage 7000 (broad network)","11512NC006",,"NCN001","NCS017","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060028-06","Blue Advantage 7000 (broad network)","94% AV Level Silver Plan",,"0.931976889291764","No","Yes","No","100%",,"$400","$0","$800","$60","$400","$80","$300","$60","$400","$60","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$1,600","$1600 per person","$3200 per group","$2,400","$2400 per person","$4800 per group","$400","$400 per person","$800 per group","30.00%",,,,,"$800","$800 per person","$1600 per group","$1,200","$1200 per person","$2400 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_400_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100022","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS025","NCF004","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100022-00","Blue Value 2500 (limited network)","Standard Gold Off Exchange Plan",,"0.775197716450845","No","Yes","No","100%",,"$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_2500_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100022","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS025","NCF004","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100022-01","Blue Value 2500 (limited network)","Standard Gold On Exchange Plan",,"0.775197716450845","No","Yes","No","100%",,"$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_2500_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100022","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS025","NCF004","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100022-02","Blue Value 2500 (limited network)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100022","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS025","NCF004","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100022-03","Blue Value 2500 (limited network)","Limited Cost Sharing Plan Variation",,"0.775197716450845","No","Yes","No","100%",,"$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_2500_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100024","Blue Value 4000 (limited network)","11512NC010",,"NCN002","NCS025","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100024-00","Blue Value 4000 (limited network)","Standard Silver Off Exchange Plan",,"0.718064643847287","No","Yes","No","100%",,"$4,000","$30","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$16,000","$16000 per person","$32000 per group","$20,000","$20000 per person","$40000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_4000_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100024","Blue Value 4000 (limited network)","11512NC010",,"NCN002","NCS025","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100024-01","Blue Value 4000 (limited network)","Standard Silver On Exchange Plan",,"0.718064643847287","No","Yes","No","100%",,"$4,000","$30","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$16,000","$16000 per person","$32000 per group","$20,000","$20000 per person","$40000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_4000_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100024","Blue Value 4000 (limited network)","11512NC010",,"NCN002","NCS025","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100024-02","Blue Value 4000 (limited network)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100024","Blue Value 4000 (limited network)","11512NC010",,"NCN002","NCS025","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100024-03","Blue Value 4000 (limited network)","Limited Cost Sharing Plan Variation",,"0.718064643847287","No","Yes","No","100%",,"$4,000","$30","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$16,000","$16000 per person","$32000 per group","$20,000","$20000 per person","$40000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_4000_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100024","Blue Value 4000 (limited network)","11512NC010",,"NCN002","NCS025","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100024-04","Blue Value 4000 (limited network)","73% AV Level Silver Plan",,"0.739094469641127","No","Yes","No","100%",,"$3,600","$0","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$23,400","$23400 per person","$46800 per group","$29,250","$29250 per person","$58500 per group","$3,600","$3600 per person","$7200 per group","30.00%",,,,,"$14,400","$14400 per person","$28800 per group","$18,000","$18000 per person","$36000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_3600_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100024","Blue Value 4000 (limited network)","11512NC010",,"NCN002","NCS025","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100024-05","Blue Value 4000 (limited network)","87% AV Level Silver Plan",,"0.873897827171341","No","Yes","No","100%",,"$600","$0","$2,400","$60","$600","$200","$500","$60","$600","$60","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$9,800","$9800 per person","$19600 per group","$12,250","$12250 per person","$24500 per group","$600","$600 per person","$1200 per group","30.00%",,,,,"$2,400","$2400 per person","$4800 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_600_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100024","Blue Value 4000 (limited network)","11512NC010",,"NCN002","NCS025","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100024-06","Blue Value 4000 (limited network)","94% AV Level Silver Plan",,"0.939007913764171","No","Yes","No","100%",,"$300","$0","$800","$60","$300","$80","$300","$60","$300","$60","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$2,800","$2800 per person","$5600 per group","$3,500","$3500 per person","$7000 per group","$300","$300 per person","$600 per group","30.00%",,,,,"$1,200","$1200 per person","$2400 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_300_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100032","Blue Value 7000 (limited network)","11512NC010",,"NCN002","NCS025","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100032-00","Blue Value 7000 (limited network)","Standard Silver Off Exchange Plan",,"0.663928788449717","No","Yes","No","100%",,"$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group","$400","$400 per person","per group not applicable","30.00%",,,,,"$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_7000_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100032","Blue Value 7000 (limited network)","11512NC010",,"NCN002","NCS025","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100032-01","Blue Value 7000 (limited network)","Standard Silver On Exchange Plan",,"0.663928788449717","No","Yes","No","100%",,"$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group","$400","$400 per person","per group not applicable","30.00%",,,,,"$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_7000_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100032","Blue Value 7000 (limited network)","11512NC010",,"NCN002","NCS025","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100032-02","Blue Value 7000 (limited network)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100032","Blue Value 7000 (limited network)","11512NC010",,"NCN002","NCS025","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100032-03","Blue Value 7000 (limited network)","Limited Cost Sharing Plan Variation",,"0.663928788449717","No","Yes","No","100%",,"$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group","$400","$400 per person","per group not applicable","30.00%",,,,,"$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_7000_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100032","Blue Value 7000 (limited network)","11512NC010",,"NCN002","NCS025","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100032-04","Blue Value 7000 (limited network)","73% AV Level Silver Plan",,"0.735345670401859","No","Yes","No","100%",,"$3,900","$0","$2,000","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$23,400","$23400 per person","$46800 per group","$29,250","$29250 per person","$58500 per group","$3,900","$3900 per person","$7800 per group","30.00%",,,,,"$15,600","$15600 per person","$31200 per group","$19,500","$19500 per person","$39000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_3900_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100032","Blue Value 7000 (limited network)","11512NC010",,"NCN002","NCS025","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100032-05","Blue Value 7000 (limited network)","87% AV Level Silver Plan",,"0.867671087038711","No","Yes","No","100%",,"$800","$0","$2,200","$60","$800","$200","$500","$60","$800","$60","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$9,800","$9800 per person","$19600 per group","$12,250","$12250 per person","$24500 per group","$800","$800 per person","$1600 per group","30.00%",,,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_800_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100032","Blue Value 7000 (limited network)","11512NC010",,"NCN002","NCS025","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100032-06","Blue Value 7000 (limited network)","94% AV Level Silver Plan",,"0.931976889291764","No","Yes","No","100%",,"$400","$0","$800","$60","$400","$80","$300","$60","$400","$60","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$400","$400 per person","$800 per group","30.00%",,,,,"$1,600","$1600 per person","$3200 per group","$2,000","$2000 per person","$4000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_400_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100034","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS019","NCF004","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100034-00","Blue Value 2500 (limited network)","Standard Gold Off Exchange Plan",,"0.775197716450845","No","Yes","No","100%",,"$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_2500_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100034","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS019","NCF004","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100034-01","Blue Value 2500 (limited network)","Standard Gold On Exchange Plan",,"0.775197716450845","No","Yes","No","100%",,"$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_2500_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100034","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS019","NCF004","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100034-02","Blue Value 2500 (limited network)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100034","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS019","NCF004","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100034-03","Blue Value 2500 (limited network)","Limited Cost Sharing Plan Variation",,"0.775197716450845","No","Yes","No","100%",,"$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_2500_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100036","Blue Value 4000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100036-00","Blue Value 4000 (limited network)","Standard Silver Off Exchange Plan",,"0.718064643847287","No","Yes","No","100%",,"$4,000","$30","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$16,000","$16000 per person","$32000 per group","$20,000","$20000 per person","$40000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_4000_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100036","Blue Value 4000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100036-01","Blue Value 4000 (limited network)","Standard Silver On Exchange Plan",,"0.718064643847287","No","Yes","No","100%",,"$4,000","$30","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$16,000","$16000 per person","$32000 per group","$20,000","$20000 per person","$40000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_4000_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100036","Blue Value 4000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100036-02","Blue Value 4000 (limited network)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100036","Blue Value 4000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100036-03","Blue Value 4000 (limited network)","Limited Cost Sharing Plan Variation",,"0.718064643847287","No","Yes","No","100%",,"$4,000","$30","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$16,000","$16000 per person","$32000 per group","$20,000","$20000 per person","$40000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_4000_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100036","Blue Value 4000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100036-04","Blue Value 4000 (limited network)","73% AV Level Silver Plan",,"0.739094469641127","No","Yes","No","100%",,"$3,600","$0","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$23,400","$23400 per person","$46800 per group","$29,250","$29250 per person","$58500 per group","$3,600","$3600 per person","$7200 per group","30.00%",,,,,"$14,400","$14400 per person","$28800 per group","$18,000","$18000 per person","$36000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_3600_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100036","Blue Value 4000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100036-05","Blue Value 4000 (limited network)","87% AV Level Silver Plan",,"0.873897827171341","No","Yes","No","100%",,"$600","$0","$2,400","$60","$600","$200","$500","$60","$600","$60","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$9,800","$9800 per person","$19600 per group","$12,250","$12250 per person","$24500 per group","$600","$600 per person","$1200 per group","30.00%",,,,,"$2,400","$2400 per person","$4800 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_600_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100036","Blue Value 4000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100036-06","Blue Value 4000 (limited network)","94% AV Level Silver Plan",,"0.939007913764171","No","Yes","No","100%",,"$300","$0","$800","$60","$300","$80","$300","$60","$300","$60","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$2,800","$2800 per person","$5600 per group","$3,500","$3500 per person","$7000 per group","$300","$300 per person","$600 per group","30.00%",,,,,"$1,200","$1200 per person","$2400 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_300_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100044","Blue Value 7000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100044-00","Blue Value 7000 (limited network)","Standard Silver Off Exchange Plan",,"0.663928788449717","No","Yes","No","100%",,"$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group","$400","$400 per person","per group not applicable","30.00%",,,,,"$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_7000_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100044","Blue Value 7000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100044-01","Blue Value 7000 (limited network)","Standard Silver On Exchange Plan",,"0.663928788449717","No","Yes","No","100%",,"$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group","$400","$400 per person","per group not applicable","30.00%",,,,,"$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_7000_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100044","Blue Value 7000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100044-02","Blue Value 7000 (limited network)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100044","Blue Value 7000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100044-03","Blue Value 7000 (limited network)","Limited Cost Sharing Plan Variation",,"0.663928788449717","No","Yes","No","100%",,"$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group","$400","$400 per person","per group not applicable","30.00%",,,,,"$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_7000_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100044","Blue Value 7000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100044-04","Blue Value 7000 (limited network)","73% AV Level Silver Plan",,"0.735345670401859","No","Yes","No","100%",,"$3,900","$0","$2,000","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$23,400","$23400 per person","$46800 per group","$29,250","$29250 per person","$58500 per group","$3,900","$3900 per person","$7800 per group","30.00%",,,,,"$15,600","$15600 per person","$31200 per group","$19,500","$19500 per person","$39000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_3900_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100044","Blue Value 7000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100044-05","Blue Value 7000 (limited network)","87% AV Level Silver Plan",,"0.867671087038711","No","Yes","No","100%",,"$800","$0","$2,200","$60","$800","$200","$500","$60","$800","$60","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$9,800","$9800 per person","$19600 per group","$12,250","$12250 per person","$24500 per group","$800","$800 per person","$1600 per group","30.00%",,,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_800_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100044","Blue Value 7000 (limited network)","11512NC010",,"NCN002","NCS019","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100044-06","Blue Value 7000 (limited network)","94% AV Level Silver Plan",,"0.931976889291764","No","Yes","No","100%",,"$400","$0","$800","$60","$400","$80","$300","$60","$400","$60","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$400","$400 per person","$800 per group","30.00%",,,,,"$1,600","$1600 per person","$3200 per group","$2,000","$2000 per person","$4000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_400_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140002","Blue Local 2500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF004","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140002-00","Blue Local 2500 (local network with Carolinas HealthCare System)","Standard Gold Off Exchange Plan",,"0.775197716450845","No","Yes","No","100%",,"$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Gold_2500_with_Carolinas_HealthCare_System_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140002","Blue Local 2500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF004","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140002-01","Blue Local 2500 (local network with Carolinas HealthCare System)","Standard Gold On Exchange Plan",,"0.775197716450845","No","Yes","No","100%",,"$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Gold_2500_with_Carolinas_HealthCare_System_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140002","Blue Local 2500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF004","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140002-02","Blue Local 2500 (local network with Carolinas HealthCare System)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_with_Carolinas_HealthCare_System_100_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140002","Blue Local 2500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF004","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140002-03","Blue Local 2500 (local network with Carolinas HealthCare System)","Limited Cost Sharing Plan Variation",,"0.775197716450845","No","Yes","No","100%",,"$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Gold_2500_with_Carolinas_HealthCare_System_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140003","Blue Local 4000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140003-00","Blue Local 4000 (local network with Carolinas HealthCare System)","Standard Silver Off Exchange Plan",,"0.718064643847287","No","Yes","No","100%",,"$4,000","$30","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$16,000","$16000 per person","$32000 per group","$20,000","$20000 per person","$40000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_4000_with_Carolinas_HealthCare_System_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140003","Blue Local 4000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140003-01","Blue Local 4000 (local network with Carolinas HealthCare System)","Standard Silver On Exchange Plan",,"0.718064643847287","No","Yes","No","100%",,"$4,000","$30","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$16,000","$16000 per person","$32000 per group","$20,000","$20000 per person","$40000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_4000_with_Carolinas_HealthCare_System_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140003","Blue Local 4000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140003-02","Blue Local 4000 (local network with Carolinas HealthCare System)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_with_Carolinas_HealthCare_System_100_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140003","Blue Local 4000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140003-03","Blue Local 4000 (local network with Carolinas HealthCare System)","Limited Cost Sharing Plan Variation",,"0.718064643847287","No","Yes","No","100%",,"$4,000","$30","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$16,000","$16000 per person","$32000 per group","$20,000","$20000 per person","$40000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_4000_with_Carolinas_HealthCare_System_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140003","Blue Local 4000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140003-04","Blue Local 4000 (local network with Carolinas HealthCare System)","73% AV Level Silver Plan",,"0.739094469641127","No","Yes","No","100%",,"$3,600","$0","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$23,400","$23400 per person","$46800 per group","$29,250","$29250 per person","$58500 per group","$3,600","$3600 per person","$7200 per group","30.00%",,,,,"$14,400","$14400 per person","$28800 per group","$18,000","$18000 per person","$36000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_3600_with_Carolinas_HealthCare_System_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140003","Blue Local 4000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140003-05","Blue Local 4000 (local network with Carolinas HealthCare System)","87% AV Level Silver Plan",,"0.873897827171341","No","Yes","No","100%",,"$600","$0","$2,400","$60","$600","$200","$500","$60","$600","$60","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$9,800","$9800 per person","$19600 per group","$12,250","$12250 per person","$24500 per group","$600","$600 per person","$1200 per group","30.00%",,,,,"$2,400","$2400 per person","$4800 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_600_with_Carolinas_HealthCare_System_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140003","Blue Local 4000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140003-06","Blue Local 4000 (local network with Carolinas HealthCare System)","94% AV Level Silver Plan",,"0.939007913764171","No","Yes","No","100%",,"$300","$0","$800","$60","$300","$80","$300","$60","$300","$60","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$2,800","$2800 per person","$5600 per group","$3,500","$3500 per person","$7000 per group","$300","$300 per person","$600 per group","30.00%",,,,,"$1,200","$1200 per person","$2400 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_300_with_Carolinas_HealthCare_System_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140004","Blue Local 7000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140004-00","Blue Local 7000 (local network with Carolinas HealthCare System)","Standard Silver Off Exchange Plan",,"0.663928788449717","No","Yes","No","100%",,"$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group","$400","$400 per person","per group not applicable","30.00%",,,,,"$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_7000_with_Carolinas_HealthCare_System_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140004","Blue Local 7000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140004-01","Blue Local 7000 (local network with Carolinas HealthCare System)","Standard Silver On Exchange Plan",,"0.663928788449717","No","Yes","No","100%",,"$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group","$400","$400 per person","per group not applicable","30.00%",,,,,"$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_7000_with_Carolinas_HealthCare_System_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140004","Blue Local 7000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140004-02","Blue Local 7000 (local network with Carolinas HealthCare System)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_with_Carolinas_HealthCare_System_100_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140004","Blue Local 7000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140004-03","Blue Local 7000 (local network with Carolinas HealthCare System)","Limited Cost Sharing Plan Variation",,"0.663928788449717","No","Yes","No","100%",,"$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group","$400","$400 per person","per group not applicable","30.00%",,,,,"$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_7000_with_Carolinas_HealthCare_System_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140004","Blue Local 7000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140004-04","Blue Local 7000 (local network with Carolinas HealthCare System)","73% AV Level Silver Plan",,"0.735345670401859","No","Yes","No","100%",,"$3,900","$0","$2,000","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$23,400","$23400 per person","$46800 per group","$29,250","$29250 per person","$58500 per group","$3,900","$3900 per person","$7800 per group","30.00%",,,,,"$15,600","$15600 per person","$31200 per group","$19,500","$19500 per person","$39000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_3900_with_Carolinas_HealthCare_System_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140004","Blue Local 7000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140004-05","Blue Local 7000 (local network with Carolinas HealthCare System)","87% AV Level Silver Plan",,"0.867671087038711","No","Yes","No","100%",,"$800","$0","$2,200","$60","$800","$200","$500","$60","$800","$60","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$9,800","$9800 per person","$19600 per group","$12,250","$12250 per person","$24500 per group","$800","$800 per person","$1600 per group","30.00%",,,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_800_with_Carolinas_HealthCare_System_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140004","Blue Local 7000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS020","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140004-06","Blue Local 7000 (local network with Carolinas HealthCare System)","94% AV Level Silver Plan",,"0.931976889291764","No","Yes","No","100%",,"$400","$0","$800","$60","$400","$80","$300","$60","$400","$60","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$400","$400 per person","$800 per group","30.00%",,,,,"$1,600","$1600 per person","$3200 per group","$2,000","$2000 per person","$4000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_400_with_Carolinas_HealthCare_System_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170002","Blue Local 2500 (local network with Duke Health and WakeMed)","11512NC017",,"NCN004","NCS027","NCF004","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170002-00","Blue Local 2500 (local network with Duke Health and WakeMed)","Standard Gold Off Exchange Plan",,"0.775197716450845","No","Yes","No","100%",,"$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Gold_2500_with_Duke_Health_and_WakeMed_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170002","Blue Local 2500 (local network with Duke Health and WakeMed)","11512NC017",,"NCN004","NCS027","NCF004","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170002-01","Blue Local 2500 (local network with Duke Health and WakeMed)","Standard Gold On Exchange Plan",,"0.775197716450845","No","Yes","No","100%",,"$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Gold_2500_with_Duke_Health_and_WakeMed_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170002","Blue Local 2500 (local network with Duke Health and WakeMed)","11512NC017",,"NCN004","NCS027","NCF004","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170002-02","Blue Local 2500 (local network with Duke Health and WakeMed)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_with_Duke_Health_and_WakeMed_100_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170002","Blue Local 2500 (local network with Duke Health and WakeMed)","11512NC017",,"NCN004","NCS027","NCF004","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170002-03","Blue Local 2500 (local network with Duke Health and WakeMed)","Limited Cost Sharing Plan Variation",,"0.775197716450845","No","Yes","No","100%",,"$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$200","$200 per person","per group not applicable","10.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Gold_2500_with_Duke_Health_and_WakeMed_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170003","Blue Local 4000 (local network with Duke Health and WakeMed)","11512NC017",,"NCN004","NCS027","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170003-00","Blue Local 4000 (local network with Duke Health and WakeMed)","Standard Silver Off Exchange Plan",,"0.718064643847287","No","Yes","No","100%",,"$4,000","$30","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$16,000","$16000 per person","$32000 per group","$20,000","$20000 per person","$40000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_4000_with_Duke_Health_and_WakeMed_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170003","Blue Local 4000 (local network with Duke Health and WakeMed)","11512NC017",,"NCN004","NCS027","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170003-01","Blue Local 4000 (local network with Duke Health and WakeMed)","Standard Silver On Exchange Plan",,"0.718064643847287","No","Yes","No","100%",,"$4,000","$30","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$16,000","$16000 per person","$32000 per group","$20,000","$20000 per person","$40000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_4000_with_Duke_Health_and_WakeMed_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170003","Blue Local 4000 (local network with Duke Health and WakeMed)","11512NC017",,"NCN004","NCS027","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170003-02","Blue Local 4000 (local network with Duke Health and WakeMed)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_with_Duke_Health_and_WakeMed_100_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170003","Blue Local 4000 (local network with Duke Health and WakeMed)","11512NC017",,"NCN004","NCS027","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170003-03","Blue Local 4000 (local network with Duke Health and WakeMed)","Limited Cost Sharing Plan Variation",,"0.718064643847287","No","Yes","No","100%",,"$4,000","$30","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$16,000","$16000 per person","$32000 per group","$20,000","$20000 per person","$40000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_4000_with_Duke_Health_and_WakeMed_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170003","Blue Local 4000 (local network with Duke Health and WakeMed)","11512NC017",,"NCN004","NCS027","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170003-04","Blue Local 4000 (local network with Duke Health and WakeMed)","73% AV Level Silver Plan",,"0.739094469641127","No","Yes","No","100%",,"$3,600","$0","$2,300","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$23,400","$23400 per person","$46800 per group","$29,250","$29250 per person","$58500 per group","$3,600","$3600 per person","$7200 per group","30.00%",,,,,"$14,400","$14400 per person","$28800 per group","$18,000","$18000 per person","$36000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_3600_with_Duke_Health_and_WakeMed_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170003","Blue Local 4000 (local network with Duke Health and WakeMed)","11512NC017",,"NCN004","NCS027","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170003-05","Blue Local 4000 (local network with Duke Health and WakeMed)","87% AV Level Silver Plan",,"0.873897827171341","No","Yes","No","100%",,"$600","$0","$2,400","$60","$600","$200","$500","$60","$600","$60","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$9,800","$9800 per person","$19600 per group","$12,250","$12250 per person","$24500 per group","$600","$600 per person","$1200 per group","30.00%",,,,,"$2,400","$2400 per person","$4800 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_600_with_Duke_Health_and_WakeMed_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170003","Blue Local 4000 (local network with Duke Health and WakeMed)","11512NC017",,"NCN004","NCS027","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170003-06","Blue Local 4000 (local network with Duke Health and WakeMed)","94% AV Level Silver Plan",,"0.939007913764171","No","Yes","No","100%",,"$300","$0","$800","$60","$300","$80","$300","$60","$300","$60","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$2,800","$2800 per person","$5600 per group","$3,500","$3500 per person","$7000 per group","$300","$300 per person","$600 per group","30.00%",,,,,"$1,200","$1200 per person","$2400 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_300_with_Duke_Health_and_WakeMed_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170004","Blue Local 7000 (local network with Duke Health and WakeMed)","11512NC017",,"NCN004","NCS027","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170004-00","Blue Local 7000 (local network with Duke Health and WakeMed)","Standard Silver Off Exchange Plan",,"0.663928788449717","No","Yes","No","100%",,"$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group","$400","$400 per person","per group not applicable","30.00%",,,,,"$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_7000_with_Duke_Health_and_WakeMed_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170004","Blue Local 7000 (local network with Duke Health and WakeMed)","11512NC017",,"NCN004","NCS027","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170004-01","Blue Local 7000 (local network with Duke Health and WakeMed)","Standard Silver On Exchange Plan",,"0.663928788449717","No","Yes","No","100%",,"$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group","$400","$400 per person","per group not applicable","30.00%",,,,,"$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_7000_with_Duke_Health_and_WakeMed_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170004","Blue Local 7000 (local network with Duke Health and WakeMed)","11512NC017",,"NCN004","NCS027","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170004-02","Blue Local 7000 (local network with Duke Health and WakeMed)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_with_Duke_Health_and_WakeMed_100_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170004","Blue Local 7000 (local network with Duke Health and WakeMed)","11512NC017",,"NCN004","NCS027","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170004-03","Blue Local 7000 (local network with Duke Health and WakeMed)","Limited Cost Sharing Plan Variation",,"0.663928788449717","No","Yes","No","100%",,"$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group","$400","$400 per person","per group not applicable","30.00%",,,,,"$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_7000_with_Duke_Health_and_WakeMed_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170004","Blue Local 7000 (local network with Duke Health and WakeMed)","11512NC017",,"NCN004","NCS027","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170004-04","Blue Local 7000 (local network with Duke Health and WakeMed)","73% AV Level Silver Plan",,"0.735345670401859","No","Yes","No","100%",,"$3,900","$0","$2,000","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$23,400","$23400 per person","$46800 per group","$29,250","$29250 per person","$58500 per group","$3,900","$3900 per person","$7800 per group","30.00%",,,,,"$15,600","$15600 per person","$31200 per group","$19,500","$19500 per person","$39000 per group","$200","$200 per person","per group not applicable","30.00%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_3900_with_Duke_Health_and_WakeMed_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170004","Blue Local 7000 (local network with Duke Health and WakeMed)","11512NC017",,"NCN004","NCS027","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170004-05","Blue Local 7000 (local network with Duke Health and WakeMed)","87% AV Level Silver Plan",,"0.867671087038711","No","Yes","No","100%",,"$800","$0","$2,200","$60","$800","$200","$500","$60","$800","$60","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$9,800","$9800 per person","$19600 per group","$12,250","$12250 per person","$24500 per group","$800","$800 per person","$1600 per group","30.00%",,,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_800_with_Duke_Health_and_WakeMed_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170004","Blue Local 7000 (local network with Duke Health and WakeMed)","11512NC017",,"NCN004","NCS027","NCF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170004-06","Blue Local 7000 (local network with Duke Health and WakeMed)","94% AV Level Silver Plan",,"0.931976889291764","No","Yes","No","100%",,"$400","$0","$800","$60","$400","$80","$300","$60","$400","$60","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$3,200","$3200 per person","$6400 per group","$4,000","$4000 per person","$8000 per group","$400","$400 per person","$800 per group","30.00%",,,,,"$1,600","$1600 per person","$3200 per group","$2,000","$2000 per person","$4000 per group","$0","$0 per person","per group not applicable","30.00%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Silver_Enhanced_400_with_Duke_Health_and_WakeMed_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120001","Blue Select 2500 (tiered network)","11512NC012",,"NCN005","NCS022","NCF004","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120001-00","Blue Select 2500 (tiered network)","Standard Gold Off Exchange Plan",,"0.770002109116674","No","Yes","Yes","85%","15%","$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","30.00%","$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_2500_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120001","Blue Select 2500 (tiered network)","11512NC012",,"NCN005","NCS022","NCF004","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120001-01","Blue Select 2500 (tiered network)","Standard Gold On Exchange Plan",,"0.770002109116674","No","Yes","Yes","85%","15%","$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","30.00%","$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_2500_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120001","Blue Select 2500 (tiered network)","11512NC012",,"NCN005","NCS022","NCF004","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120001-02","Blue Select 2500 (tiered network)","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_100_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120001","Blue Select 2500 (tiered network)","11512NC012",,"NCN005","NCS022","NCF004","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120001-03","Blue Select 2500 (tiered network)","Limited Cost Sharing Plan Variation",,"0.770002109116674","No","Yes","Yes","85%","15%","$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","30.00%","$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_2500_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120002","Blue Select 7000 (tiered network)","11512NC012",,"NCN005","NCS022","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120002-00","Blue Select 7000 (tiered network)","Standard Silver Off Exchange Plan",,"0.661804634972946","No","Yes","Yes","85%","15%","$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$7,000","$7000 per person","$14000 per group","30.00%","$7,000","$7000 per person","$14000 per group","50.00%","$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","$400","$400 per person","per group not applicable","30.00%","$400","$400 per person","per group not applicable","30.00%","$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_7000_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120002","Blue Select 7000 (tiered network)","11512NC012",,"NCN005","NCS022","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120002-01","Blue Select 7000 (tiered network)","Standard Silver On Exchange Plan",,"0.661804634972946","No","Yes","Yes","85%","15%","$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$7,000","$7000 per person","$14000 per group","30.00%","$7,000","$7000 per person","$14000 per group","50.00%","$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","$400","$400 per person","per group not applicable","30.00%","$400","$400 per person","per group not applicable","30.00%","$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_7000_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120002","Blue Select 7000 (tiered network)","11512NC012",,"NCN005","NCS022","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120002-02","Blue Select 7000 (tiered network)","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_100_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120002","Blue Select 7000 (tiered network)","11512NC012",,"NCN005","NCS022","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120002-03","Blue Select 7000 (tiered network)","Limited Cost Sharing Plan Variation",,"0.661804634972946","No","Yes","Yes","85%","15%","$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$7,000","$7000 per person","$14000 per group","30.00%","$7,000","$7000 per person","$14000 per group","50.00%","$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","$400","$400 per person","per group not applicable","30.00%","$400","$400 per person","per group not applicable","30.00%","$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_7000_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120002","Blue Select 7000 (tiered network)","11512NC012",,"NCN005","NCS022","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120002-04","Blue Select 7000 (tiered network)","73% AV Level Silver Plan",,"0.733018594489479","No","Yes","Yes","85%","15%","$3,900","$0","$2,000","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","$11,700","$11700 per person","$23400 per group","$17,550","$17550 per person","$35100 per group","$3,900","$3900 per person","$7800 per group","30.00%","$3,900","$3900 per person","$7800 per group","50.00%","$7,800","$7800 per person","$15600 per group","$11,700","$11700 per person","$23400 per group","$200","$200 per person","per group not applicable","30.00%","$200","$200 per person","per group not applicable","30.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_Enhanced_3900_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120002","Blue Select 7000 (tiered network)","11512NC012",,"NCN005","NCS022","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120002-05","Blue Select 7000 (tiered network)","87% AV Level Silver Plan",,"0.86806148258944","No","Yes","Yes","85%","15%","$800","$0","$2,200","$60","$800","$200","$500","$60","$800","$60","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","$4,900","$4900 per person","$9800 per group","$7,350","$7350 per person","$14700 per group","$800","$800 per person","$1600 per group","30.00%","$800","$800 per person","$1600 per group","50.00%","$1,600","$1600 per person","$3200 per group","$2,400","$2400 per person","$4800 per group","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_Enhanced_800_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120002","Blue Select 7000 (tiered network)","11512NC012",,"NCN005","NCS022","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120002-06","Blue Select 7000 (tiered network)","94% AV Level Silver Plan",,"0.931553533547788","No","Yes","Yes","85%","15%","$400","$0","$800","$60","$400","$80","$300","$60","$400","$60","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","$1,600","$1600 per person","$3200 per group","$2,400","$2400 per person","$4800 per group","$400","$400 per person","$800 per group","30.00%","$400","$400 per person","$800 per group","50.00%","$800","$800 per person","$1600 per group","$1,200","$1200 per person","$2400 per group","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_Enhanced_400_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120003","Blue Select 2500 (tiered network)","11512NC012",,"NCN005","NCS023","NCF004","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120003-00","Blue Select 2500 (tiered network)","Standard Gold Off Exchange Plan",,"0.770002109116674","No","Yes","Yes","85%","15%","$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","30.00%","$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_2500_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120003","Blue Select 2500 (tiered network)","11512NC012",,"NCN005","NCS023","NCF004","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120003-01","Blue Select 2500 (tiered network)","Standard Gold On Exchange Plan",,"0.770002109116674","No","Yes","Yes","85%","15%","$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","30.00%","$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_2500_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120003","Blue Select 2500 (tiered network)","11512NC012",,"NCN005","NCS023","NCF004","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120003-02","Blue Select 2500 (tiered network)","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_100_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120003","Blue Select 2500 (tiered network)","11512NC012",,"NCN005","NCS023","NCF004","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120003-03","Blue Select 2500 (tiered network)","Limited Cost Sharing Plan Variation",,"0.770002109116674","No","Yes","Yes","85%","15%","$2,500","$20","$900","$60","$2,700","$200","$10","$60","$1,500","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$2,500","$2500 per person","$5000 per group","10.00%","$2,500","$2500 per person","$5000 per group","30.00%","$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","10.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_2500_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120004","Blue Select 7000 (tiered network)","11512NC012",,"NCN005","NCS023","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120004-00","Blue Select 7000 (tiered network)","Standard Silver Off Exchange Plan",,"0.661804634972946","No","Yes","Yes","85%","15%","$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$7,000","$7000 per person","$14000 per group","30.00%","$7,000","$7000 per person","$14000 per group","50.00%","$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","$400","$400 per person","per group not applicable","30.00%","$400","$400 per person","per group not applicable","30.00%","$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_7000_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120004","Blue Select 7000 (tiered network)","11512NC012",,"NCN005","NCS023","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120004-01","Blue Select 7000 (tiered network)","Standard Silver On Exchange Plan",,"0.661804634972946","No","Yes","Yes","85%","15%","$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$7,000","$7000 per person","$14000 per group","30.00%","$7,000","$7000 per person","$14000 per group","50.00%","$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","$400","$400 per person","per group not applicable","30.00%","$400","$400 per person","per group not applicable","30.00%","$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_7000_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120004","Blue Select 7000 (tiered network)","11512NC012",,"NCN005","NCS023","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120004-02","Blue Select 7000 (tiered network)","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_100_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120004","Blue Select 7000 (tiered network)","11512NC012",,"NCN005","NCS023","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120004-03","Blue Select 7000 (tiered network)","Limited Cost Sharing Plan Variation",,"0.661804634972946","No","Yes","Yes","85%","15%","$7,000","$0","$400","$60","$2,900","$600","$0","$60","$1,500","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$7,000","$7000 per person","$14000 per group","30.00%","$7,000","$7000 per person","$14000 per group","50.00%","$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","$400","$400 per person","per group not applicable","30.00%","$400","$400 per person","per group not applicable","30.00%","$400","$400 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_7000_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120004","Blue Select 7000 (tiered network)","11512NC012",,"NCN005","NCS023","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120004-04","Blue Select 7000 (tiered network)","73% AV Level Silver Plan",,"0.733018594489479","No","Yes","Yes","85%","15%","$3,900","$0","$2,000","$60","$2,800","$500","$0","$60","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","$11,700","$11700 per person","$23400 per group","$17,550","$17550 per person","$35100 per group","$3,900","$3900 per person","$7800 per group","30.00%","$3,900","$3900 per person","$7800 per group","50.00%","$7,800","$7800 per person","$15600 per group","$11,700","$11700 per person","$23400 per group","$200","$200 per person","per group not applicable","30.00%","$200","$200 per person","per group not applicable","30.00%","$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_Enhanced_3900_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120004","Blue Select 7000 (tiered network)","11512NC012",,"NCN005","NCS023","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120004-05","Blue Select 7000 (tiered network)","87% AV Level Silver Plan",,"0.86806148258944","No","Yes","Yes","85%","15%","$800","$0","$2,200","$60","$800","$200","$500","$60","$800","$60","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","$4,900","$4900 per person","$9800 per group","$7,350","$7350 per person","$14700 per group","$800","$800 per person","$1600 per group","30.00%","$800","$800 per person","$1600 per group","50.00%","$1,600","$1600 per person","$3200 per group","$2,400","$2400 per person","$4800 per group","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_Enhanced_800_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0120004","Blue Select 7000 (tiered network)","11512NC012",,"NCN005","NCS023","NCF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0120004-06","Blue Select 7000 (tiered network)","94% AV Level Silver Plan",,"0.931553533547788","No","Yes","Yes","85%","15%","$400","$0","$800","$60","$400","$80","$300","$60","$400","$60","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","$1,600","$1600 per person","$3200 per group","$2,400","$2400 per person","$4800 per group","$400","$400 per person","$800 per group","30.00%","$400","$400 per person","$800 per group","50.00%","$800","$800 per person","$1600 per group","$1,200","$1200 per person","$2400 per group","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","30.00%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_Enhanced_400_2018.pdf","http://www.bcbsnc.com/bsplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060024","Blue Advantage 6650 (broad network, HSA eligible)","11512NC006",,"NCN001","NCS017","NCF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060024-00","Blue Advantage 6650 (broad network, HSA eligible)","Standard Bronze Off Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,700","$0","$0","$60","$3,700","$3,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_6650_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060024","Blue Advantage 6650 (broad network, HSA eligible)","11512NC006",,"NCN001","NCS017","NCF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060024-01","Blue Advantage 6650 (broad network, HSA eligible)","Standard Bronze On Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,700","$0","$0","$60","$3,700","$3,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_6650_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060024","Blue Advantage 6650 (broad network, HSA eligible)","11512NC006",,"NCN001","NCS017","NCF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060024-02","Blue Advantage 6650 (broad network, HSA eligible)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_100_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060024","Blue Advantage 6650 (broad network, HSA eligible)","11512NC006",,"NCN001","NCS017","NCF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060024-03","Blue Advantage 6650 (broad network, HSA eligible)","Limited Cost Sharing Plan Variation",,"0.602242888854189","Yes","Yes","No","100%",,"$6,700","$0","$0","$60","$3,700","$3,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_6650_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100028","Blue Value 6650 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS025","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100028-00","Blue Value 6650 (limited network, HSA eligible)","Standard Bronze Off Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,700","$0","$0","$60","$3,700","$3,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_6650_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100028","Blue Value 6650 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS025","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100028-01","Blue Value 6650 (limited network, HSA eligible)","Standard Bronze On Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,700","$0","$0","$60","$3,700","$3,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_6650_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100028","Blue Value 6650 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS025","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100028-02","Blue Value 6650 (limited network, HSA eligible)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100028","Blue Value 6650 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS025","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100028-03","Blue Value 6650 (limited network, HSA eligible)","Limited Cost Sharing Plan Variation",,"0.602242888854189","Yes","Yes","No","100%",,"$6,700","$0","$0","$60","$3,700","$3,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_6650_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100040","Blue Value 6650 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS019","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100040-00","Blue Value 6650 (limited network, HSA eligible)","Standard Bronze Off Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,700","$0","$0","$60","$3,700","$3,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_6650_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100040","Blue Value 6650 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS019","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100040-01","Blue Value 6650 (limited network, HSA eligible)","Standard Bronze On Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,700","$0","$0","$60","$3,700","$3,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_6650_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100040","Blue Value 6650 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS019","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100040-02","Blue Value 6650 (limited network, HSA eligible)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100040","Blue Value 6650 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS019","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100040-03","Blue Value 6650 (limited network, HSA eligible)","Limited Cost Sharing Plan Variation",,"0.602242888854189","Yes","Yes","No","100%",,"$6,700","$0","$0","$60","$3,700","$3,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_6650_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140005","Blue Local 6650 (local network with Carolinas HealthCare System, HSA eligible)","11512NC014",,"NCN003","NCS020","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140005-00","Blue Local 6650 (local network with Carolinas HealthCare System, HSA eligible)","Standard Bronze Off Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,700","$0","$0","$60","$3,700","$3,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_6650_with_Carolinas_HealthCare_System_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140005","Blue Local 6650 (local network with Carolinas HealthCare System, HSA eligible)","11512NC014",,"NCN003","NCS020","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140005-01","Blue Local 6650 (local network with Carolinas HealthCare System, HSA eligible)","Standard Bronze On Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,700","$0","$0","$60","$3,700","$3,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_6650_with_Carolinas_HealthCare_System_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140005","Blue Local 6650 (local network with Carolinas HealthCare System, HSA eligible)","11512NC014",,"NCN003","NCS020","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140005-02","Blue Local 6650 (local network with Carolinas HealthCare System, HSA eligible)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_with_Carolinas_HealthCare_System_100_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0140005","Blue Local 6650 (local network with Carolinas HealthCare System, HSA eligible)","11512NC014",,"NCN003","NCS020","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0140005-03","Blue Local 6650 (local network with Carolinas HealthCare System, HSA eligible)","Limited Cost Sharing Plan Variation",,"0.602242888854189","Yes","Yes","No","100%",,"$6,700","$0","$0","$60","$3,700","$3,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_6650_with_Carolinas_HealthCare_System_2018.pdf","http://www.bcbsnc.com/blplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170006","Blue Local 6650 (local network with Duke Health and WakeMed, HSA eligible)","11512NC017",,"NCN004","NCS027","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170006-00","Blue Local 6650 (local network with Duke Health and WakeMed, HSA eligible)","Standard Bronze Off Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,700","$0","$0","$60","$3,700","$3,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_6650_with_Duke_Health_and_WakeMed_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170006","Blue Local 6650 (local network with Duke Health and WakeMed, HSA eligible)","11512NC017",,"NCN004","NCS027","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170006-01","Blue Local 6650 (local network with Duke Health and WakeMed, HSA eligible)","Standard Bronze On Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,700","$0","$0","$60","$3,700","$3,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_6650_with_Duke_Health_and_WakeMed_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170006","Blue Local 6650 (local network with Duke Health and WakeMed, HSA eligible)","11512NC017",,"NCN004","NCS027","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170006-02","Blue Local 6650 (local network with Duke Health and WakeMed, HSA eligible)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_with_Duke_Health_and_WakeMed_100_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0170006","Blue Local 6650 (local network with Duke Health and WakeMed, HSA eligible)","11512NC017",,"NCN004","NCS027","NCF006","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0170006-03","Blue Local 6650 (local network with Duke Health and WakeMed, HSA eligible)","Limited Cost Sharing Plan Variation",,"0.602242888854189","Yes","Yes","No","100%",,"$6,700","$0","$0","$60","$3,700","$3,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$26,600","$26600 per person","$53200 per group","$33,250","$33250 per person","$66500 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_Bronze_6650_with_Duke_Health_and_WakeMed_2018.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060027","Blue Advantage Catastrophic (broad network)","11512NC006",,"NCN001","NCS017","NCF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060027-00","Blue Advantage Catastrophic (broad network)","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$3,400","$3,400","$0","$60","$1,900","$40","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Catastrophic_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0060027","Blue Advantage Catastrophic (broad network)","11512NC006",,"NCN001","NCS017","NCF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0060027-01","Blue Advantage Catastrophic (broad network)","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$3,400","$3,400","$0","$60","$1,900","$40","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Catastrophic_2018.pdf","http://www.bcbsnc.com/baplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100031","Blue Value Catastrophic (limited network)","11512NC010",,"NCN002","NCS025","NCF006","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100031-00","Blue Value Catastrophic (limited network)","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$3,400","$3,400","$0","$60","$1,900","$40","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100031","Blue Value Catastrophic (limited network)","11512NC010",,"NCN002","NCS025","NCF006","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100031-01","Blue Value Catastrophic (limited network)","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$3,400","$3,400","$0","$60","$1,900","$40","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100043","Blue Value Catastrophic (limited network)","11512NC010",,"NCN002","NCS019","NCF006","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100043-00","Blue Value Catastrophic (limited network)","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$3,400","$3,400","$0","$60","$1,900","$40","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","11512","HIOS","2017-08-08 02:20:26","Individual","No","56-0894904","11512NC0100043","Blue Value Catastrophic (limited network)","11512NC010",,"NCN002","NCS019","NCF006","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NC_6T_HealthInsuranceMarketplace.pdf","11512NC0100043-01","Blue Value Catastrophic (limited network)","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$3,400","$3,400","$0","$60","$1,900","$40","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$29,400","$29400 per person","$58800 per group","$36,750","$36750 per person","$73500 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic_2018.pdf","http://www.bcbsnc.com/bvplanbrochure_2018"
"2018","NC","25741","HIOS","2017-08-04 02:20:25","Individual","Yes","47-0397286","25741NC0010003","Delta Dental Individual PPO, EHB Certified","25741NC001",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","25741NC0010003-00","Delta Dental Individual PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","25741","HIOS","2017-08-04 02:20:25","Individual","Yes","47-0397286","25741NC0010004","Delta Dental Individual PPO, EHB Certified","25741NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","25741NC0010004-00","Delta Dental Individual PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","25741","HIOS","2017-08-04 02:20:25","Individual","Yes","47-0397286","25741NC0060003","Delta Dental Individual PPO, EHB Certified (Exchange)","25741NC006",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/25741","","25741NC0060003-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnc.com/NC_EHB_High_2018","http://www.deltadentalnc.com/NC_EHB_High_2018"
"2018","NC","25741","HIOS","2017-08-04 02:20:25","Individual","Yes","47-0397286","25741NC0060004","Delta Dental Individual PPO, EHB Certified (Exchange)","25741NC006",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/25741","","25741NC0060004-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnc.com/NC_EHB_Low_2018","http://www.deltadentalnc.com/NC_EHB_Low_2018"
"2018","NC","25741","HIOS","2017-08-04 02:20:25","Individual","Yes","47-0397286","25741NC0070003","Delta Dental Individual Pediatric-Only PPO, EHB Certified","25741NC007",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","25741NC0070003-00","Delta Dental Individual Pediatric-Only PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","25741","HIOS","2017-08-04 02:20:25","Individual","Yes","47-0397286","25741NC0070004","Delta Dental Individual Pediatric-Only PPO, EHB Certified","25741NC007",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","25741NC0070004-00","Delta Dental Individual Pediatric-Only PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","25741","HIOS","2017-08-04 02:20:25","Individual","Yes","47-0397286","25741NC0080003","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","25741NC008",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/25741","","25741NC0080003-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnc.com/NC_Ped_High_2018","http://www.deltadentalnc.com/NC_Ped_High_2018"
"2018","NC","25741","HIOS","2017-08-04 02:20:25","Individual","Yes","47-0397286","25741NC0080004","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","25741NC008",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/25741","","25741NC0080004-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnc.com/NC_Ped_Low_2018","http://www.deltadentalnc.com/NC_Ped_Low_2018"
"2018","NC","37576","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","37576NC0010007","Dentegra Dental PPO Pediatric Basic Plan","37576NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","37576NC0010007-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","$65 per person","per group not applicable",,,,,,"$65","$65 per person","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nc/37576nc0010007-18"
"2018","NC","37576","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","37576NC0010012","Dentegra Dental PPO Family Preferred Plan","37576NC001",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","37576NC0010012-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nc/37576nc0010012-18"
"2018","NC","37576","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","37576NC0010011","Dentegra Dental PPO Family Basic Plan","37576NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","37576NC0010011-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","$65 per person","per group not applicable",,,,,,"$65","$65 per person","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nc/37576nc0010011-18"
"2018","NC","40411","HIOS","2017-06-21 02:20:35","Individual","Yes","59-1031071","40411NC0030001","Cigna Dental Pediatric","40411NC003","7730182962","NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Services","Yes",,"","40411NC0030001-00","Cigna Dental Pediatric","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2018/sob/cigna-dental-pediatric-nc"
"2018","NC","40435","HIOS","2017-06-02 02:20:22","SHOP (Small Group)","Yes","13-5581829","40435NC0170001","EHB Basic Dental Plan (Low)","40435NC017",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","40435NC0170001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","55440","HIOS","2017-06-21 02:20:35","Individual","Yes","13-5123390","55440NC0210002","Guardian Essentials for Families and Individuals","55440NC021",,"NCN002","NCS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","55440NC0210002-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/north-carolina/","https://dentalexchange.guardianlife.com/our-plans/north-carolina/"
"2018","NC","55440","HIOS","2017-06-21 02:20:35","Individual","Yes","13-5123390","55440NC0210002","Guardian Essentials for Families and Individuals","55440NC021",,"NCN002","NCS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","55440NC0210002-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/north-carolina/","https://dentalexchange.guardianlife.com/our-plans/north-carolina/"
"2018","NC","55440","HIOS","2017-06-21 02:20:35","Individual","Yes","13-5123390","55440NC0220002","Guardian Select for Families and Individuals","55440NC022",,"NCN002","NCS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","55440NC0220002-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/north-carolina/","https://dentalexchange.guardianlife.com/our-plans/north-carolina/"
"2018","NC","55440","HIOS","2017-06-21 02:20:35","Individual","Yes","13-5123390","55440NC0220002","Guardian Select for Families and Individuals","55440NC022",,"NCN002","NCS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","55440NC0220002-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/north-carolina/","https://dentalexchange.guardianlife.com/our-plans/north-carolina/"
"2018","NC","56891","HIOS","2017-07-20 02:20:21","Individual","Yes","56-1018068","56891NC0030005","Delta Dental Individual and Family Plans, EHB Certified","56891NC003",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0030005-00","Delta Dental Individual and Family Plans, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","56891","HIOS","2017-07-20 02:20:21","SHOP (Small Group)","Yes","56-1018068","56891NC0050005","Delta Dental Group PPO; EHB Certified","56891NC005",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits Paid at Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0050005-00","Delta Dental Group PPO; EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","56891","HIOS","2017-07-20 02:20:21","SHOP (Small Group)","Yes","56-1018068","56891NC0050006","Delta Dental Group PPO; EHB Certified","56891NC005",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits Paid at Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0050006-00","Delta Dental Group PPO; EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","56891","HIOS","2017-07-20 02:20:21","Individual","Yes","56-1018068","56891NC0030006","Delta Dental Individual and Family Plans, EHB Certified","56891NC003",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0030006-00","Delta Dental Individual and Family Plans, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","56891","HIOS","2017-07-20 02:20:21","Individual","Yes","56-1018068","56891NC0030007","Delta Dental Individual and Family Plans, EHB Certified","56891NC003",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0030007-00","Delta Dental Individual and Family Plans, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","56891","HIOS","2017-07-20 02:20:21","SHOP (Small Group)","Yes","56-1018068","56891NC0050007","Delta Dental Group PPO; EHB Certified","56891NC005",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits Paid at Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0050007-00","Delta Dental Group PPO; EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","56891","HIOS","2017-07-20 02:20:21","SHOP (Small Group)","Yes","56-1018068","56891NC0050008","Delta Dental Group PPO; EHB Certified","56891NC005",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits Paid at Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0050008-00","Delta Dental Group PPO; EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","56891","HIOS","2017-07-20 02:20:21","Individual","Yes","56-1018068","56891NC0030008","Delta Dental Individual and Family Plans, EHB Certified","56891NC003",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0030008-00","Delta Dental Individual and Family Plans, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","56891","HIOS","2017-07-20 02:20:21","Individual","Yes","56-1018068","56891NC0040003","Delta Dental Individual Pediatric-Only, EHB","56891NC004",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0040003-00","Delta Dental Individual Pediatric-Only, EHB","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","56891","HIOS","2017-07-20 02:20:21","SHOP (Small Group)","Yes","56-1018068","56891NC0060005","Delta Dental Group Pediatric Only: EHB Certified","56891NC006",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits Paid at Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0060005-00","Delta Dental Group Pediatric Only: EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","56891","HIOS","2017-07-20 02:20:21","SHOP (Small Group)","Yes","56-1018068","56891NC0060006","Delta Dental Group Pediatric Only: EHB Certified","56891NC006",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits Paid at Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0060006-00","Delta Dental Group Pediatric Only: EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","56891","HIOS","2017-07-20 02:20:21","Individual","Yes","56-1018068","56891NC0040004","Delta Dental Individual Pediatric-Only, EHB","56891NC004",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0040004-00","Delta Dental Individual Pediatric-Only, EHB","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","56891","HIOS","2017-07-20 02:20:21","SHOP (Small Group)","Yes","56-1018068","56891NC0060007","Delta Dental Group Pediatric Only: EHB Certified","56891NC006",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits Paid at Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0060007-00","Delta Dental Group Pediatric Only: EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","56891","HIOS","2017-07-20 02:20:21","SHOP (Small Group)","Yes","56-1018068","56891NC0060008","Delta Dental Group Pediatric Only: EHB Certified","56891NC006",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits Paid at Out of Network Level","Yes","Same Benefit Level","Yes",,"","56891NC0060008-00","Delta Dental Group Pediatric Only: EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070002","Cigna Connect 6000","73943NC007",,"NCN001","NCS001","NCF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070002-00","Cigna Connect 6000","Standard Bronze Off Exchange Plan","61.44%","0.632347081700832","Yes","Yes","No","100%",,"$6,000","$40","$1,300","$10","$130","$300","$3,000","$200","$1,590","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6000-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-6000-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070002","Cigna Connect 6000","73943NC007",,"NCN001","NCS001","NCF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070002-01","Cigna Connect 6000","Standard Bronze On Exchange Plan","61.44%","0.632347081700832","Yes","Yes","No","100%",,"$6,000","$40","$1,300","$10","$130","$300","$3,000","$200","$1,590","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6000-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-6000-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070002","Cigna Connect 6000","73943NC007",,"NCN001","NCS001","NCF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070002-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-0-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070002","Cigna Connect 6000","73943NC007",,"NCN001","NCS001","NCF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070002-03","Cigna Connect 6000-1","Limited Cost Sharing Plan Variation","61.44%","0.632347081700832","Yes","Yes","No","100%",,"$6,000","$40","$1,300","$10","$130","$300","$3,000","$200","$1,590","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6000-1-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-6000-1-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070003","Cigna Connect 6400","73943NC007",,"NCN001","NCS001","NCF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070003-00","Cigna Connect 6400","Standard Bronze Off Exchange Plan","60.34%","0.603388977639918","Yes","Yes","No","100%",,"$6,400","$50","$900","$10","$6,400","$100","$0","$200","$1,590","$100","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6400-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-6400-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070003","Cigna Connect 6400","73943NC007",,"NCN001","NCS001","NCF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070003-01","Cigna Connect 6400","Standard Bronze On Exchange Plan","60.34%","0.603388977639918","Yes","Yes","No","100%",,"$6,400","$50","$900","$10","$6,400","$100","$0","$200","$1,590","$100","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6400-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-6400-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070003","Cigna Connect 6400","73943NC007",,"NCN001","NCS001","NCF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070003-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-0-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070003","Cigna Connect 6400","73943NC007",,"NCN001","NCS001","NCF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070003-03","Cigna Connect 6400-1","Limited Cost Sharing Plan Variation","60.34%","0.603388977639918","Yes","Yes","No","100%",,"$6,400","$50","$900","$10","$6,400","$100","$0","$200","$1,590","$100","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6400-1-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-6400-1-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070014","Cigna Connect 5500","73943NC007",,"NCN001","NCS001","NCF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070014-00","Cigna Connect 5500","Standard Silver Off Exchange Plan","66.08%","0.669846791422948","Yes","Yes","No","100%",,"$5,500","$20","$1,800","$10","$130","$800","$0","$200","$1,590","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-5500-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-5500-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070014","Cigna Connect 5500","73943NC007",,"NCN001","NCS001","NCF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070014-01","Cigna Connect 5500","Standard Silver On Exchange Plan","66.08%","0.669846791422948","Yes","Yes","No","100%",,"$5,500","$20","$1,800","$10","$130","$800","$0","$200","$1,590","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-5500-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-5500-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070014","Cigna Connect 5500","73943NC007",,"NCN001","NCS001","NCF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070014-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-0-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070014","Cigna Connect 5500","73943NC007",,"NCN001","NCS001","NCF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070014-03","Cigna Connect 5500-1","Limited Cost Sharing Plan Variation","66.08%","0.669846791422948","Yes","Yes","No","100%",,"$5,500","$20","$1,800","$10","$130","$800","$0","$200","$1,590","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-5500-1-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-5500-1-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070014","Cigna Connect 5500","73943NC007",,"NCN001","NCS001","NCF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070014-04","Cigna Connect 2700-2","73% AV Level Silver Plan","72.46%","0.733587399701834","Yes","Yes","No","100%",,"$2,700","$30","$2,000","$10","$130","$800","$0","$200","$1,590","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-2700-2-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-2700-2-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070014","Cigna Connect 5500","73943NC007",,"NCN001","NCS001","NCF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070014-05","Cigna Connect 825-3A","87% AV Level Silver Plan","86.16%","0.863885744825862","Yes","Yes","No","100%",,"$825","$20","$1,200","$10","$130","$500","$0","$200","$825","$300","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-825-3a-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-825-3a-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070014","Cigna Connect 5500","73943NC007",,"NCN001","NCS001","NCF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070014-06","Cigna Connect 125-4","94% AV Level Silver Plan","93.59%","0.938491077664299","Yes","Yes","No","100%",,"$125","$20","$600","$10","$125","$400","$0","$200","$125","$200","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-125-4-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-125-4-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070006","Cigna Connect 4000","73943NC007",,"NCN001","NCS001","NCF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070006-00","Cigna Connect 4000","Standard Silver Off Exchange Plan","68.27%","0.692031035807479","Yes","Yes","No","100%",,"$4,000","$40","$1,300","$10","$650","$1,500","$0","$200","$1,590","$40","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4000-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-4000-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070006","Cigna Connect 4000","73943NC007",,"NCN001","NCS001","NCF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070006-01","Cigna Connect 4000","Standard Silver On Exchange Plan","68.27%","0.692031035807479","Yes","Yes","No","100%",,"$4,000","$40","$1,300","$10","$650","$1,500","$0","$200","$1,590","$40","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4000-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-4000-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070006","Cigna Connect 4000","73943NC007",,"NCN001","NCS001","NCF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070006-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-0-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070006","Cigna Connect 4000","73943NC007",,"NCN001","NCS001","NCF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070006-03","Cigna Connect 4000-1","Limited Cost Sharing Plan Variation","68.27%","0.692031035807479","Yes","Yes","No","100%",,"$4,000","$40","$1,300","$10","$650","$1,500","$0","$200","$1,590","$40","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4000-1-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-4000-1-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070006","Cigna Connect 4000","73943NC007",,"NCN001","NCS001","NCF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070006-04","Cigna Connect 2500-2","73% AV Level Silver Plan","72.90%","0.738400934225845","Yes","Yes","No","100%",,"$2,500","$40","$1,500","$10","$650","$1,500","$0","$200","$1,590","$40","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-2500-2-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-2500-2-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070006","Cigna Connect 4000","73943NC007",,"NCN001","NCS001","NCF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070006-05","Cigna Connect 825-3","87% AV Level Silver Plan","86.11%","0.863358592896078","Yes","Yes","No","100%",,"$825","$20","$1,200","$10","$130","$500","$0","$200","$825","$300","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-825-3-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-825-3-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070006","Cigna Connect 4000","73943NC007",,"NCN001","NCS001","NCF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070006-06","Cigna Connect 150-4","94% AV Level Silver Plan","93.42%","0.936773115550459","Yes","Yes","No","100%",,"$150","$20","$600","$10","$130","$400","$0","$200","$150","$200","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-150-4-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-150-4-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070013","Cigna Connect 3750","73943NC007",,"NCN001","NCS001","NCF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070013-00","Cigna Connect 3750","Standard Silver Off Exchange Plan","69.02%","0.699548863904962","Yes","Yes","No","100%",,"$3,750","$50","$1,800","$10","$130","$1,000","$0","$200","$1,590","$60","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-3750-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-3750-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070013","Cigna Connect 3750","73943NC007",,"NCN001","NCS001","NCF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070013-01","Cigna Connect 3750","Standard Silver On Exchange Plan","69.02%","0.699548863904962","Yes","Yes","No","100%",,"$3,750","$50","$1,800","$10","$130","$1,000","$0","$200","$1,590","$60","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-3750-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-3750-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070013","Cigna Connect 3750","73943NC007",,"NCN001","NCS001","NCF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070013-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-0-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070013","Cigna Connect 3750","73943NC007",,"NCN001","NCS001","NCF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070013-03","Cigna Connect 3750-1","Limited Cost Sharing Plan Variation","69.02%","0.699548863904962","Yes","Yes","No","100%",,"$3,750","$50","$1,800","$10","$130","$1,000","$0","$200","$1,590","$60","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-3750-1-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-3750-1-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070013","Cigna Connect 3750","73943NC007",,"NCN001","NCS001","NCF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070013-04","Cigna Connect 2750-2","73% AV Level Silver Plan","72.32%","0.733204974556591","Yes","Yes","No","100%",,"$2,750","$50","$2,000","$10","$130","$1,000","$0","$200","$1,590","$60","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-2750-2-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-2750-2-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070013","Cigna Connect 3750","73943NC007",,"NCN001","NCS001","NCF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070013-05","Cigna Connect 900-3","87% AV Level Silver Plan","86.02%","0.861525371839697","Yes","Yes","No","100%",,"$900","$10","$1,500","$10","$130","$500","$0","$200","$900","$20","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-900-3-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-900-3-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070013","Cigna Connect 3750","73943NC007",,"NCN001","NCS001","NCF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070013-06","Cigna Connect 100-4","94% AV Level Silver Plan","93.03%","0.933662129282111","Yes","Yes","No","100%",,"$100","$10","$1,100","$10","$100","$400","$0","$200","$100","$10","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-100-4-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-100-4-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070008","Cigna Connect 1200","73943NC007",,"NCN001","NCS001","NCF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070008-00","Cigna Connect 1200","Standard Gold Off Exchange Plan","79.19%","0.795804314612715","Yes","Yes","No","100%",,"$1,200","$30","$1,700","$10","$130","$700","$0","$200","$1,200","$30","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1200-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-1200-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070008","Cigna Connect 1200","73943NC007",,"NCN001","NCS001","NCF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070008-01","Cigna Connect 1200","Standard Gold On Exchange Plan","79.19%","0.795804314612715","Yes","Yes","No","100%",,"$1,200","$30","$1,700","$10","$130","$700","$0","$200","$1,200","$30","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1200-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-1200-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070008","Cigna Connect 1200","73943NC007",,"NCN001","NCS001","NCF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070008-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-0-ral-nc"
"2018","NC","73943","HIOS","2017-11-01 02:20:20","Individual","No","56-1479515","73943NC0070008","Cigna Connect 1200","73943NC007",,"NCN001","NCS001","NCF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","73943NC0070008-03","Cigna Connect 1200-1","Limited Cost Sharing Plan Variation","79.19%","0.795804314612715","Yes","Yes","No","100%",,"$1,200","$30","$1,700","$10","$130","$700","$0","$200","$1,200","$30","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1200-1-ral-nc","http://www.cigna.com/2018/sob/cigna-connect-1200-1-ral-nc"
"2018","NC","82612","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","82612NC0010001","TruAssure Basic Adult or Child Dental Plan","82612NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82612NC0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$155","$155 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NC","https://www.truassure.com/brochure?state=NC"
"2018","NC","82612","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","82612NC0030001","TruAssure Dental Small Group Basic Plan","82612NC003",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","82612NC0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","82612","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","82612NC0040001","TruAssure Dental Small Group Preferred Plan","82612NC004",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","82612NC0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NC","82612","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","82612NC0010001","TruAssure Basic Adult or Child Dental Plan","82612NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82612NC0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$155","$155 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NC","https://www.truassure.com/brochure?state=NC"
"2018","NC","82612","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","82612NC0020001","TruAssure Preferred Adult or Child Dental Plan","82612NC002",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82612NC0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NC","https://www.truassure.com/brochure?state=NC"
"2018","NC","82612","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","82612NC0020001","TruAssure Preferred Adult or Child Dental Plan","82612NC002",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82612NC0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NC","https://www.truassure.com/brochure?state=NC"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","94482NC0020003","BESTOne Advantage Gold","94482NC002",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NC/current/NC_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","94482NC0010007","BESTDental Premium","94482NC001",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010007-00","BESTDental Premium","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/CURRENT/NC_BESTDental_Premium_Plan.pdf"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","94482NC0010007","BESTDental Premium","94482NC001",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010007-01","BESTDental Premium","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/CURRENT/NC_BESTDental_Premium_Plan.pdf"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","94482NC0020003","BESTOne Advantage Gold","94482NC002",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NC/current/NC_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","94482NC0020004","BESTOne Plus Gold","94482NC002",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NC/current/NC_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","94482NC0010008","BESTDental Standard - H","94482NC001",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/current/NC_BESTDental_Standard-H_Plan.pdf"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","94482NC0010008","BESTDental Standard - H","94482NC001",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/current/NC_BESTDental_Standard-H_Plan.pdf"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","94482NC0020004","BESTOne Plus Gold","94482NC002",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NC/current/NC_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","94482NC0010010","BESTDental Choice - H","94482NC001",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/current/NC_BESTDental_Choice-H_Plan.pdf"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","94482NC0010010","BESTDental Choice - H","94482NC001",,"NCN001","NCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/current/NC_BESTDental_Choice-H_Plan.pdf"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","94482NC0010009","BESTDental Standard - L","94482NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/current/NC_BESTDental_Standard-L_Plan.pdf"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","94482NC0020005","BESTOne Plus Silver","94482NC002",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NC/current/NC_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","94482NC0020005","BESTOne Plus Silver","94482NC002",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NC/current/NC_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","94482NC0010009","BESTDental Standard - L","94482NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/current/NC_BESTDental_Standard-L_Plan.pdf"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","94482NC0010011","BESTDental Choice - L","94482NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/current/NC_BESTDental_Choice-L_Plan.pdf"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","94482NC0020006","BESTOne Basic Silver","94482NC002",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NC/current/NC_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","94482NC0020006","BESTOne Basic Silver","94482NC002",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NC/current/NC_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","94482NC0010011","BESTDental Choice - L","94482NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/current/NC_BESTDental_Choice-L_Plan.pdf"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","94482NC0010012","BESTDental Value","94482NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/current/NC_BESTDental_Value_Plan.pdf"
"2018","NC","94482","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","94482NC0010012","BESTDental Value","94482NC001",,"NCN001","NCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/current/NC_BESTDental_Value_Plan.pdf"
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0010001","Delta Dental Pediatric Low","27882ND001",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0010001-00","Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www/deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","SHOP (Small Group)","Yes","41-0952670","27882ND0170001","Delta Dental Pediatric Low","27882ND017",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0170001-00","Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www/deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0010001","Delta Dental Pediatric Low","27882ND001",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0010001-01","Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www/deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0020001","Delta Dental Bronze + Delta Dental Pediatric Low","27882ND002",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.62","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0020001-00","Delta Dental Bronze + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","SHOP (Small Group)","Yes","41-0952670","27882ND0180001","Delta Dental Bronze + Delta Dental Pediatric Low","27882ND018",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.62","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0180001-00","Delta Dental Bronze + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0020001","Delta Dental Bronze + Delta Dental Pediatric Low","27882ND002",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.62","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0020001-01","Delta Dental Bronze + Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0040001","Delta Dental Silver + Delta Dental Pediatric Low","27882ND004",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.48","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0040001-00","Delta Dental Silver + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","SHOP (Small Group)","Yes","41-0952670","27882ND0200001","Delta Dental Silver + Delta Dental Pediatric Low","27882ND020",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.48","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0200001-00","Delta Dental Silver + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0040001","Delta Dental Silver + Delta Dental Pediatric Low","27882ND004",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.48","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0040001-01","Delta Dental Silver + Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0060001","Delta Dental Gold + Delta Dental Pediatric Low","27882ND006",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.37","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0060001-00","Delta Dental Gold + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","SHOP (Small Group)","Yes","41-0952670","27882ND0220001","Delta Dental Gold + Delta Dental Pediatric Low","27882ND022",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.37","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0220001-00","Delta Dental Gold + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0060001","Delta Dental Gold + Delta Dental Pediatric Low","27882ND006",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.37","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0060001-01","Delta Dental Gold + Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0080001","Delta Dental Platinum + Delta Dental Pediatric Low","27882ND008",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.33","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0080001-00","Delta Dental Platinum + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","SHOP (Small Group)","Yes","41-0952670","27882ND0240001","Delta Dental Platinum + Delta Dental Pediatric Low","27882ND024",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.33","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0240001-00","Delta Dental Platinum + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0080001","Delta Dental Platinum + Delta Dental Pediatric Low","27882ND008",,"NDN001","NDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.33","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0080001-01","Delta Dental Platinum + Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0090001","Delta Dental Pediatric High","27882ND009",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0090001-00","Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www/deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","SHOP (Small Group)","Yes","41-0952670","27882ND0250001","Delta Dental Pediatric High","27882ND025",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0250001-00","Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0090001","Delta Dental Pediatric High","27882ND009",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0090001-01","Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www/deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0100001","Delta Dental Bronze + Delta Dental Pediatric High","27882ND010",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.68","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0100001-00","Delta Dental Bronze + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","SHOP (Small Group)","Yes","41-0952670","27882ND0260001","Delta Dental Bronze + Delta Dental Pediatric High","27882ND026",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.68","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services onlyl","Yes","similar benefits as in service area","Yes",,"","27882ND0260001-00","Delta Dental Bronze + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0100001","Delta Dental Bronze + Delta Dental Pediatric High","27882ND010",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.68","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/27882","","27882ND0100001-01","Delta Dental Bronze + Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0120001","Delta Dental Silver + Delta Dental Pediatric High","27882ND012",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.54","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0120001-00","Delta Dental Silver + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","SHOP (Small Group)","Yes","41-0952670","27882ND0280001","Delta Dental Silver + Delta Dental Pediatric High","27882ND028",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.54","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0280001-00","Delta Dental Silver + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0120001","Delta Dental Silver + Delta Dental Pediatric High","27882ND012",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.54","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0120001-01","Delta Dental Silver + Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0140001","Delta Dental Gold + Delta Dental Pediatric High","27882ND014",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.43","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0140001-00","Delta Dental Gold + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","SHOP (Small Group)","Yes","41-0952670","27882ND0300001","Delta Dental Gold + Delta Dental Pediatric High","27882ND030",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.43","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0300001-00","Delta Dental Gold + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0140001","Delta Dental Gold + Delta Dental Pediatric High","27882ND014",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.43","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0140001-01","Delta Dental Gold + Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0160001","Delta Dental Platinum + Delta Dental Pediatric High","27882ND016",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.39","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency servives only","Yes","similar benefits as in service area","Yes",,"","27882ND0160001-00","Delta Dental Platinum + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","27882","HIOS","2017-08-17 02:20:39","SHOP (Small Group)","Yes","41-0952670","27882ND0320001","Delta Dental Platinum + Delta Dental Pediatric High","27882ND032",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.39","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","27882ND0320001-00","Delta Dental Platinum + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 Silver","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410014-05","BlueDirect 80 Silver","87% AV Level Silver Plan",,"0.865715201475744","Yes","Yes","No","100%",,"$700","$0","$1,200","$60","$700","$0","$600","$60","$700","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$4,500","$4500 per person","$9000 per group","$6,750","$6750 per person","$13500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","10.00%",,,,,"$1,400","$1400 per person","$2800 per group","$2,100","$2100 per person","$4200 per group","No",,,"https://www.bcbsnd.com/2018-bluedirect-80-2700-silver-87","https://www.bcbsnd.com/2018-bluedirect-80-2700-silver-87-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 Silver","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410014-06","BlueDirect 80 Silver","94% AV Level Silver Plan",,"0.939005190049583","Yes","Yes","No","100%",,"$0","$0","$1,300","$60","$0","$0","$700","$60","$0","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$4,200","$4200 per person","$8400 per group","$6,300","$6300 per person","$12600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/2018-bluedirect-80-2700-silver-94","https://www.bcbsnd.com/2018-bluedirect-80-2700-silver-94-brochure"
"2018","ND","27882","HIOS","2017-08-17 02:20:39","Individual","Yes","41-0952670","27882ND0160001","Delta Dental Platinum + Delta Dental Pediatric High","27882ND016",,"NDN001","NDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.39","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency servives only","Yes","similar benefits as in service area","Yes",,"","27882ND0160001-01","Delta Dental Platinum + Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/2018HCR-ND.pdf",
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410002","BlueCare 70 Silver","37160ND241",,"NDN001","NDS001","NDF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410002-00","BlueCare 70 Silver","Standard Silver Off Exchange Plan",,"0.717349490664485","Yes","Yes","No","100%",,"$3,500","$20","$2,700","$60","$200","$900","$0","$60","$1,300","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","No",,,"https://www.bcbsnd.com/2018-bluecare-70-3500-silver","https://www.bcbsnd.com/2018-bluecare-70-3500-silver-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410002","BlueCare 70 Silver","37160ND241",,"NDN001","NDS001","NDF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410002-01","BlueCare 70 Silver","Standard Silver On Exchange Plan",,"0.717349490664485","Yes","Yes","No","100%",,"$3,500","$20","$2,700","$60","$200","$900","$0","$60","$1,300","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","No",,,"https://www.bcbsnd.com/2018-bluecare-70-3500-silver","https://www.bcbsnd.com/2018-bluecare-70-3500-silver-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410002","BlueCare 70 Silver","37160ND241",,"NDN001","NDS001","NDF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410002-02","BlueCare 70 Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/2018-american-indian-alaska-native","https://www.bcbsnd.com/2018-american-indian-alaska-native-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410002","BlueCare 70 Silver","37160ND241",,"NDN001","NDS001","NDF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410002-03","BlueCare 70 Silver","Limited Cost Sharing Plan Variation",,"0.717349490664485","Yes","Yes","No","100%",,"$3,500","$20","$2,700","$60","$200","$900","$0","$60","$1,300","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","No",,,"https://www.bcbsnd.com/2018-bluecare-70-3500-silver-ihs","https://www.bcbsnd.com/2018-bluecare-70-3500-silver-ihs-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410002","BlueCare 70 Silver","37160ND241",,"NDN001","NDS001","NDF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410002-04","BlueCare 70 Silver","73% AV Level Silver Plan",,"0.737776848302484","Yes","Yes","No","100%",,"$3,500","$20","$1,800","$60","$200","$900","$0","$60","$1,300","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$11,700","$11700 per person","$23400 per group","$17,550","$17550 per person","$35100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","No",,,"https://www.bcbsnd.com/2018-bluecare-70-3500-silver-73","https://www.bcbsnd.com/2018-bluecare-70-3500-silver-73-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410002","BlueCare 70 Silver","37160ND241",,"NDN001","NDS001","NDF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410002-05","BlueCare 70 Silver","87% AV Level Silver Plan",,"0.871664293802889","Yes","Yes","No","100%",,"$500","$0","$1,100","$60","$200","$900","$0","$60","$500","$500","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$3,200","$3200 per person","$6400 per group","$4,800","$4800 per person","$9600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","No",,,"https://www.bcbsnd.com/2018-bluecare-70-3500-silver-87","https://www.bcbsnd.com/2018-bluecare-70-3500-silver-87-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410002","BlueCare 70 Silver","37160ND241",,"NDN001","NDS001","NDF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410002-06","BlueCare 70 Silver","94% AV Level Silver Plan",,"0.934141340583391","Yes","Yes","No","100%",,"$0","$0","$800","$60","$0","$700","$20","$60","$0","$500","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,500","$1500 per person","$3000 per group","$2,250","$2250 per person","$4500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/2018-bluecare-70-3500-silver-94","https://www.bcbsnd.com/2018-bluecare-70-3500-silver-94-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410005","BlueCare 70 Gold","37160ND241",,"NDN001","NDS001","NDF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410005-00","BlueCare 70 Gold","Standard Gold Off Exchange Plan",,"0.811491088369166","Yes","Yes","No","100%",,"$500","$10","$3,600","$60","$200","$400","$0","$60","$500","$300","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","No",,,"https://www.bcbsnd.com/2018-bluecare-70-500-gold","https://www.bcbsnd.com/2018-bluecare-70-500-gold-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410005","BlueCare 70 Gold","37160ND241",,"NDN001","NDS001","NDF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410005-01","BlueCare 70 Gold","Standard Gold On Exchange Plan",,"0.811491088369166","Yes","Yes","No","100%",,"$500","$10","$3,600","$60","$200","$400","$0","$60","$500","$300","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","No",,,"https://www.bcbsnd.com/2018-bluecare-70-500-gold","https://www.bcbsnd.com/2018-bluecare-70-500-gold-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410005","BlueCare 70 Gold","37160ND241",,"NDN001","NDS001","NDF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410005-02","BlueCare 70 Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/2018-american-indian-alaska-native","https://www.bcbsnd.com/2018-american-indian-alaska-native-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410005","BlueCare 70 Gold","37160ND241",,"NDN001","NDS001","NDF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410005-03","BlueCare 70 Gold","Limited Cost Sharing Plan Variation",,"0.811491088369166","Yes","Yes","No","100%",,"$500","$10","$3,600","$60","$200","$400","$0","$60","$500","$300","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","No",,,"https://www.bcbsnd.com/2018-bluecare-70-500-gold-ihs","https://www.bcbsnd.com/2018-bluecare-70-500-gold-ihs-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 Silver","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410014-00","BlueDirect 80 Silver","Standard Silver Off Exchange Plan",,"0.686089904738914","Yes","Yes","No","100%",,"$2,700","$0","$200","$60","$2,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$8100 per person","$16200 per group","No",,,"https://www.bcbsnd.com/2018-bluedirect-80-2700-silver","https://www.bcbsnd.com/2018-bluedirect-80-2700-silver-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 Silver","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410014-01","BlueDirect 80 Silver","Standard Silver On Exchange Plan",,"0.686089904738914","Yes","Yes","No","100%",,"$2,700","$0","$200","$60","$2,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$8100 per person","$16200 per group","No",,,"https://www.bcbsnd.com/2018-bluedirect-80-2700-silver","https://www.bcbsnd.com/2018-bluedirect-80-2700-silver-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 Silver","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410014-02","BlueDirect 80 Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/2018-american-indian-alaska-native","https://www.bcbsnd.com/2018-american-indian-alaska-native-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 Silver","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410014-03","BlueDirect 80 Silver","Limited Cost Sharing Plan Variation",,"0.686089904738914","Yes","Yes","No","100%",,"$2,700","$0","$200","$60","$2,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$8100 per person","$16200 per group","No",,,"https://www.bcbsnd.com/2018-bluedirect-80-2700-silver-ihs","https://www.bcbsnd.com/2018-bluedirect-80-2700-silver-ihs-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 Silver","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410014-04","BlueDirect 80 Silver","73% AV Level Silver Plan",,"0.734228859539501","Yes","Yes","No","100%",,"$1,800","$0","$2,100","$60","$1,800","$0","$1,100","$60","$1,800","$0","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20.00%",,,,,"$3,600","$3600 per person","$7200 per group","$5,400","$5400 per person","$10800 per group","No",,,"https://www.bcbsnd.com/2018-bluedirect-80-2700-silver-73","https://www.bcbsnd.com/2018-bluedirect-80-2700-silver-73-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410022","BlueDirect 90 Gold","37160ND241","7194728540","NDN001","NDS001","NDF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410022-00","BlueDirect 90 Gold","Standard Gold Off Exchange Plan",,"0.784405029007203","Yes","Yes","No","100%",,"$1,700","$0","$1,100","$60","$1,700","$0","$500","$60","$1,700","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,675","$7350 per person","$7350 per group",,,,"$7,350","$14700 per person","$14700 per group","$11,025","$22050 per person","$22050 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","10.00%",,,,,"$3,400","$6800 per person","$6800 per group","$5,100","$10200 per person","$10200 per group","No",,,"https://www.bcbsnd.com/2018-bluedirect-90-1700-gold","https://www.bcbsnd.com/2018-bluedirect-90-1700-gold-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410022","BlueDirect 90 Gold","37160ND241","7194728540","NDN001","NDS001","NDF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410022-01","BlueDirect 90 Gold","Standard Gold On Exchange Plan",,"0.784405029007203","Yes","Yes","No","100%",,"$1,700","$0","$1,100","$60","$1,700","$0","$500","$60","$1,700","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,675","$7350 per person","$7350 per group",,,,"$7,350","$14700 per person","$14700 per group","$11,025","$22050 per person","$22050 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","10.00%",,,,,"$3,400","$6800 per person","$6800 per group","$5,100","$10200 per person","$10200 per group","No",,,"https://www.bcbsnd.com/2018-bluedirect-90-1700-gold","https://www.bcbsnd.com/2018-bluedirect-90-1700-gold-brochure"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100006","Sanford Simplicity $1,250","89364ND010",,"NDN001","NDS001","NDF008","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100006-01","Sanford Simplicity $1,250","Standard Gold On Exchange Plan",,"0.812484821028003","Yes","Yes","No","100%",,"$1,250","$30","$1,500","$60","$100","$1,200","$0","$60","$1,250","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_simplicity_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100001","Sanford Simplicity $500","89364ND010",,"NDN001","NDS001","NDF027","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100001-00","Sanford Simplicity $500","Standard Platinum Off Exchange Plan",,"0.909971278107127","Yes","Yes","No","100%",,"$500","$0","$500","$60","$100","$900","$0","$60","$500","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_simplicity_500.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100001","Sanford Simplicity $500","89364ND010",,"NDN001","NDS001","NDF027","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100001-01","Sanford Simplicity $500","Standard Platinum On Exchange Plan",,"0.909971278107127","Yes","Yes","No","100%",,"$500","$0","$500","$60","$100","$900","$0","$60","$500","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_simplicity_500.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100021","Sanford Simplicity $4500 HSA/HDHP","89364ND010",,"NDN001","NDS001","NDF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100021-00","Sanford Simplicity $4500 HSA/HDHP","Standard Silver Off Exchange Plan",,"0.681162826616788","Yes","Yes","No","100%",,"$4,500","$0","$0","$60","$4,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_simplicity_4500.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100021","Sanford Simplicity $4500 HSA/HDHP","89364ND010",,"NDN001","NDS001","NDF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100021-01","Sanford Simplicity $4500 HSA/HDHP","Standard Silver On Exchange Plan",,"0.681162826616788","Yes","Yes","No","100%",,"$4,500","$0","$0","$60","$4,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_simplicity_4500.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100003","Sanford Simplicity $3,500","89364ND010",,"NDN001","NDS001","NDF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100003-00","Sanford Simplicity $3,500","Standard Silver Off Exchange Plan",,"0.719799914352739","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$100","$1,800","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100003","Sanford Simplicity $3,500","89364ND010",,"NDN001","NDS001","NDF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100003-01","Sanford Simplicity $3,500","Standard Silver On Exchange Plan",,"0.719799914352739","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$100","$1,800","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2018.pdf"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410022","BlueDirect 90 Gold","37160ND241","7194728540","NDN001","NDS001","NDF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410022-02","BlueDirect 90 Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/2018-american-indian-alaska-native","https://www.bcbsnd.com/2018-american-indian-alaska-native-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410022","BlueDirect 90 Gold","37160ND241","7194728540","NDN001","NDS001","NDF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410022-03","BlueDirect 90 Gold","Limited Cost Sharing Plan Variation",,"0.784405029007203","Yes","Yes","No","100%",,"$1,700","$0","$1,100","$60","$1,700","$0","$500","$60","$1,700","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,675","$7350 per person","$7350 per group",,,,"$7,350","$14700 per person","$14700 per group","$11,025","$22050 per person","$22050 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","10.00%",,,,,"$3,400","$6800 per person","$6800 per group","$5,100","$10200 per person","$10200 per group","No",,,"https://www.bcbsnd.com/2018-bluedirect-90-1700-gold-ihs","https://www.bcbsnd.com/2018-bluedirect-90-1700-gold-ihs-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410020","BlueDirect 100 Bronze","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410020-00","BlueDirect 100 Bronze","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,700","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","$26,600","$26600 per person","$53200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$19,950","$19950 per person","$39900 per group","$26,600","$26600 per person","$53200 per group","No",,,"https://www.bcbsnd.com/2018-bluedirect-100-6650-bronze","https://www.bcbsnd.com/2018-bluedirect-100-6650-bronze-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410020","BlueDirect 100 Bronze","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410020-01","BlueDirect 100 Bronze","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,700","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","$26,600","$26600 per person","$53200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$19,950","$19950 per person","$39900 per group","$26,600","$26600 per person","$53200 per group","No",,,"https://www.bcbsnd.com/2018-bluedirect-100-6650-bronze","https://www.bcbsnd.com/2018-bluedirect-100-6650-bronze-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410020","BlueDirect 100 Bronze","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410020-02","BlueDirect 100 Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/2018-american-indian-alaska-native","https://www.bcbsnd.com/2018-american-indian-alaska-native-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410020","BlueDirect 100 Bronze","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410020-03","BlueDirect 100 Bronze","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"$6,700","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","$26,600","$26600 per person","$53200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$19,950","$19950 per person","$39900 per group","$26,600","$26600 per person","$53200 per group","No",,,"https://www.bcbsnd.com/2018-bluedirect-100-6650-bronze-ihs","https://www.bcbsnd.com/2018-bluedirect-100-6650-bronze-ihs-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410021","BlueEssential 100","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410021-00","BlueEssential 100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,200","$0","$0","$60","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","$29,400","$29400 per person","$58800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","$29,400","$29400 per person","$58800 per group","No",,,"https://www.bcbsnd.com/2018-blueessential-100-7350","https://www.bcbsnd.com/2018-blueessential-100-7350-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410021","BlueEssential 100","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410021-01","BlueEssential 100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,200","$0","$0","$60","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","$29,400","$29400 per person","$58800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","$29,400","$29400 per person","$58800 per group","No",,,"https://www.bcbsnd.com/2018-blueessential-100-7350","https://www.bcbsnd.com/2018-blueessential-100-7350-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410023","SimplyBlue 60","37160ND241","7194728540","NDN002","NDS001","NDF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410023-00","SimplyBlue 60","Standard Bronze Off Exchange Plan",,"0.580750899397144","Yes","Yes","No","100%",,"$6,800","$0","$600","$60","$2,900","$1,000","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","40.00%",,,,,"$13,600","$13600 per person","$27200 per group","$20,400","$20400 per person","$40800 per group","No",,,"https://www.bcbsnd.com/2018-simplyblue-60-bronze","https://www.bcbsnd.com/2018-simplyblue-60-bronze-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410023","SimplyBlue 60","37160ND241","7194728540","NDN002","NDS001","NDF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410023-01","SimplyBlue 60","Standard Bronze On Exchange Plan",,"0.580750899397144","Yes","Yes","No","100%",,"$6,800","$0","$600","$60","$2,900","$1,000","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","40.00%",,,,,"$13,600","$13600 per person","$27200 per group","$20,400","$20400 per person","$40800 per group","No",,,"https://www.bcbsnd.com/2018-simplyblue-60-bronze","https://www.bcbsnd.com/2018-simplyblue-60-bronze-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410023","SimplyBlue 60","37160ND241","7194728540","NDN002","NDS001","NDF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410023-02","SimplyBlue 60","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/2018-simplyblue-american-indian-alaska-native","https://www.bcbsnd.com/2018-simplyblue-american-indian-alaska-native-brochure"
"2018","ND","37160","HIOS","2017-08-17 02:20:39","Individual","No","45-0173185","37160ND2410023","SimplyBlue 60","37160ND241","7194728540","NDN002","NDS001","NDF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","http://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_ND_4T_HealthInsuranceMarketplace.pdf","37160ND2410023-03","SimplyBlue 60","Limited Cost Sharing Plan Variation",,"0.580750899397144","Yes","Yes","No","100%",,"$6,800","$0","$600","$60","$2,900","$1,000","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","40.00%",,,,,"$13,600","$13600 per person","$27200 per group","$20,400","$20400 per person","$40800 per group","No",,,"https://www.bcbsnd.com/2018-simplyblue-60-bronze-ihs","https://www.bcbsnd.com/2018-simplyblue-60-bronze-ihs-brochure"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","75329ND0010007","BESTDental Premium","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010007-00","BESTDental Premium","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTDental_Premium_Plan.pdf"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","75329ND0020003","BESTOne Advantage Gold","75329ND002",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","75329ND0020003","BESTOne Advantage Gold","75329ND002",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","75329ND0010007","BESTDental Premium","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010007-01","BESTDental Premium","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTDental_Premium_Plan.pdf"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","75329ND0010008","BESTDental Standard - H","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTDental_Standard-H_Plan.pdf"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","75329ND0020004","BESTOne Plus Gold","75329ND002",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","75329ND0020004","BESTOne Plus Gold","75329ND002",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","75329ND0010008","BESTDental Standard - H","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTDental_Standard-H_Plan.pdf"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","75329ND0010010","BESTDental Choice - H","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTDental_Standard-H_Plan.pdf"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","75329ND0010010","BESTDental Choice - H","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTDental_Standard-H_Plan.pdf"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","75329ND0010009","BESTDental Standard - L","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTDental_Standard-L_Plan.pdf"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","75329ND0020005","BESTOne Plus Silver","75329ND002",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","75329ND0020005","BESTOne Plus Silver","75329ND002",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","75329ND0010009","BESTDental Standard - L","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTDental_Standard-L_Plan.pdf"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","75329ND0010011","BESTDental Choice - L","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTDental_Choice-L_Plan.pdf"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","75329ND0020006","BESTOne Basic Silver","75329ND002",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","75329ND0020006","BESTOne Basic Silver","75329ND002",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","75329ND0010011","BESTDental Choice - L","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTDental_Choice-L_Plan.pdf"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","75329ND0010012","BESTDental Value","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010012-00","BESTDental Value","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTDental_Value_Plan.pdf"
"2018","ND","75329","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","75329ND0010012","BESTDental Value","75329ND001",,"NDN001","NDS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010012-01","BESTDental Value","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nd/current/ND_BESTDental_Value_Plan.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100019","Sanford Simplicity $5,000","89364ND010",,"NDN001","NDS001","NDF026","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100019-00","Sanford Simplicity $5,000","Standard Bronze Off Exchange Plan",,"0.649614631115679","Yes","Yes","No","100%",,"$5,000","$40","$1,600","$60","$300","$2,600","$0","$60","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","$10,000","$10000 per person","$20000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_simplicity_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100019","Sanford Simplicity $5,000","89364ND010",,"NDN001","NDS001","NDF026","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100019-01","Sanford Simplicity $5,000","Standard Bronze On Exchange Plan",,"0.649614631115679","Yes","Yes","No","100%",,"$5,000","$40","$1,600","$60","$300","$2,600","$0","$60","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","$10,000","$10000 per person","$20000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_simplicity_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100006","Sanford Simplicity $1,250","89364ND010",,"NDN001","NDS001","NDF008","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100006-00","Sanford Simplicity $1,250","Standard Gold Off Exchange Plan",,"0.812484821028003","Yes","Yes","No","100%",,"$1,250","$30","$1,500","$60","$100","$1,200","$0","$60","$1,250","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_simplicity_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100009","Sanford Simplicity $2,700 HSA/HDHP","89364ND010",,"NDN001","NDS001","NDF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100009-00","Sanford Simplicity $2,700 HSA/HDHP","Standard Silver Off Exchange Plan",,"0.703127193341871","Yes","Yes","No","100%",,"$2,700","$0","$1,800","$60","$2,700","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_simplicity_2700.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100009","Sanford Simplicity $2,700 HSA/HDHP","89364ND010",,"NDN001","NDS001","NDF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100009-01","Sanford Simplicity $2,700 HSA/HDHP","Standard Silver On Exchange Plan",,"0.703127193341871","Yes","Yes","No","100%",,"$2,700","$0","$1,800","$60","$2,700","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_simplicity_2700.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100020","Sanford Simplicity $2,250","89364ND010",,"NDN001","NDS001","NDF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100020-00","Sanford Simplicity $2,250","Standard Silver Off Exchange Plan",,"0.718187645415684","Yes","Yes","No","100%",,"$2,250","$40","$2,700","$60","$100","$1,900","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","40.00%",,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_simplicity_2250.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100020","Sanford Simplicity $2,250","89364ND010",,"NDN001","NDS001","NDF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100020-01","Sanford Simplicity $2,250","Standard Silver On Exchange Plan",,"0.718187645415684","Yes","Yes","No","100%",,"$2,250","$40","$2,700","$60","$100","$1,900","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","40.00%",,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_simplicity_2250.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100016","Sanford TRUE $5,000","89364ND010",,"NDN002","NDS002","NDF026","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100016-00","Sanford TRUE $5,000","Standard Bronze Off Exchange Plan",,"0.649614631115679","Yes","Yes","No","100%",,"$5,000","$40","$1,600","$60","$300","$2,600","$0","$60","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_true_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-1603-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100016","Sanford TRUE $5,000","89364ND010",,"NDN002","NDS002","NDF026","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100016-01","Sanford TRUE $5,000","Standard Bronze On Exchange Plan",,"0.649614631115679","Yes","Yes","No","100%",,"$5,000","$40","$1,600","$60","$300","$2,600","$0","$60","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_true_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-1603-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100014","Sanford TRUE $4,500 HSA/HDHP","89364ND010",,"NDN002","NDS002","NDF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100014-00","Sanford TRUE $4,500 HSA/HDHP","Standard Silver Off Exchange Plan",,"0.681162826616788","Yes","Yes","No","100%",,"$4,500","$0","$0","$60","$4,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_true_4500.pdf","http://www.sanfordhealthplan.com/policy/HP-1603-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100014","Sanford TRUE $4,500 HSA/HDHP","89364ND010",,"NDN002","NDS002","NDF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100014-01","Sanford TRUE $4,500 HSA/HDHP","Standard Silver On Exchange Plan",,"0.681162826616788","Yes","Yes","No","100%",,"$4,500","$0","$0","$60","$4,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_true_4500.pdf","http://www.sanfordhealthplan.com/policy/HP-1603-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100012","Sanford TRUE $2,700 HSA/HDHP","89364ND010",,"NDN002","NDS002","NDF028","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100012-00","Sanford TRUE $2,700 HSA/HDHP","Standard Silver Off Exchange Plan",,"0.703127193341871","Yes","Yes","No","100%",,"$2,700","$0","$1,800","$60","$2,700","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,700","$2700 per person","$5400 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_true_2700.pdf","http://www.sanfordhealthplan.com/policy/HP-1603-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100012","Sanford TRUE $2,700 HSA/HDHP","89364ND010",,"NDN002","NDS002","NDF028","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100012-01","Sanford TRUE $2,700 HSA/HDHP","Standard Silver On Exchange Plan",,"0.703127193341871","Yes","Yes","No","100%",,"$2,700","$0","$1,800","$60","$2,700","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,700","$2700 per person","$5400 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_true_2700.pdf","http://www.sanfordhealthplan.com/policy/HP-1603-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100013","Sanford TRUE $3,500","89364ND010",,"NDN002","NDS002","NDF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100013-00","Sanford TRUE $3,500","Standard Silver Off Exchange Plan","70.80%","0.727926104913845","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$20","$2,400","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_true_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-1603-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100013","Sanford TRUE $3,500","89364ND010",,"NDN002","NDS002","NDF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100013-01","Sanford TRUE $3,500","Standard Silver On Exchange Plan","70.80%","0.727926104913845","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$20","$2,400","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_true_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-1603-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100015","Sanford TRUE $2,250","89364ND010",,"NDN002","NDS002","NDF017","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100015-00","Sanford TRUE $2,250","Standard Silver Off Exchange Plan","71.10%","0.728852107025107","Yes","Yes","No","100%",,"$2,250","$40","$2,700","$60","$20","$2,400","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_true_2250.pdf","http://www.sanfordhealthplan.com/policy/HP-1603-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100015","Sanford TRUE $2,250","89364ND010",,"NDN002","NDS002","NDF017","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100015-01","Sanford TRUE $2,250","Standard Silver On Exchange Plan","71.10%","0.728852107025107","Yes","Yes","No","100%",,"$2,250","$40","$2,700","$60","$20","$2,400","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_true_2250.pdf","http://www.sanfordhealthplan.com/policy/HP-1603-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100017","Sanford TRUE $1,250","89364ND010",,"NDN002","NDS002","NDF019","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100017-00","Sanford TRUE $1,250","Standard Gold Off Exchange Plan","81.20%","0.824805976190172","Yes","Yes","No","100%",,"$1,250","$30","$1,500","$60","$20","$1,500","$0","$60","$1,250","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_true_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-1603-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100017","Sanford TRUE $1,250","89364ND010",,"NDN002","NDS002","NDF019","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100017-01","Sanford TRUE $1,250","Standard Gold On Exchange Plan","81.20%","0.824805976190172","Yes","Yes","No","100%",,"$1,250","$30","$1,500","$60","$20","$1,500","$0","$60","$1,250","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_true_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-1603-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100018","Sanford TRUE $500","89364ND010",,"NDN002","NDS002","NDF029","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100018-00","Sanford TRUE $500","Standard Platinum Off Exchange Plan","91.30%","0.914372609982335","Yes","Yes","No","100%",,"$500","$0","$600","$60","$10","$1,100","$0","$60","$500","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,100","$1100 per person","$2200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_true_500.pdf","http://www.sanfordhealthplan.com/policy/HP-1603-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100018","Sanford TRUE $500","89364ND010",,"NDN002","NDS002","NDF029","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100018-01","Sanford TRUE $500","Standard Platinum On Exchange Plan","91.30%","0.914372609982335","Yes","Yes","No","100%",,"$500","$0","$600","$60","$10","$1,100","$0","$60","$500","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,100","$1100 per person","$2200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_true_500.pdf","http://www.sanfordhealthplan.com/policy/HP-1603-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090017","Sanford TRUE $2,800","89364ND009",,"NDN002","NDS002","NDF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090017-02","Sanford TRUE $2,800","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_2800_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100011","Sanford TRUE $6,000","89364ND010",,"NDN002","NDS002","NDF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100011-00","Sanford TRUE $6,000","Standard Bronze Off Exchange Plan","62.10%","0.619097304291478","Yes","Yes","No","100%",,"$6,000","$0","$1,550","$60","$4,400","$1,600","$0","$60","$1,800","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_true_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-1603-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100011","Sanford TRUE $6,000","89364ND010",,"NDN002","NDS002","NDF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100011-01","Sanford TRUE $6,000","Standard Bronze On Exchange Plan","62.10%","0.619097304291478","Yes","Yes","No","100%",,"$6,000","$0","$1,550","$60","$4,400","$1,600","$0","$60","$1,800","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_true_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-1603-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090007","Sanford TRUE $6,000","89364ND009",,"NDN002","NDS002","NDF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090007-00","Sanford TRUE $6,000","Standard Bronze Off Exchange Plan","61.00%","0.606846570796385","Yes","Yes","No","100%",,"$6,000","$0","$1,150","$60","$4,400","$1,600","$0","$60","$1,800","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090007","Sanford TRUE $6,000","89364ND009",,"NDN002","NDS002","NDF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090007-01","Sanford TRUE $6,000","Standard Bronze On Exchange Plan","61.00%","0.606846570796385","Yes","Yes","No","100%",,"$6,000","$0","$1,150","$60","$4,400","$1,600","$0","$60","$1,800","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090007","Sanford TRUE $6,000","89364ND009",,"NDN002","NDS002","NDF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090007-02","Sanford TRUE $6,000","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_6000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090017","Sanford TRUE $2,800","89364ND009",,"NDN002","NDS002","NDF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090017-03","Sanford TRUE $2,800","Limited Cost Sharing Plan Variation","71.00%","0.729621951902622","Yes","Yes","No","100%",,"$2,800","$40","$2,500","$60","$20","$2,400","$0","$60","$1,400","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_2800_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090017","Sanford TRUE $2,800","89364ND009",,"NDN002","NDS002","NDF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090017-04","Sanford TRUE $2,800","73% AV Level Silver Plan","73.30%","0.750766297888302","Yes","Yes","No","100%",,"$2,750","$40","$2,500","$60","$20","$2,200","$0","$60","$1,400","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_2800_73.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0010001","Classic Bronze","23818NJ001",,"NJN001","NJS001","NJF001","New","EPO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.99871",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0010001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF001","23818NJ0010001-02","Classic Bronze","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0010001-02","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0010001-02"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0010001","Classic Bronze","23818NJ001",,"NJN001","NJS001","NJF001","New","EPO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.99871",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0010001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF001","23818NJ0010001-03","Classic Bronze","Limited Cost Sharing Plan Variation","62.44%",,"Yes","Yes","No","100%",,"$3,000","$20","$1,600","$200","$3,000","$300","$500","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0010001-03","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0010001-03"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0020001","Classic Silver","23818NJ002",,"NJN001","NJS001","NJF001","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.99842",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0020001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF001","23818NJ0020001-00","Classic Silver","Standard Silver Off Exchange Plan","66.77%",,"Yes","Yes","No","100%",,"$2,500","$20","$1,900","$200","$2,500","$800","$300","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0020001-00","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0020001-00"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100008","Sanford Simplicity $6,000","89364ND010",,"NDN001","NDS001","NDF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100008-00","Sanford Simplicity $6,000","Standard Bronze Off Exchange Plan","62.10%","0.619097304291478","Yes","Yes","No","100%",,"$6,000","$0","$1,150","$60","$4,400","$700","$0","$60","$1,800","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","SHOP (Small Group)","No","91-1842494","89364ND0100008","Sanford Simplicity $6,000","89364ND010",,"NDN001","NDS001","NDF003","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100008-01","Sanford Simplicity $6,000","Standard Bronze On Exchange Plan","62.10%","0.619097304291478","Yes","Yes","No","100%",,"$6,000","$0","$1,150","$60","$4,400","$700","$0","$60","$1,800","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/sg_nd_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0347-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090007","Sanford TRUE $6,000","89364ND009",,"NDN002","NDS002","NDF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090007-03","Sanford TRUE $6,000","Limited Cost Sharing Plan Variation","61.00%","0.606846570796385","Yes","Yes","No","100%",,"$6,000","$0","$1,150","$60","$4,400","$1,600","$0","$60","$1,800","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_6000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $4,000 HSA/HDHP","89364ND009",,"NDN002","NDS002","NDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-00","Sanford TRUE $4,000 HSA/HDHP","Standard Silver Off Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_4000.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $4,000 HSA/HDHP","89364ND009",,"NDN002","NDS002","NDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-01","Sanford TRUE $4,000 HSA/HDHP","Standard Silver On Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_4000.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $4,000 HSA/HDHP","89364ND009",,"NDN002","NDS002","NDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-02","Sanford TRUE $4,000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_4000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $4,000 HSA/HDHP","89364ND009",,"NDN002","NDS002","NDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-03","Sanford TRUE $4,000 HSA/HDHP","Limited Cost Sharing Plan Variation",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_4000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $4,000 HSA/HDHP","89364ND009",,"NDN002","NDS002","NDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-04","Sanford TRUE $4,000 HSA/HDHP","73% AV Level Silver Plan",,"0.722667595838822","Yes","Yes","No","100%",,"$3,500","$0","$0","$60","$3,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_4000_73.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $4,000 HSA/HDHP","89364ND009",,"NDN002","NDS002","NDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-05","Sanford TRUE $4,000","87% AV Level Silver Plan",,"0.862986557484674","Yes","Yes","No","100%",,"$1,250","$0","$0","$60","$1,250","$0","$0","$60","$1,250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_4000_87.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $4,000 HSA/HDHP","89364ND009",,"NDN002","NDS002","NDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-06","Sanford TRUE $4,000","94% AV Level Silver Plan",,"0.932658386848586","Yes","Yes","No","100%",,"$550","$0","$0","$60","$550","$0","$0","$60","$550","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$550","$550 per person","$1100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$550","$550 per person","$1100 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_4000_94.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090016","Sanford TRUE $4,750","89364ND009",,"NDN002","NDS002","NDF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090016-00","Sanford TRUE $4,750","Standard Silver Off Exchange Plan","67.60%","0.684924064961709","Yes","Yes","No","100%",,"$4,750","$40","$2,100","$60","$3,700","$1,200","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_4750.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090016","Sanford TRUE $4,750","89364ND009",,"NDN002","NDS002","NDF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090016-01","Sanford TRUE $4,750","Standard Silver On Exchange Plan","67.60%","0.684924064961709","Yes","Yes","No","100%",,"$4,750","$40","$2,100","$60","$3,700","$1,200","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_4750.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090016","Sanford TRUE $4,750","89364ND009",,"NDN002","NDS002","NDF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090016-02","Sanford TRUE $4,750","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_4750_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090016","Sanford TRUE $4,750","89364ND009",,"NDN002","NDS002","NDF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090016-03","Sanford TRUE $4,750","Limited Cost Sharing Plan Variation","67.60%","0.684924064961709","Yes","Yes","No","100%",,"$4,750","$40","$2,100","$60","$3,700","$1,200","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_4750_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090016","Sanford TRUE $4,750","89364ND009",,"NDN002","NDS002","NDF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090016-04","Sanford TRUE $4,750","73% AV Level Silver Plan","72.20%","0.728063519552374","Yes","Yes","No","100%",,"$3,500","$30","$2,200","$60","$3,500","$1,000","$60","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_4750_73.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090016","Sanford TRUE $4,750","89364ND009",,"NDN002","NDS002","NDF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090016-05","Sanford TRUE $4,750","87% AV Level Silver Plan","86.20%","0.864299158266428","Yes","Yes","No","100%",,"$1,000","$0","$1,000","$60","$1,000","$400","$600","$60","$1,000","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_4750_87.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090016","Sanford TRUE $4,750","89364ND009",,"NDN002","NDS002","NDF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090016-06","Sanford TRUE $4,750","94% AV Level Silver Plan","93.20%","0.932961278163279","Yes","Yes","No","100%",,"$200","$0","$800","$60","$200","$300","$500","$60","$200","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_4750_94.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090017","Sanford TRUE $2,800","89364ND009",,"NDN002","NDS002","NDF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090017-00","Sanford TRUE $2,800","Standard Silver Off Exchange Plan","71.00%","0.729621951902622","Yes","Yes","No","100%",,"$2,800","$40","$2,500","$60","$20","$2,400","$0","$60","$1,400","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_2800.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090017","Sanford TRUE $2,800","89364ND009",,"NDN002","NDS002","NDF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090017-01","Sanford TRUE $2,800","Standard Silver On Exchange Plan","71.00%","0.729621951902622","Yes","Yes","No","100%",,"$2,800","$40","$2,500","$60","$20","$2,400","$0","$60","$1,400","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_2800.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090017","Sanford TRUE $2,800","89364ND009",,"NDN002","NDS002","NDF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090017-05","Sanford TRUE $2,800","87% AV Level Silver Plan","86.20%","0.870176781566599","Yes","Yes","No","100%",,"$750","$0","$1,500","$60","$20","$1,500","$0","$60","$750","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_2800_87.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090017","Sanford TRUE $2,800","89364ND009",,"NDN002","NDS002","NDF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090017-06","Sanford TRUE $2,800","94% AV Level Silver Plan","93.50%","0.939116656567483","Yes","Yes","No","100%",,"$300","$0","$700","$60","$20","$600","$0","$60","$300","$70","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_2800_94.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090018","Sanford TRUE $1,250","89364ND009",,"NDN002","NDS002","NDF019","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090018-00","Sanford TRUE $1,250","Standard Gold Off Exchange Plan","81.20%","0.824805976190172","Yes","Yes","No","100%",,"$1,250","$30","$1,500","$60","$20","$1,500","$0","$60","$1,250","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090018","Sanford TRUE $1,250","89364ND009",,"NDN002","NDS002","NDF019","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090018-01","Sanford TRUE $1,250","Standard Gold On Exchange Plan","81.20%","0.824805976190172","Yes","Yes","No","100%",,"$1,250","$30","$1,500","$60","$20","$1,500","$0","$60","$1,250","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090018","Sanford TRUE $1,250","89364ND009",,"NDN002","NDS002","NDF019","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090018-02","Sanford TRUE $1,250","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_1250_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090018","Sanford TRUE $1,250","89364ND009",,"NDN002","NDS002","NDF019","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090018-03","Sanford TRUE $1,250","Limited Cost Sharing Plan Variation","81.20%","0.824805976190172","Yes","Yes","No","100%",,"$1,250","$30","$1,500","$60","$20","$1,500","$0","$60","$1,250","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_1250_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090015","Sanford TRUE $7,350","89364ND009",,"NDN002","NDS002","NDF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090015-00","Sanford TRUE $7,350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,700","$0","$0","$60","$1,800","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_7350.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090015","Sanford TRUE $7,350","89364ND009",,"NDN002","NDS002","NDF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090015-01","Sanford TRUE $7,350","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,700","$0","$0","$60","$1,800","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_7350.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090009","Sanford TRUE $5,000 HSA/HDHP","89364ND009",,"NDN002","NDS002","NDF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090009-00","Sanford TRUE $5,000 HSA/HDHP","Standard Bronze Off Exchange Plan",,"0.612130834321578","Yes","Yes","No","100%",,"$5,000","$0","$1,600","$60","$5,000","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090009","Sanford TRUE $5,000 HSA/HDHP","89364ND009",,"NDN002","NDS002","NDF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090009-01","Sanford TRUE $5,000 HSA/HDHP","Standard Bronze On Exchange Plan",,"0.612130834321578","Yes","Yes","No","100%",,"$5,000","$0","$1,600","$60","$5,000","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090009","Sanford TRUE $5,000 HSA/HDHP","89364ND009",,"NDN002","NDS002","NDF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090009-02","Sanford TRUE $5,000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_5000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090009","Sanford TRUE $5,000 HSA/HDHP","89364ND009",,"NDN002","NDS002","NDF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090009-03","Sanford TRUE $5,000 HSA/HDHP","Limited Cost Sharing Plan Variation",,"0.612130834321578","Yes","Yes","No","100%",,"$5,000","$0","$1,600","$60","$5,000","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_5000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-00","Sanford TRUE $3,500","Standard Silver Off Exchange Plan","70.80%","0.727926104913845","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$20","$2,400","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-01","Sanford TRUE $3,500","Standard Silver On Exchange Plan","70.80%","0.727926104913845","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$20","$2,400","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-02","Sanford TRUE $3,500","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_3500_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-03","Sanford TRUE $3,500","Limited Cost Sharing Plan Variation","70.80%","0.727926104913845","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$20","$2,400","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_3500_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-04","Sanford TRUE $3,500","73% AV Level Silver Plan","73.10%","0.749800953308837","Yes","Yes","No","100%",,"$3,000","$40","$1,200","$60","$20","$2,400","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_3500_73.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-05","Sanford TRUE $3,500","87% AV Level Silver Plan","86.50%","0.873041883221702","Yes","Yes","No","100%",,"$700","$0","$1,550","$60","$20","$1,600","$0","$60","$700","$100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_3500_87.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","ND","89364","HIOS","2017-10-18 02:20:18","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-06","Sanford TRUE $3,500","94% AV Level Silver Plan","94.30%","0.946469799559918","Yes","Yes","No","100%",,"$250","$10","$400","$60","$20","$400","$0","$60","$250","$70","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/2018/i_nd_true_3500_94.pdf","http://www.sanfordhealthplan.com/policy/HP-1601-2018.pdf"
"2018","NJ","15720","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","15720NJ0020001","Renaissance Individual Dental PPO, EHB Certified","15720NJ002",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","15720NJ0020001-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","15720","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","15720NJ0020002","Renaissance Individual Dental PPO, EHB Certified","15720NJ002",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","15720NJ0020002-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","15720","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","15720NJ0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","15720NJ004",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/15720","","15720NJ0040001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/NJ_EHB_High_2018","http://www.renaissancedental.com/NJ_EHB_High_2018"
"2018","NJ","15720","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","15720NJ0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","15720NJ004",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/15720","","15720NJ0040002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/NJ_EHB_Low_2018","http://www.renaissancedental.com/NJ_EHB_Low_2018"
"2018","NJ","15720","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","15720NJ0050001","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","15720NJ005",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/15720","","15720NJ0050001-01","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/NJ_Ped_High_2018","http://www.renaissancedental.com/NJ_Ped_High_2018"
"2018","NJ","15720","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","15720NJ0050002","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","15720NJ005",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/15720","","15720NJ0050002-01","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/NJ_Ped_Low_2018","http://www.renaissancedental.com/NJ_Ped_Low_2018"
"2018","NJ","15720","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","15720NJ0060001","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","15720NJ006",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","15720NJ0060001-00","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","15720","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","15720NJ0060002","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","15720NJ006",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","15720NJ0060002-00","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0010001","Classic Bronze","23818NJ001",,"NJN001","NJS001","NJF001","New","EPO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.99871",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0010001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF001","23818NJ0010001-00","Classic Bronze","Standard Bronze Off Exchange Plan","62.44%",,"Yes","Yes","No","100%",,"$3,000","$20","$1,600","$200","$3,000","$300","$500","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0010001-00","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0010001-00"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0010001","Classic Bronze","23818NJ001",,"NJN001","NJS001","NJF001","New","EPO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.99871",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0010001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF001","23818NJ0010001-01","Classic Bronze","Standard Bronze On Exchange Plan","62.44%",,"Yes","Yes","No","100%",,"$3,000","$20","$1,600","$200","$3,000","$300","$500","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0010001-01","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0010001-01"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0020001","Classic Silver","23818NJ002",,"NJN001","NJS001","NJF001","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.99842",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0020001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF001","23818NJ0020001-01","Classic Silver","Standard Silver On Exchange Plan","66.77%",,"Yes","Yes","No","100%",,"$2,500","$20","$1,900","$200","$2,500","$800","$300","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0020001-01","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0020001-01"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0020001","Classic Silver","23818NJ002",,"NJN001","NJS001","NJF001","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.99842",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0020001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF001","23818NJ0020001-02","Classic Silver","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0020001-02","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0020001-02"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0020001","Classic Silver","23818NJ002",,"NJN001","NJS001","NJF001","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.99842",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0020001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF001","23818NJ0020001-03","Classic Silver","Limited Cost Sharing Plan Variation","66.77%",,"Yes","Yes","No","100%",,"$2,500","$20","$1,900","$200","$2,500","$800","$300","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0020001-03","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0020001-03"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0020001","Classic Silver","23818NJ002",,"NJN001","NJS001","NJF001","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.99842",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0020001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF001","23818NJ0020001-04","Classic Silver CSR 250","73% AV Level Silver Plan","73.36%",,"Yes","Yes","No","100%",,"$2,500","$20","$1,100","$200","$2,500","$600","$300","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0020001-04","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0020001-04"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0020001","Classic Silver","23818NJ002",,"NJN001","NJS001","NJF001","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.99842",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0020001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF001","23818NJ0020001-05","Classic Silver CSR 200","87% AV Level Silver Plan","87.62%",,"Yes","Yes","No","100%",,"$800","$0","$1,100","$200","$800","$100","$500","$80","$800","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0020001-05","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0020001-05"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0020001","Classic Silver","23818NJ002",,"NJN001","NJS001","NJF001","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.99842",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0020001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF001","23818NJ0020001-06","Classic Silver CSR 150","94% AV Level Silver Plan","93.37%",,"Yes","Yes","No","100%",,"$300","$0","$600","$200","$300","$100","$300","$80","$300","$100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0020001-06","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0020001-06"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0030001","Classic Gold","23818NJ003",,"NJN001","NJS001","NJF002","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.99923",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0030001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF002","23818NJ0030001-00","Classic Gold","Standard Gold Off Exchange Plan","80.64%",,"Yes","Yes","No","100%",,"$1,000","$10","$1,100","$200","$1,000","$300","$800","$80","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0030001-00","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0030001-00"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0030001","Classic Gold","23818NJ003",,"NJN001","NJS001","NJF002","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.99923",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0030001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF002","23818NJ0030001-01","Classic Gold","Standard Gold On Exchange Plan","80.64%",,"Yes","Yes","No","100%",,"$1,000","$10","$1,100","$200","$1,000","$300","$800","$80","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0030001-01","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0030001-01"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0030001","Classic Gold","23818NJ003",,"NJN001","NJS001","NJF002","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.99923",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0030001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF002","23818NJ0030001-02","Classic Gold","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0030001-02","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0030001-02"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0030001","Classic Gold","23818NJ003",,"NJN001","NJS001","NJF002","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.99923",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0030001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF002","23818NJ0030001-03","Classic Gold","Limited Cost Sharing Plan Variation","80.64%",,"Yes","Yes","No","100%",,"$1,000","$10","$1,100","$200","$1,000","$300","$800","$80","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0030001-03","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0030001-03"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0040001","Backup Silver","23818NJ004",,"NJN001","NJS001","NJF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.9984",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0040001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF003","23818NJ0040001-00","Backup Silver","Standard Silver Off Exchange Plan","66.28%",,"Yes","Yes","No","100%",,"$2,500","$0","$1,500","$200","$2,500","$0","$1,100","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0040001-00","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0040001-00"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0040001","Backup Silver","23818NJ004",,"NJN001","NJS001","NJF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.9984",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0040001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF003","23818NJ0040001-01","Backup Silver","Standard Silver On Exchange Plan","66.28%",,"Yes","Yes","No","100%",,"$2,500","$0","$1,500","$200","$2,500","$0","$1,100","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0040001-01","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0040001-01"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0040001","Backup Silver","23818NJ004",,"NJN001","NJS001","NJF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.9984",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0040001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF003","23818NJ0040001-02","Backup Silver","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0040001-02","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0040001-02"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0040001","Backup Silver","23818NJ004",,"NJN001","NJS001","NJF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.9984",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0040001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF003","23818NJ0040001-03","Backup Silver","Limited Cost Sharing Plan Variation","66.28%",,"Yes","Yes","No","100%",,"$2,500","$0","$1,500","$200","$2,500","$0","$1,100","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0040001-03","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0040001-03"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0040001","Backup Silver","23818NJ004",,"NJN001","NJS001","NJF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.9984",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0040001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF003","23818NJ0040001-04","Backup Silver CSR 250","73% AV Level Silver Plan","73.00%",,"Yes","Yes","No","100%",,"$2,000","$0","$900","$200","$2,000","$0","$600","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0040001-04","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0040001-04"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0040001","Backup Silver","23818NJ004",,"NJN001","NJS001","NJF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.9984",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0040001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF003","23818NJ0040001-05","Backup Silver CSR 200","87% AV Level Silver Plan","87.56%",,"Yes","Yes","No","100%",,"$600","$0","$600","$200","$600","$0","$500","$80","$600","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0040001-05","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0040001-05"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0040001","Backup Silver","23818NJ004",,"NJN001","NJS001","NJF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.9984",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0040001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF003","23818NJ0040001-06","Backup Silver CSR 150","94% AV Level Silver Plan","94.35%",,"Yes","Yes","No","100%",,"$100","$0","$600","$200","$100","$0","$500","$80","$100","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0040001-06","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0040001-06"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0050001","Classic Secure","23818NJ005",,"NJN001","NJS001","NJF004","New","EPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.9985",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0050001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF004","23818NJ0050001-00","Classic Secure","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0050001-00","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0050001-00"
"2018","NJ","23818","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23818NJ0050001","Classic Secure","23818NJ005",,"NJN001","NJS001","NJF004","New","EPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No",,"0.9985",,,"2018-01-01",,"No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2018&hios=23818NJ0050001","https://www.hioscar.com/search/NJ/drugs?year=2018&formulary=NJF004","23818NJ0050001-01","Classic Secure","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2018&hios=23818NJ0050001-01","https://www.hioscar.com/hx/brochure?state=nj&year=2018&hios=23818NJ0050001-01"
"2018","NJ","48608","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","48608NJ0010008","Dentegra Dental PPO Family Preferred Plan","48608NJ001",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0010008-18"
"2018","NJ","48608","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","48608NJ0010007","Dentegra Dental PPO Family Basic Plan","48608NJ001",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0010007-00","Dentegra Dental PPO Family Basic Plan","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0010007-18"
"2018","NJ","48608","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","48608NJ0010007","Dentegra Dental PPO Family Basic Plan","48608NJ001",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0010007-18"
"2018","NJ","51791","HIOS","2017-06-07 02:20:25","SHOP (Small Group)","Yes","93-0242990","51791NJ0040002","EHB High PPO","51791NJ004",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","51791NJ0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","Individual","Yes","81-3569969","52944NJ0010002","Choice PPO Premium","52944NJ001","7962405180","NJN002","NJS002",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","52944NJ0010002-00","Choice PPO Premium","Standard High Off Exchange Plan","83.3%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$50 per group",,,,,,"$25","$25 per person","$50 per group","$25","$25 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18SBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18SBHINDFAMEHB.PDF"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","Individual","Yes","81-3569969","52944NJ0010002","Choice PPO Premium","52944NJ001","7962405180","NJN002","NJS002",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","52944NJ0010002-01","Choice PPO Premium","Standard High On Exchange Plan","83.3%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$50 per group",,,,,,"$25","$25 per person","$50 per group","$25","$25 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18SBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18SBHINDFAMEHB.PDF"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","Individual","Yes","81-3569969","52944NJ0020001","Select Plan Basic","52944NJ002","7962405180","NJN001","NJS001",,"New","EPO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","52944NJ0020001-00","Select Plan Basic","Standard Low Off Exchange Plan","71.6%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18DBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18DBLINDFAMEHB.PDF"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","Yes","81-3569969","52944NJ0030001","Select Plan Premium","52944NJ003","7962405180","NJN001","NJS001",,"New","EPO","High","Not Applicable",,"Off the Exchange",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","52944NJ0030001-00","Select Plan Premium","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18DBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18DBHSMGFAMEHB.PDF"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","Individual","Yes","81-3569969","52944NJ0020001","Select Plan Basic","52944NJ002","7962405180","NJN001","NJS001",,"New","EPO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","52944NJ0020001-01","Select Plan Basic","Standard Low On Exchange Plan","71.6%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18DBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18DBLINDFAMEHB.PDF"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","Individual","Yes","81-3569969","52944NJ0020002","Select Plan Premium","52944NJ002","7962405180","NJN001","NJS001",,"New","EPO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","52944NJ0020002-00","Select Plan Premium","Standard High Off Exchange Plan","85.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18DBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18DBHINDFAMEHB.PDF"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","Individual","Yes","81-3569969","52944NJ0020002","Select Plan Premium","52944NJ002","7962405180","NJN001","NJS001",,"New","EPO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","52944NJ0020002-01","Select Plan Premium","Standard High On Exchange Plan","85.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18DBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18DBHINDFAMEHB.PDF"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","Individual","Yes","81-3569969","52944NJ0010005","Choice PPO Plus","52944NJ001","7962405180","NJN002","NJS002",,"New","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","52944NJ0010005-00","Choice PPO Plus","Standard Low Off Exchange Plan","70.1%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","Individual","Yes","81-3569969","52944NJ0010005","Choice PPO Plus","52944NJ001","7962405180","NJN002","NJS002",,"New","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","52944NJ0010005-01","Choice PPO Plus","Standard Low On Exchange Plan","70.1%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","53877","HIOS","2017-06-03 02:07:36","SHOP (Small Group)","Yes","13-5581829","53877NJ0230001","EHB Basic Dental Plan (Low)","53877NJ023",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","53877NJ0230001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2270002","Horizon Advantage EPO Bronze","91661NJ227",,"NJN001","NJS001","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9984",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270002-00","Horizon Advantage EPO Bronze","Standard Bronze Off Exchange Plan",,"0.647990350541493","Yes","Yes","No","100%",,"$3,000","$560","$1,297","$60","$3,000","$240","$3,129","$55","$855","$120","$855","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2018/sbc-advantage-epo-bronze-standard","http://horizonblue.com/2018/brochure-advantage-epo-bronze"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2300001","Advantage EPO Gold 100  $25/$45","91661NJ230",,"NJN001","NJS001","NJF008","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9987",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2300001-00","Advantage EPO Gold 100  $25/$45","Standard Gold Off Exchange Plan",,"0.789359009097387","No","Yes","No","100%",,"$0","$1,460","$0","$60","$0","$2,565","$0","$55","$0","$280","$18","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://horizonblue.com/2018/sbc-advantage-epo-100-25-45","http://horizonblue.com/2018/brochure-advantage-epo-100-25-45"
"2018","NJ","77606","HIOS","2017-11-02 02:20:21","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred  $50/$75","77606NJ004",,"NJN001","NJS001","NJF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9987",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040065-02","IHC Silver HMO Regional Preferred Zero Dollar","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHCPZERO217.pdf",
"2018","NJ","77606","HIOS","2017-11-02 02:20:21","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred  $50/$75","77606NJ004",,"NJN001","NJS001","NJF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9987",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040065-03","IHC Silver HMO Regional Preferred $50/$75 Limited","Limited Cost Sharing Plan Variation",,"0.715971056497919","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC217PLTD.pdf",
"2018","NJ","77606","HIOS","2017-11-02 02:20:21","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred  $50/$75","77606NJ004",,"NJN001","NJS001","NJF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9987",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040065-04","IHC Silver HMO Regional Preferred  $50/$75","73% AV Level Silver Plan",,"0.736229736519178","Yes","Yes","No","100%",,"$2,500","$50","$3100","$10","$0","$500","$2,800","$60","$1,500","$300","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC217P73.pdf",
"2018","NJ","40704","HIOS","2017-06-02 02:20:22","SHOP (Small Group)","Yes","47-0098400","40704NJ0040002","EHB High PPO","40704NJ004",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","40704NJ0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","NJ","40704","HIOS","2017-06-02 02:20:22","SHOP (Small Group)","Yes","47-0098400","40704NJ0040001","EHB Low PPO","40704NJ004",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","40704NJ0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","NJ","40704","HIOS","2017-06-02 02:20:22","SHOP (Small Group)","Yes","47-0098400","40704NJ0030002","EHB High Passive","40704NJ003",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","40704NJ0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","NJ","40704","HIOS","2017-06-02 02:20:22","SHOP (Small Group)","Yes","47-0098400","40704NJ0030001","EHB Low Passive","40704NJ003",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","40704NJ0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","NJ","44811","HIOS","2017-05-14 02:20:57","SHOP (Small Group)","Yes","22-3849572","44811NJ0050005","Managed DentalGuard NJ 10 Family Plan","44811NJ005",,"NJN001","NJS002",,"New","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.995","Estimated Rate","2018-01-01",,"No",,"No",,"No",,"","44811NJ0050005-00","Managed DentalGuard NJ 10 Family Plan","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","44811","HIOS","2017-05-14 02:20:57","Individual","Yes","22-3849572","44811NJ0120002","Managed DentalGuard NJ Essentials 1","44811NJ012",,"NJN002","NJS001",,"New","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.995","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","44811NJ0120002-00","Managed DentalGuard NJ Essentials 1","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/new-jersey/","https://dentalexchange.guardianlife.com/our-plans/new-jersey/"
"2018","NJ","44811","HIOS","2017-05-14 02:20:57","Individual","Yes","22-3849572","44811NJ0120002","Managed DentalGuard NJ Essentials 1","44811NJ012",,"NJN002","NJS001",,"New","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.995","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","44811NJ0120002-01","Managed DentalGuard NJ Essentials 1","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/new-jersey/","https://dentalexchange.guardianlife.com/our-plans/new-jersey/"
"2018","NJ","44811","HIOS","2017-05-14 02:20:57","SHOP (Small Group)","Yes","22-3849572","44811NJ0070004","Managed DentalGuard NJ 20 Family Plan","44811NJ007",,"NJN001","NJS002",,"New","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.993","Estimated Rate","2018-01-01",,"No",,"No",,"No",,"","44811NJ0070004-00","Managed DentalGuard NJ 20 Family Plan","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","44811","HIOS","2017-05-14 02:20:57","SHOP (Small Group)","Yes","22-3849572","44811NJ0080004","Managed DentalGuard NJ 30 Family Plan","44811NJ008",,"NJN001","NJS002",,"New","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.994","Estimated Rate","2018-01-01",,"No",,"No",,"No",,"","44811NJ0080004-00","Managed DentalGuard NJ 30 Family Plan","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","48608","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","48608NJ0010001","Dentegra Dental PPO Pediatric Basic Plan","48608NJ001",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0010001-18"
"2018","NJ","48608","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","48608NJ0010008","Dentegra Dental PPO Family Preferred Plan","48608NJ001",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide network","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0010008-00","Dentegra Dental PPO Family Preferred Plan","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0010008-18"
"2018","NJ","51791","HIOS","2017-06-07 02:20:25","SHOP (Small Group)","Yes","93-0242990","51791NJ0040001","EHB Low PPO","51791NJ004",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","51791NJ0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2018","NJ","51791","HIOS","2017-06-07 02:20:25","SHOP (Small Group)","Yes","93-0242990","51791NJ0030002","EHB High Passive","51791NJ003",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","51791NJ0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2018","NJ","51791","HIOS","2017-06-07 02:20:25","SHOP (Small Group)","Yes","93-0242990","51791NJ0030001","EHB Low Passive","51791NJ003",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","51791NJ0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2018","NJ","52095","HIOS","2017-08-16 02:20:33","SHOP (Small Group)","Yes","22-2321226","52095NJ0020001","NJ Affordable Smiles","52095NJ002",,"NJN001","NJS001",,"Existing","EPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.0833","Guaranteed Rate","2018-01-01",,"No",,"No",,"No",,"","52095NJ0020001-01","NJ Affordable Smiles","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/NJAFFORDABLESMILES_BENEFITS","http://www.healthplex.com/doc/no/NJAFFORDABLESMILES_BROCHURE"
"2018","NJ","52095","HIOS","2017-08-16 02:20:33","Individual","Yes","22-2321226","52095NJ0010001","NJ Young Smiles","52095NJ001",,"NJN001","NJS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No",,"","52095NJ0010001-00","NJ Young Smiles","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/NJFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/NJFAMILYSMILES_BROCHURE"
"2018","NJ","52095","HIOS","2017-08-16 02:20:33","Individual","Yes","22-2321226","52095NJ0010001","NJ Young Smiles","52095NJ001",,"NJN001","NJS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No",,"","52095NJ0010001-01","NJ Young Smiles","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/NJFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/NJFAMILYSMILES_BROCHURE"
"2018","NJ","52095","HIOS","2017-08-16 02:20:33","SHOP (Small Group)","Yes","22-2321226","52095NJ0020002","NJ Affordable Smiles","52095NJ002",,"NJN001","NJS001",,"Existing","EPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.0833","Guaranteed Rate","2018-01-01",,"No",,"No",,"No",,"","52095NJ0020002-00","NJ Affordable Smiles","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/NJAFFORDABLESMILES_BENEFITS","http://www.healthplex.com/doc/no/NJAFFORDABLESMILES_BROCHURE"
"2018","NJ","52095","HIOS","2017-08-16 02:20:33","Individual","Yes","22-2321226","52095NJ0010002","NJ Family Smiles","52095NJ001",,"NJN001","NJS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.0833","Guaranteed Rate","2018-01-01",,"No",,"No",,"No",,"","52095NJ0010002-00","NJ Family Smiles","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/NJFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/NJFAMILYSMILES_BROCHURE"
"2018","NJ","52095","HIOS","2017-08-16 02:20:33","Individual","Yes","22-2321226","52095NJ0010002","NJ Family Smiles","52095NJ001",,"NJN001","NJS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.0833","Guaranteed Rate","2018-01-01",,"No",,"No",,"No",,"","52095NJ0010002-01","NJ Family Smiles","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/NJFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/NJFAMILYSMILES_BROCHURE"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","Individual","Yes","81-3569969","52944NJ0020003","Select Plan Basic Kids","52944NJ002","7962405180","NJN001","NJS001",,"New","EPO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","52944NJ0020003-00","Select Plan Basic Kids","Standard Low Off Exchange Plan","71.6%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18DBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18DBLINDPEDEHB.PDF"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","Yes","81-3569969","52944NJ0040001","Choice PPO Basic","52944NJ004","7962405180","NJN002","NJS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","52944NJ0040001-00","Choice PPO Basic","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$50 per group",,,,,,"$25","$25 per person","$50 per group","$25","$25 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DNINJ17SBLSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DNINJ17SBLSMGFAMEHB.PDF"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","Yes","81-3569969","52944NJ0040002","Choice PPO Premium","52944NJ004","7962405180","NJN002","NJS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","52944NJ0040002-00","Choice PPO Premium","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$50 per group",,,,,,"$25","$25 per person","$50 per group","$25","$25 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DNINJ17SBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DNINJ17SBHSMGFAMEHB.PDF"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","Individual","Yes","81-3569969","52944NJ0020003","Select Plan Basic Kids","52944NJ002","7962405180","NJN001","NJS001",,"New","EPO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","52944NJ0020003-01","Select Plan Basic Kids","Standard Low On Exchange Plan","71.6%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18DBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18DBLINDPEDEHB.PDF"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","Individual","Yes","81-3569969","52944NJ0020004","Select Plan Premium Kids","52944NJ002","7962405180","NJN001","NJS001",,"New","EPO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","52944NJ0020004-00","Select Plan Premium Kids","Standard High Off Exchange Plan","85.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18DBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18DBHINDPEDEHB.PDF"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","Individual","Yes","81-3569969","52944NJ0020004","Select Plan Premium Kids","52944NJ002","7962405180","NJN001","NJS001",,"New","EPO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","52944NJ0020004-01","Select Plan Premium Kids","Standard High On Exchange Plan","85.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18DBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18DBHINDPEDEHB.PDF"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","Individual","Yes","81-3569969","52944NJ0010003","Choice PPO Basic Kids","52944NJ001","7962405180","NJN002","NJS002",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","52944NJ0010003-00","Choice PPO Basic Kids","Standard Low Off Exchange Plan","70.1%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18SBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18SBLINDPEDEHB.PDF"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","Individual","Yes","81-3569969","52944NJ0010003","Choice PPO Basic Kids","52944NJ001","7962405180","NJN002","NJS002",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","52944NJ0010003-01","Choice PPO Basic Kids","Standard Low On Exchange Plan","70.1%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18SBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18SBLINDPEDEHB.PDF"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","Individual","Yes","81-3569969","52944NJ0010004","Choice PPO Premium Kids","52944NJ001","7962405180","NJN002","NJS002",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","52944NJ0010004-00","Choice PPO Premium Kids","Standard High Off Exchange Plan","83.3%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$50 per group",,,,,,"$25","$25 per person","$50 per group","$25","$25 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18SBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18SBHINDPEDEHB.PDF"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","Individual","Yes","81-3569969","52944NJ0010004","Choice PPO Premium Kids","52944NJ001","7962405180","NJN002","NJS002",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","52944NJ0010004-01","Choice PPO Premium Kids","Standard High On Exchange Plan","83.3%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$50 per group",,,,,,"$25","$25 per person","$50 per group","$25","$25 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18SBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18SBHINDPEDEHB.PDF"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","Individual","Yes","81-3569969","52944NJ0010001","Choice PPO Basic","52944NJ001","7962405180","NJN002","NJS002",,"New","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","52944NJ0010001-00","Choice PPO Basic","Standard Low Off Exchange Plan","70.1%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18SBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18SBLINDFAMEHB.PDF"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","Yes","81-3569969","52944NJ0040003","Choice PPO Plus","52944NJ004","7962405180","NJN002","NJS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","52944NJ0040003-00","Choice PPO Plus","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$50 per group",,,,,,"$25","$25 per person","$50 per group","$25","$25 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DNINJ17SBLSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DNINJ17SBLSMGFAMEHB.PDF"
"2018","NJ","52944","HIOS","2017-11-01 02:20:20","Individual","Yes","81-3569969","52944NJ0010001","Choice PPO Basic","52944NJ001","7962405180","NJN002","NJS002",,"New","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","52944NJ0010001-01","Choice PPO Basic","Standard Low On Exchange Plan","70.1%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18SBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNNJ18SBLINDFAMEHB.PDF"
"2018","NJ","72667","HIOS","2017-06-02 02:20:22","SHOP (Small Group)","Yes","36-0883760","72667NJ0040002","EHB High PPO","72667NJ004",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","72667NJ0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2018","NJ","72667","HIOS","2017-06-02 02:20:22","SHOP (Small Group)","Yes","36-0883760","72667NJ0040001","EHB Low PPO","72667NJ004",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","72667NJ0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2018","NJ","72667","HIOS","2017-06-02 02:20:22","SHOP (Small Group)","Yes","36-0883760","72667NJ0030002","EHB High Passive","72667NJ003",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","72667NJ0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2018","NJ","72667","HIOS","2017-06-02 02:20:22","SHOP (Small Group)","Yes","36-0883760","72667NJ0030001","EHB Low Passive","72667NJ003",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","72667NJ0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2018","NJ","77606","HIOS","2017-11-02 02:20:21","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9983",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040001-00","IHC Silver HMO Local Value $50/$75","Standard Silver Off Exchange Plan",,"0.715971056497919","Yes","Yes","No","100%",,"$2,500","$50","$4,300","$10","$0","$500","$2,800","$60","$1,500","$300","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC217V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","77606","HIOS","2017-11-02 02:20:21","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9983",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040001-01","IHC Silver HMO Local Value $50/$75","Standard Silver On Exchange Plan",,"0.715971056497919","Yes","Yes","No","100%",,"$2,500","$50","$4,300","$10","$0","$500","$2,800","$60","$1,500","$300","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC217V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","77606","HIOS","2017-11-02 02:20:21","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9983",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040001-02","IHC Silver HMO Local Value Zero Dollar","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHCVZERO217.pdf",
"2018","NJ","77606","HIOS","2017-11-02 02:20:21","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9983",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040001-03","IHC Silver HMO Local Value $50/$75 Limited","Limited Cost Sharing Plan Variation",,"0.715971056497919","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC217VLTD.pdf",
"2018","NJ","77606","HIOS","2017-11-02 02:20:21","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9983",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040001-04","IHC Silver HMO Local Value $50/$75","73% AV Level Silver Plan",,"0.736229736519178","Yes","Yes","No","100%",,"$2,500","$50","$3100","$10","$0","$500","$2,800","$60","$1,500","$300","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC217V73.pdf",
"2018","NJ","77606","HIOS","2017-11-02 02:20:21","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9983",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040001-05","IHC Silver HMO Local Value $30/$60","87% AV Level Silver Plan",,"0.860667251283759","Yes","Yes","No","100%",,"$1,000","$50","$800","$10","$0","$300","$1,600","$60","$1,000","$300","$90","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC217V87.pdf",
"2018","NJ","77606","HIOS","2017-11-02 02:20:21","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9983",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040001-06","IHC Silver HMO Local Value $15/$30","94% AV Level Silver Plan",,"0.9302777452317","Yes","Yes","No","100%",,"$250","$0","$600","$10","$0","$90","$700","$60","$250","$200","$300","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC217V94.pdf",
"2018","NJ","77606","HIOS","2017-11-02 02:20:21","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred  $50/$75","77606NJ004",,"NJN001","NJS001","NJF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9987",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040065-00","IHC Silver HMO Regional Preferred  $50/$75","Standard Silver Off Exchange Plan",,"0.715971056497919","Yes","Yes","No","100%",,"$2,500","$50","$4,300","$10","$0","$500","$2,800","$60","$1,500","$300","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC217P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","77606","HIOS","2017-11-02 02:20:21","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred  $50/$75","77606NJ004",,"NJN001","NJS001","NJF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9987",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040065-01","IHC Silver HMO Regional Preferred  $50/$75","Standard Silver On Exchange Plan",,"0.715971056497919","Yes","Yes","No","100%",,"$2,500","$50","$4,300","$10","$0","$500","$2,800","$60","$1,500","$300","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC217P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","77606","HIOS","2017-11-02 02:20:21","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred  $50/$75","77606NJ004",,"NJN001","NJS001","NJF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9987",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040065-05","IHC Silver HMO Regional Preferred $30/$60","87% AV Level Silver Plan",,"0.860667251283759","Yes","Yes","No","100%",,"$1,000","$50","$800","$10","$0","$300","$1,600","$60","$1,000","$300","$90","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC217P87.pdf",
"2018","NJ","77606","HIOS","2017-11-02 02:20:21","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred  $50/$75","77606NJ004",,"NJN001","NJS001","NJF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9987",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040065-06","IHC Silver HMO Regional Preferred $15/$30","94% AV Level Silver Plan",,"0.9302777452317","Yes","Yes","No","100%",,"$250","$0","$600","$10","$0","$90","$700","$60","$250","$200","$300","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC217P94.pdf",
"2018","NJ","77606","HIOS","2017-11-02 02:20:21","Individual","No","23-2314460","77606NJ0040066","IHC Gold HMO Regional Preferred $15/$30","77606NJ004",,"NJN001","NJS001","NJF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9983",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040066-00","IHC Gold HMO Regional Preferred $15/$30","Standard Gold Off Exchange Plan",,"0.816438695859194","No","Yes","No","100%",,"$2,000","$50","$2,600","$10","$0","$400","$2,500","$60","$800","$200","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC315P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","77606","HIOS","2017-11-02 02:20:21","Individual","No","23-2314460","77606NJ0040066","IHC Gold HMO Regional Preferred $15/$30","77606NJ004",,"NJN001","NJS001","NJF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9983",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040066-01","IHC Gold HMO Regional Preferred $15/$30","Standard Gold On Exchange Plan",,"0.816438695859194","No","Yes","No","100%",,"$2,000","$50","$2,600","$10","$0","$400","$2,500","$60","$800","$200","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC315P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","77606","HIOS","2017-11-02 02:20:21","Individual","No","23-2314460","77606NJ0040066","IHC Gold HMO Regional Preferred $15/$30","77606NJ004",,"NJN001","NJS001","NJF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9983",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040066-02","IHC Gold HMO Regional Preferred Zero Dollar","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC315PZERO315.pdf",
"2018","NJ","77606","HIOS","2017-11-02 02:20:21","Individual","No","23-2314460","77606NJ0040066","IHC Gold HMO Regional Preferred $15/$30","77606NJ004",,"NJN001","NJS001","NJF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9983",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","77606NJ0040066-03","IHC Gold HMO Regional Preferred $15/$30 Limited","Limited Cost Sharing Plan Variation",,"0.816438695859194","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC315PLTD.pdf",
"2018","NJ","79370","HIOS","2017-06-02 02:20:22","SHOP (Small Group)","Yes","42-0127290","79370NJ0040001","Principal Plan Dental 70","79370NJ004",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"0.81","Estimated Rate","2018-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","79370NJ0040001-00","Principal Plan Dental 70","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","79422","HIOS","2017-07-25 02:20:16","SHOP (Small Group)","Yes","33-0733552","79422NJ0010001","EHB Basic Dental Plan (Low)","79422NJ001",,"NJN001","NJS001",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","79422NJ0010001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340001","OMNIA Bronze HSA","91661NJ234",,"NJN002","NJS001","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.998",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340001-03","OMNIA Bronze HSA","Limited Cost Sharing Plan Variation",,"0.63791533323247","Yes","Yes","Yes","74%","26%","$3,000","$1,410","$100","$60","$3,000","$340","$2,993","$55","$1,343","$270","$312","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50.00%","$3,000","per person not applicable","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://horizonblue.com/2018/sbc-omnia-bronze-limited-cost","http://horizonblue.com/2018/brochure-omnia-bronze-limited-cost"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","Yes","22-0999690","91661NJ2330001","Horizon Young Grins","91661NJ233",,"NJN003","NJS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"No",,"No",,"No",,"","91661NJ2330001-00","Horizon Young Grins","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9987",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270001-00","Horizon Advantage EPO Silver","Standard Silver Off Exchange Plan",,"0.699608585475824","No","Yes","No","100%",,"$2,120","$750","$4,480","$60","$0","$1,315","$1,791","$55","$693","$320","$693","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2018/sbc-advantage-epo-silver-standard","http://horizonblue.com/2018/brochure-advantage-epo-silver"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2290002","Direct Access Gold 100/80/60 BlueCard","91661NJ229",,"NJN001","NJS001","NJF010","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9987",,,"2018-01-01",,"No",,"Yes","Offers out of network coverage","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2290002-00","Direct Access Gold 100/80/60 BlueCard","Standard Gold Off Exchange Plan",,"0.816874814710424","Yes","Yes","No","100%",,"$1,500","$20","$590","$150","$1,130","$600","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2018/sbc-advantage-Direct-access-100-80-60","http://horizonblue.com/2018/brochure-advantage-Direct-access-100-80-60"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","Yes","22-0999690","91661NJ2310001","Horizon Young Grins","91661NJ231",,"NJN003","NJS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No",,"","91661NJ2310001-00","Horizon Young Grins","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","Yes","22-0999690","91661NJ2310001","Horizon Young Grins","91661NJ231",,"NJN003","NJS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No",,"","91661NJ2310001-01","Horizon Young Grins","Standard High On Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2290002","Direct Access Gold 100/80/60 BlueCard","91661NJ229",,"NJN001","NJS001","NJF010","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9987",,,"2018-01-01",,"No",,"Yes","Offers out of network coverage","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2290002-01","Direct Access Gold 100/80/60 BlueCard","Standard Gold On Exchange Plan",,"0.816874814710424","Yes","Yes","No","100%",,"$1,500","$20","$590","$150","$1,130","$600","$450","$80","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2018/sbc-advantage-Direct-access-100-80-60","http://horizonblue.com/2018/brochure-advantage-Direct-access-100-80-60"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9987",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270001-01","Horizon Advantage EPO Silver","Standard Silver On Exchange Plan",,"0.699608585475824","No","Yes","No","100%",,"$2,120","$750","$4,480","$60","$0","$1,315","$1,791","$55","$693","$320","$693","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2018/sbc-advantage-epo-silver-standard","http://horizonblue.com/2018/brochure-advantage-epo-silver"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9987",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270001-02","Horizon Advantage EPO Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2018/sbc-advantage-epo-silver-Zero-cost","http://horizonblue.com/2018/brochure-advantage-epo-silver-zero-cost"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9987",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270001-03","Horizon Advantage EPO Silver","Limited Cost Sharing Plan Variation",,"0.699608585475824","No","Yes","No","100%",,"$2,120","$750","$4,480","$60","$0","$1,315","$1,791","$55","$693","$320","$693","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2018/sbc-advantage-epo-silver-limited-cost","http://horizonblue.com/2018/brochure-advantage-epo-silver-limited-cost"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9987",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270001-04","Horizon Advantage EPO Silver","73% AV Level Silver Plan",,"0.739047743846469","No","Yes","No","100%",,"$1,516","$750","$3,584","$60","$0","$1,275","$1,433","$55","$831","$300","$554","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2018/sbc-advantage-epo-silver-73av-level","http://horizonblue.com/2018/brochure-advantage-epo-silver-73av-level"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9987",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270001-05","Horizon Advantage EPO Silver","87% AV Level Silver Plan",,"0.876431367323629","No","Yes","No","100%",,"$0","$300","$1,700","$60","$0","$445","$716","$55","$750","$160","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2018/sbc-advantage-epo-silver-87av-level","http://horizonblue.com/2018/brochure-advantage-epo-silver-87av-level"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9987",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270001-06","Horizon Advantage EPO Silver","94% AV Level Silver Plan",,"0.941835285535976","No","Yes","No","100%",,"$0","$400","$896","$60","$0","$445","$358","$55","$0","$160","$139","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2018/sbc-advantage-epo-silver-94av-level","http://horizonblue.com/2018/brochure-advantage-epo-silver-94av-level"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","Yes","22-0999690","91661NJ2330003","Horizon Family Grins","91661NJ233",,"NJN003","NJS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.459","Estimated Rate","2018-01-01",,"No",,"No",,"No",,"","91661NJ2330003-00","Horizon Family Grins","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","Yes","22-0999690","91661NJ2310003","Horizon Family Grins","91661NJ231",,"NJN003","NJS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.521","Guaranteed Rate","2018-01-01",,"No",,"No",,"No",,"","91661NJ2310003-00","Horizon Family Grins","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","Yes","22-0999690","91661NJ2310003","Horizon Family Grins","91661NJ231",,"NJN003","NJS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.521","Guaranteed Rate","2018-01-01",,"No",,"No",,"No",,"","91661NJ2310003-01","Horizon Family Grins","Standard High On Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2300001","Advantage EPO Gold 100  $25/$45","91661NJ230",,"NJN001","NJS001","NJF008","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9987",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2300001-01","Advantage EPO Gold 100  $25/$45","Standard Gold On Exchange Plan",,"0.789359009097387","No","Yes","No","100%",,"$0","$1,460","$0","$60","$0","$2,565","$0","$55","$0","$280","$18","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://horizonblue.com/2018/sbc-advantage-epo-100-25-45","http://horizonblue.com/2018/brochure-advantage-epo-100-25-45"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2270002","Horizon Advantage EPO Bronze","91661NJ227",,"NJN001","NJS001","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9984",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270002-01","Horizon Advantage EPO Bronze","Standard Bronze On Exchange Plan",,"0.647990350541493","Yes","Yes","No","100%",,"$3,000","$560","$1,297","$60","$3,000","$240","$3,129","$55","$855","$120","$855","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2018/sbc-advantage-epo-bronze-standard","http://horizonblue.com/2018/brochure-advantage-epo-bronze"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2270002","Horizon Advantage EPO Bronze","91661NJ227",,"NJN001","NJS001","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9984",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270002-02","Horizon Advantage EPO Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2018/sbc-advantage-epo-bronze-zero-cost","http://horizonblue.com/2018/brochure-advantage-epo-bronze-zero-cost"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2270002","Horizon Advantage EPO Bronze","91661NJ227",,"NJN001","NJS001","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9984",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2270002-03","Horizon Advantage EPO Bronze","Limited Cost Sharing Plan Variation",,"0.647990350541493","Yes","Yes","No","100%",,"$3,000","$560","$1,297","$60","$3,000","$240","$3,129","$55","$855","$120","$855","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2018/sbc-advantage-epo-bronze-limited-cost","http://horizonblue.com/2018/brochure-advantage-epo-bronze-limited-cost"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340001","OMNIA Bronze HSA","91661NJ234",,"NJN002","NJS001","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.998",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340001-00","OMNIA Bronze HSA","Standard Bronze Off Exchange Plan",,"0.63791533323247","Yes","Yes","Yes","74%","26%","$3,000","$1,410","$100","$60","$3,000","$340","$2,993","$55","$1,343","$270","$312","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50.00%","$3,000","per person not applicable","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://horizonblue.com/2018/sbc-omnia-bronze-standard","http://horizonblue.com/2018/brochure-omnia-bronze"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2300003","Advantage EPO Gold 100/80","91661NJ230",,"NJN001","NJS001","NJF009","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9986",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2300003-00","Advantage EPO Gold 100/80","Standard Gold Off Exchange Plan",,"0.814568003611597","Yes","Yes","No","100%",,"$500","$1,060","$1,792","$60","$0","$1,995","$0","$55","$500","$320","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2018/sbc-advantage-epo-100-80","http://horizonblue.com/2018/brochure-advantage-epo-100-80"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","Yes","22-0999690","91661NJ2330004","Horizon Family Grins Plus","91661NJ233",,"NJN003","NJS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.262","Estimated Rate","2018-01-01",,"No",,"No",,"No",,"","91661NJ2330004-00","Horizon Family Grins Plus","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","Yes","22-0999690","91661NJ2310004","Horizon Family Grins Plus","91661NJ231",,"NJN003","NJS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.292","Guaranteed Rate","2018-01-01",,"No",,"No",,"No",,"","91661NJ2310004-00","Horizon Family Grins Plus","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","Yes","22-0999690","91661NJ2310004","Horizon Family Grins Plus","91661NJ231",,"NJN003","NJS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.292","Guaranteed Rate","2018-01-01",,"No",,"No",,"No",,"","91661NJ2310004-01","Horizon Family Grins Plus","Standard High On Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2300003","Advantage EPO Gold 100/80","91661NJ230",,"NJN001","NJS001","NJF009","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9986",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2300003-01","Advantage EPO Gold 100/80","Standard Gold On Exchange Plan",,"0.814568003611597","Yes","Yes","No","100%",,"$500","$1,060","$1,792","$60","$0","$1,995","$0","$55","$500","$320","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2018/sbc-advantage-epo-100-80","http://horizonblue.com/2018/brochure-advantage-epo-100-80"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340001","OMNIA Bronze HSA","91661NJ234",,"NJN002","NJS001","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.998",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340001-01","OMNIA Bronze HSA","Standard Bronze On Exchange Plan",,"0.63791533323247","Yes","Yes","Yes","74%","26%","$3,000","$1,410","$100","$60","$3,000","$340","$2,993","$55","$1,343","$270","$312","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50.00%","$3,000","per person not applicable","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://horizonblue.com/2018/sbc-omnia-bronze-standard","http://horizonblue.com/2018/brochure-omnia-bronze"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340001","OMNIA Bronze HSA","91661NJ234",,"NJN002","NJS001","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.998",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340001-02","OMNIA Bronze HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","74%","26%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2018/sbc-omnia-bronze-zero-cost","http://horizonblue.com/2018/brochure-omnia-bronze-zero-cost"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9983",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340002-00","OMNIA Silver","Standard Silver Off Exchange Plan",,"0.705046697300152","No","Yes","Yes","78%","22%","$1,500","$1,520","$0","$60","$200","$1,315","$1,791","$55","$1,349","$320","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%","$2,500","$2500 per person","$5000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","50.00%","$200","$200 per person","$400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2018/sbc-omnia-silver-standard","http://horizonblue.com/2018/brochure-omnia-silver"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2300007","Advantage EPO HSA Bronze 100 Compatible","91661NJ230",,"NJN001","NJS001","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9979",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2300007-00","Advantage EPO HSA Bronze 100 Compatible","Standard Bronze Off Exchange Plan",,"0.634475870324568","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://horizonblue.com/2018/sbc-advantage-epo-100-30-50-bronze","http://horizonblue.com/2018/brochure-advantage-epo-100-30-50-bronze"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2300007","Advantage EPO HSA Bronze 100 Compatible","91661NJ230",,"NJN001","NJS001","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9979",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2300007-01","Advantage EPO HSA Bronze 100 Compatible","Standard Bronze On Exchange Plan",,"0.634475870324568","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://horizonblue.com/2018/sbc-advantage-epo-100-30-50-bronze","http://horizonblue.com/2018/brochure-advantage-epo-100-30-50-bronze"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9983",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340002-01","OMNIA Silver","Standard Silver On Exchange Plan",,"0.705046697300152","No","Yes","Yes","78%","22%","$1,500","$1,520","$0","$60","$200","$1,315","$1,791","$55","$1,349","$320","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%","$2,500","$2500 per person","$5000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","50.00%","$200","$200 per person","$400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2018/sbc-omnia-silver-standard","http://horizonblue.com/2018/brochure-omnia-silver"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9983",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340002-02","OMNIA Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","78%","22%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2018/sbc-omnia-silver-zero-cost","http://horizonblue.com/2018/brochure-omnia-silver-zero-cost"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9983",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340002-03","OMNIA Silver","Limited Cost Sharing Plan Variation",,"0.705046697300152","No","Yes","Yes","78%","22%","$1,500","$1,520","$0","$60","$200","$1,315","$1,791","$55","$1,349","$320","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%","$2,500","$2500 per person","$5000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","50.00%","$200","$200 per person","$400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2018/sbc-omnia-silver-limited-cost","http://horizonblue.com/2018/brochure-omnia-silver-limited-cost"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9983",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340002-04","OMNIA Silver","73% AV Level Silver Plan",,"0.737962449777288","No","Yes","Yes","78%","22%","$900","$1,500","$0","$60","$150","$1,315","$1,791","$55","$900","$300","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%","$2,500","$2500 per person","$5000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","50.00%","$150","$150 per person","$300 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2018/sbc-omnia-silver-73av-level","http://horizonblue.com/2018/brochure-omnia-silver-73av-level"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9983",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340002-05","OMNIA Silver","87% AV Level Silver Plan",,"0.865464986877627","No","Yes","Yes","78%","22%","$250","$950","$0","$60","$50","$840","$358","$55","$250","$200","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$2,000","$2000 per person","$4000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","30.00%","$50","$50 per person","$100 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2018/sbc-omnia-silver-87av-level","http://horizonblue.com/2018/brochure-omnia-silver-87av-level"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9983",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340002-06","OMNIA Silver","94% AV Level Silver Plan",,"0.938466760631522","No","Yes","Yes","78%","22%","$75","$425","$0","$60","$50","$312","$138","$55","$100","$120","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%","$1,000","$1000 per person","$2000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","30.00%","$50","$50 per person","$100 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2018/sbc-omnia-silver-94av-level","http://horizonblue.com/2018/brochure-omnia-silver-94av-level"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9982",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340003-00","OMNIA Silver HSA","Standard Silver Off Exchange Plan",,"0.691401013452399","Yes","Yes","Yes","77%","23%","$3,380","$450","$2,170","$60","$3,418","$180","$2,402","$55","$1,280","$240","$405","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","per person not applicable","$3600 per group","30%","$2,500","per person not applicable","$5000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://horizonblue.com/2018/sbc-omnia-silver-hsa-standard","http://horizonblue.com/2018/brochure-omnia-silver-hsa"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2300004","Advantage EPO Silver 100/70","91661NJ230",,"NJN001","NJS001","NJF008","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9983",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2300004-00","Advantage EPO Silver 100/70","Standard Silver Off Exchange Plan",,"0.719699970563876","Yes","Yes","No","100%",,"$2,100","$1,060","$2,688","$60","$0","$2,615","$0","$55","$944","$320","$423","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2018/sbc-advantage-epo-100-70","http://horizonblue.com/2018/brochure-advantage-epo-100-70"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2300004","Advantage EPO Silver 100/70","91661NJ230",,"NJN001","NJS001","NJF008","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9983",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2300004-01","Advantage EPO Silver 100/70","Standard Silver On Exchange Plan",,"0.719699970563876","Yes","Yes","No","100%",,"$2,100","$1,060","$2,688","$60","$0","$2,615","$0","$55","$944","$320","$423","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2018/sbc-advantage-epo-100-70","http://horizonblue.com/2018/brochure-advantage-epo-100-70"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9982",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340003-01","OMNIA Silver HSA","Standard Silver On Exchange Plan",,"0.691401013452399","Yes","Yes","Yes","77%","23%","$3,380","$450","$2,170","$60","$3,418","$180","$2,402","$55","$1,280","$240","$405","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","per person not applicable","$3600 per group","30%","$2,500","per person not applicable","$5000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://horizonblue.com/2018/sbc-omnia-silver-hsa-standard","http://horizonblue.com/2018/brochure-omnia-silver-hsa"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9982",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340003-02","OMNIA Silver HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","77%","23%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://horizonblue.com/2018/sbc-omnia-silver-hsa-zero-cost","http://horizonblue.com/2018/brochure-omnia-silver-hsa-zero-cost"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9982",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340003-03","OMNIA Silver HSA","Limited Cost Sharing Plan Variation",,"0.691401013452399","Yes","Yes","Yes","77%","23%","$3,380","$450","$2,170","$60","$3,418","$180","$2,402","$55","$1,280","$240","$405","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","per person not applicable","$3600 per group","30%","$2,500","per person not applicable","$5000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://horizonblue.com/2018/sbc-omnia-silver-hsa-limited-cost","http://horizonblue.com/2018/brochure-omnia-silver-hsa-limited-cost"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9982",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340003-04","OMNIA Silver HSA","73% AV Level Silver Plan",,"0.739569488255087","Yes","Yes","Yes","77%","23%","$3,000","$300","$1,300","$60","$3,000","$110","$1,490","$55","$1,563","$160","$202","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","15%","$2,250","per person not applicable","$4500 per group","40%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://horizonblue.com/2018/sbc-omnia-silver-hsa-73av-level","http://horizonblue.com/2018/brochure-omnia-silver-hsa-73av-level"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9982",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340003-05","OMNIA Silver HSA","87% AV Level Silver Plan",,"0.876611501761228","Yes","Yes","Yes","77%","23%","$1,185","$15","$0","$60","$1,080","$37","$83","$55","$1,069","$0","$131","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","per person not applicable","$1200 per group","10%","$1,500","per person not applicable","$3000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2018/sbc-omnia-silver-hsa-87av-level","http://horizonblue.com/2018/brochure-omnia-silver-hsa-87av-level"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9982",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340003-06","OMNIA Silver HSA","94% AV Level Silver Plan",,"0.941530679968672","Yes","Yes","Yes","77%","23%","$485","$15","$0","$60","$450","$0","$50","$55","$441","$0","$59","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","per person not applicable","$500 per group","10%","$500","per person not applicable","$1000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2018/sbc-omnia-silver-hsa-94av-level","http://horizonblue.com/2018/brochure-omnia-silver-hsa-94av-level"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340004","OMNIA Gold","91661NJ234",,"NJN002","NJS001","NJF004","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9989",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340004-00","OMNIA Gold","Standard Gold Off Exchange Plan",,"0.789861302012799","Yes","Yes","Yes","86%","14%","$1,000","$1,010","$0","$60","$0","$780","$1,433","$55","$1,000","$200","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0%","$2,500","$2500 per person","$5000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2018/sbc-omnia-gold-standard","http://horizonblue.com/2018/brochure-omnia-gold"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2350001","OMNIA Bronze HSA","91661NJ235",,"NJN002","NJS001","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9974",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350001-00","OMNIA Bronze HSA","Standard Bronze Off Exchange Plan",,"0.63791533323247","Yes","Yes","Yes","74%","26%","$5,268","$1,200","$82","$60","$3,493","$340","$2,717","$55","$1,324","$270","$331","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50.00%","$3,000","per person not applicable","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://horizonblue.com/2018/sbc-omnia-bronze-standard-sg","http://horizonblue.com/2018/brochure-omnia-bronze-standard-sg"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2350001","OMNIA Bronze HSA","91661NJ235",,"NJN002","NJS001","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9974",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350001-01","OMNIA Bronze HSA","Standard Bronze On Exchange Plan",,"0.63791533323247","Yes","Yes","Yes","74%","26%","$5,268","$1,200","$82","$60","$3,493","$340","$2,717","$55","$1,324","$270","$331","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50.00%","$3,000","per person not applicable","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://horizonblue.com/2018/sbc-omnia-bronze-standard-sg","http://horizonblue.com/2018/brochure-omnia-bronze-standard-sg"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340004","OMNIA Gold","91661NJ234",,"NJN002","NJS001","NJF004","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9989",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340004-01","OMNIA Gold","Standard Gold On Exchange Plan",,"0.789861302012799","Yes","Yes","Yes","86%","14%","$1,000","$1,010","$0","$60","$0","$780","$1,433","$55","$1,000","$200","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0%","$2,500","$2500 per person","$5000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2018/sbc-omnia-gold-standard","http://horizonblue.com/2018/brochure-omnia-gold"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340004","OMNIA Gold","91661NJ234",,"NJN002","NJS001","NJF004","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9989",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340004-02","OMNIA Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","86%","14%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2018/sbc-omnia-gold-zero-cost","http://horizonblue.com/2018/brochure-omnia-gold-zero-cost"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2340004","OMNIA Gold","91661NJ234",,"NJN002","NJS001","NJF004","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9989",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2340004-03","OMNIA Gold","Limited Cost Sharing Plan Variation",,"0.789861302012799","Yes","Yes","Yes","86%","14%","$1,000","$1,010","$0","$60","$0","$780","$1,433","$55","$1,000","$200","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0%","$2,500","$2500 per person","$5000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2018/sbc-omnia-gold-limited-cost","http://horizonblue.com/2018/brochure-omnia-gold-limited-cost"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2280001","Horizon Advantage EPO Essentials","91661NJ228",,"NJN001","NJS001","NJF005","Existing","EPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9977",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2280001-00","Horizon Advantage EPO Essentials","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,050","$0","$0","$55","$1,925","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2018/sbc-advantage-epo-essentials","http://horizonblue.com/2018/brochure-advantage-epo-essentials"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2350002","OMNIA Silver","91661NJ235",,"NJN002","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9979",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350002-00","OMNIA Silver","Standard Silver Off Exchange Plan",,"0.717933001256709","No","Yes","Yes","80%","20%","$1,000","$1,520","$0","$60","$150","$1,315","$1,791","$55","$1,000","$320","$18","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$2,500","$2500 per person","$5000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","50.00%","$150","$150 per person","$300 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://horizonblue.com/2018/sbc-omnia-silver-standard-sg","http://horizonblue.com/2018/brochure-omnia-silver-standard-sg"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2350002","OMNIA Silver","91661NJ235",,"NJN002","NJS001","NJF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9979",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350002-01","OMNIA Silver","Standard Silver On Exchange Plan",,"0.717933001256709","No","Yes","Yes","80%","20%","$1,000","$1,520","$0","$60","$150","$1,315","$1,791","$55","$1,000","$320","$18","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$2,500","$2500 per person","$5000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","50.00%","$150","$150 per person","$300 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://horizonblue.com/2018/sbc-omnia-silver-standard-sg","http://horizonblue.com/2018/brochure-omnia-silver-standard-sg"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","Individual","No","22-0999690","91661NJ2280001","Horizon Advantage EPO Essentials","91661NJ228",,"NJN001","NJS001","NJF005","Existing","EPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9977",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2280001-01","Horizon Advantage EPO Essentials","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,050","$0","$0","$55","$1,925","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2018/sbc-advantage-epo-essentials","http://horizonblue.com/2018/brochure-advantage-epo-essentials"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2350003","OMNIA Silver HSA","91661NJ235",,"NJN002","NJS001","NJF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9977",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350003-00","OMNIA Silver HSA","Standard Silver Off Exchange Plan",,"0.716073791500478","Yes","Yes","Yes","77%","23%","$3,600","$380","$1,358","$60","$3,600","$110","$1,790","$55","$1,544","$160","$221","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","per person not applicable","$3600 per group","15.00%","$2,500","per person not applicable","$5000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://horizonblue.com/2018/sbc-omnia-silver-hsa-standard-sg","http://horizonblue.com/2018/brochure-omnia-silver-hsa-standard-sg"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2350003","OMNIA Silver HSA","91661NJ235",,"NJN002","NJS001","NJF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9977",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350003-01","OMNIA Silver HSA","Standard Silver On Exchange Plan",,"0.716073791500478","Yes","Yes","Yes","77%","23%","$3,600","$380","$1,358","$60","$3,600","$110","$1,790","$55","$1,544","$160","$221","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","per person not applicable","$3600 per group","15.00%","$2,500","per person not applicable","$5000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://horizonblue.com/2018/sbc-omnia-silver-hsa-standard-sg","http://horizonblue.com/2018/brochure-omnia-silver-hsa-standard-sg"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2350004","OMNIA Gold","91661NJ235",,"NJN002","NJS001","NJF004","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9982",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350004-00","OMNIA Gold","Standard Gold Off Exchange Plan",,"0.817990353169057","Yes","Yes","Yes","86%","14%","$500","$1,010","$0","$60","$0","$780","$1,433","$55","$500","$200","$18","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%","$2,500","$2500 per person","$5000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2018/sbc-omnia-gold-standard-sg","http://horizonblue.com/2018/brochure-omnia-gold-standard-sg"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2350004","OMNIA Gold","91661NJ235",,"NJN002","NJS001","NJF004","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9982",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350004-01","OMNIA Gold","Standard Gold On Exchange Plan",,"0.817990353169057","Yes","Yes","Yes","86%","14%","$500","$1,010","$0","$60","$0","$780","$1,433","$55","$500","$200","$18","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%","$2,500","$2500 per person","$5000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2018/sbc-omnia-gold-standard-sg","http://horizonblue.com/2018/brochure-omnia-gold-standard-sg"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2350005","OMNIA Platinum","91661NJ235",,"NJN002","NJS001","NJF007","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9985",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350005-00","OMNIA Platinum","Standard Platinum Off Exchange Plan",,"0.916385402364372","Yes","Yes","Yes","86%","14%","$0","$595","$0","$60","$0","$435","$358","$55","$0","$105","$18","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$2,750","$2750 per person","$5500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","0%","$1,000","$1000 per person","$2000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2018/sbc-omnia-platinum-standard-sg","http://horizonblue.com/2018/brochure-omnia-platinum-standard-sg"
"2018","NJ","91661","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","22-0999690","91661NJ2350005","OMNIA Platinum","91661NJ235",,"NJN002","NJS001","NJF007","Existing","EPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9985",,,"2018-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_NJ_3T_HealthInsuranceMarketplaceClassicDL.pdf","91661NJ2350005-01","OMNIA Platinum","Standard Platinum On Exchange Plan",,"0.916385402364372","Yes","Yes","Yes","86%","14%","$0","$595","$0","$60","$0","$435","$358","$55","$0","$105","$18","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$2,750","$2750 per person","$5500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","0%","$1,000","$1000 per person","$2000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2018/sbc-omnia-platinum-standard-sg","http://horizonblue.com/2018/brochure-omnia-platinum-standard-sg"
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO HSA Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9997",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070006-04","IHC Silver EPO HSA Local Value $50/$75","73% AV Level Silver Plan",,"0.738185105892133","Yes","Yes","No","100%",,"$1,550","$1,100","$0","$10","$1,550","$400","$2,200","$60","$1,550","$200","$20","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$3100 per person","$3100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC220V73.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO HSA Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9997",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070006-05","IHC Silver EPO Local Value $35/$60","87% AV Level Silver Plan",,"0.861827661539257","Yes","Yes","No","100%",,"$500","$800","$0","$10","$500","$300","$800","$60","$500","$300","$100","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC220V87.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO HSA Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9997",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070006-06","IHC Silver EPO Local Value $15/$30","94% AV Level Silver Plan",,"0.931085349137648","Yes","Yes","No","100%",,"$200","$500","$0","$10","$200","$100","$400","$60","$200","$200","$200","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC220V94.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO HSA Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9987",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070007-00","IHC Silver EPO HSA Tier 1 Advantage $50/$75","Standard Silver Off Exchange Plan",,"0.695592330618604","Yes","Yes","Yes","50%","50%","$1,500","$30","$2,100","$10","$1,500","$400","$2,200","$60","$1,500","$200","$50","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","50.00%","$1,500","$3000 per person","$3000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC251TIER_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070004","IHC Bronze EPO HSA Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9993",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070004-00","IHC Bronze EPO HSA Tier 1 Advantage $50/$75","Standard Bronze Off Exchange Plan",,"0.636546530782885","Yes","Yes","Yes","50%","50%","$3,000","$1,000","$200","$10","$3,000","$200","$1,800","$60","$1,900","$0","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50.00%","$3,000","$6000 per person","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC151TIER_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","Yes","22-3338404","91762NJ0120001","IHC Pediatric Dental","91762NJ012",,"NJN004","NJS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Same coverage as In-Network","Yes",,"","91762NJ0120001-00","IHC Pediatric Dental","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","Yes","22-3338404","91762NJ0130001","SEH Pediatric Dental","91762NJ013",,"NJN004","NJS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","same coverage as in-network","Yes",,"","91762NJ0130001-00","SEH Pediatric Dental","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070004","IHC Bronze EPO HSA Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9993",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070004-01","IHC Bronze EPO HSA Tier 1 Advantage $50/$75","Standard Bronze On Exchange Plan",,"0.636546530782885","Yes","Yes","Yes","50%","50%","$3,000","$1,000","$200","$10","$3,000","$200","$1,800","$60","$1,900","$0","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50.00%","$3,000","$6000 per person","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC151TIER.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070004","IHC Bronze EPO HSA Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9993",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070004-02","IHC Bronze EPO Tier 1 Advantage Zero Dollar","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","50%","50%","$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHCTIERZERO151.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070004","IHC Bronze EPO HSA Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9993",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070004-03","IHC Bronze EPO HSA Tier 1 Advantage $50/$75 Limited","Limited Cost Sharing Plan Variation",,"0.636546530782885","Yes","Yes","Yes","50%","50%","$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50.00%","$3,000","$6000 per person","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC151TIERLTD.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070097","IHC Bronze EPO HSA AmeriHealth Advantage $25/$50","91762NJ007",,"NJN003","NJS003","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.999",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070097-00","IHC Bronze EPO HSA AmeriHealth Advantage $25/$50","Standard Bronze Off Exchange Plan",,"0.638014558322757","Yes","Yes","Yes","50%","50%","$3,000","$0","$2,900","$10","$3,000","$80","$1,800","$60","$1,900","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%","$3,000","$6000 per person","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC156AA_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","Yes","22-3338404","91762NJ0120002","IHC Pediatric Dental with Adult Preventive","91762NJ012",,"NJN004","NJS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Same coverage as in-network","Yes",,"","91762NJ0120002-00","IHC Pediatric Dental with Adult Preventive","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","Yes","22-3338404","91762NJ0130002","SEH Pediatric Dental with Adult Preventative","91762NJ013",,"NJN004","NJS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","same coverage as in-network","Yes",,"","91762NJ0130002-00","SEH Pediatric Dental with Adult Preventative","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070097","IHC Bronze EPO HSA AmeriHealth Advantage $25/$50","91762NJ007",,"NJN003","NJS003","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.999",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070097-01","IHC Bronze EPO HSA AmeriHealth Advantage $25/$50","Standard Bronze On Exchange Plan",,"0.638014558322757","Yes","Yes","Yes","50%","50%","$3,000","$0","$2,900","$10","$3,000","$80","$1,800","$60","$1,900","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%","$3,000","$6000 per person","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC156AA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070097","IHC Bronze EPO HSA AmeriHealth Advantage $25/$50","91762NJ007",,"NJN003","NJS003","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.999",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070097-02","IHC Bronze EPO AmeriHealth Advantage Zero Dollar","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","50%","50%","$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHCAAZERO156.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070097","IHC Bronze EPO HSA AmeriHealth Advantage $25/$50","91762NJ007",,"NJN003","NJS003","NJF001","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.999",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070097-03","IHC Bronze EPO HSA AmeriHealth Advantage $25/$50 Limited","Limited Cost Sharing Plan Variation",,"0.638014558322757","Yes","Yes","Yes","50%","50%","$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%","$3,000","$6000 per person","$6000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC156AALTD.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO HSA Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9997",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070006-00","IHC Silver EPO HSA Local Value $50/$75","Standard Silver Off Exchange Plan",,"0.717099171732737","Yes","Yes","No","100%",,"$1,800","$1,100","$0","$10","$1,800","$400","$2,100","$60","$1,800","$90","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC220V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","SHOP (Small Group)","Yes","22-3338404","91762NJ0130003","SEH Family Dental","91762NJ013",,"NJN004","NJS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Same coverage as in-network","No",,"","91762NJ0130003-00","SEH Family Dental","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO HSA Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9997",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070006-01","IHC Silver EPO HSA Local Value $50/$75","Standard Silver On Exchange Plan",,"0.717099171732737","Yes","Yes","No","100%",,"$1,800","$1,100","$0","$10","$1,800","$400","$2,100","$60","$1,800","$90","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC220V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO HSA Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9997",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070006-02","IHC Silver EPO Local Value Zero Dollar","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHCVZERO220.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO HSA Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9997",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070006-03","IHC Silver EPO HSA Local Value $50/$75 Limited","Limited Cost Sharing Plan Variation",,"0.717099171732737","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0","$125","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC220VLTD.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO HSA Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9987",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070007-01","IHC Silver EPO HSA Tier 1 Advantage $50/$75","Standard Silver On Exchange Plan",,"0.695592330618604","Yes","Yes","Yes","50%","50%","$1,500","$30","$2,100","$10","$1,500","$400","$2,200","$60","$1,500","$200","$50","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","50.00%","$1,500","$3000 per person","$3000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC251TIER.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO HSA Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9987",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070007-02","IHC Silver EPO Tier 1 Advantage Zero Dollar","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","50%","50%","$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHCTIERZERO251.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN003","NJS003","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9989",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070093-03","IHC Silver EPO AmeriHealth Advantage $15/$35 Limited","Limited Cost Sharing Plan Variation",,"0.717459749611887","No","Yes","Yes","50%","50%","$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%","$2,500","$2500 per person","$5000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC256AALTD.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO HSA Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9987",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070007-03","IHC Silver EPO HSA Tier 1 Advantage $50/$75 Limited","Limited Cost Sharing Plan Variation",,"0.695592330618604","Yes","Yes","Yes","50%","50%","$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","50.00%","$1,500","$3000 per person","$3000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC251TIERLTD.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO HSA Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9987",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070007-04","IHC Silver EPO HSA Tier 1 Advantage $30/$60","73% AV Level Silver Plan",,"0.730570858170319","Yes","Yes","Yes","50%","50%","$1,300","$30","$2,200","$10","$1,300","$400","$2,200","$60","$1,300","$300","$70","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","20.00%","$1,350","$2700 per person","$2700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC251TIER73.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO HSA Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9987",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070007-05","IHC Silver EPO Tier 1 Advantage $20/$40","87% AV Level Silver Plan",,"0.870098409779327","Yes","Yes","Yes","50%","50%","$300","$30","$1,200","$10","$300","$200","$1,100","$60","$300","$200","$200","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%","$300","$300 per person","$600 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC251TIER87.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO HSA Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9987",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070007-06","IHC Silver EPO Tier 1 Advantage $15/$30","94% AV Level Silver Plan",,"0.93427109710483","Yes","Yes","Yes","50%","50%","$50","$0","$700","$10","$50","$100","$600","$60","$50","$200","$300","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","10.00%","$50","$50 per person","$100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC251TIER94.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN003","NJS003","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9989",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070093-00","IHC Silver EPO AmeriHealth Advantage $15/$35","Standard Silver Off Exchange Plan",,"0.717459749611887","No","Yes","Yes","50%","50%","$2,500","$30","$1,900","$10","$0","$400","$2,500","$60","$1,700","$70","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%","$2,500","$2500 per person","$5000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC256AA_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN003","NJS003","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9989",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070093-01","IHC Silver EPO AmeriHealth Advantage $15/$35","Standard Silver On Exchange Plan",,"0.717459749611887","No","Yes","Yes","50%","50%","$2,500","$30","$1,900","$10","$0","$400","$2,500","$60","$1,700","$70","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%","$2,500","$2500 per person","$5000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC256AA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN003","NJS003","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9989",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070093-02","IHC Silver EPO AmeriHealth Advantage Zero Dollar","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","50%","50%","$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHCAAZERO256.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN003","NJS003","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9989",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070093-04","IHC Silver EPO AmeriHealth Advantage $15/$35","73% AV Level Silver Plan",,"0.738072249362608","No","Yes","Yes","50%","50%","$2,500","$30","$1,900","$10","$0","$400","$2,500","$60","$1,700","$70","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20.00%","$2,500","$2500 per person","$5000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC256AA73.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN003","NJS003","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9989",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070093-05","IHC Silver EPO AmeriHealth Advantage $15/$35","87% AV Level Silver Plan",,"0.861895951202637","No","Yes","Yes","50%","50%","$750","$0","$1,100","$10","$0","$300","$1,500","$60","$750","$70","$200","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC256AA87.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN003","NJS003","NJF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9989",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070093-06","IHC Silver EPO AmeriHealth Advantage $15/$35","94% AV Level Silver Plan",,"0.932693665694318","No","Yes","Yes","50%","50%","$200","$0","$500","$10","$0","$100","$600","$60","$200","$70","$400","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10.00%","$200","$200 per person","$400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC256AA94.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070095","IHC Silver EPO Regional Preferred $30/$60","91762NJ007",,"NJN001","NJS001","NJF001","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.999",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070095-00","IHC Silver EPO Regional Preferred $30/$60","Standard Silver Off Exchange Plan",,"0.714577639768986","No","Yes","No","100%",,"$2,500","$0","$4,600","$10","$0","$300","$2,800","$60","$1,500","$300","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC294P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070095","IHC Silver EPO Regional Preferred $30/$60","91762NJ007",,"NJN001","NJS001","NJF001","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.999",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070095-01","IHC Silver EPO Regional Preferred $30/$60","Standard Silver On Exchange Plan",,"0.714577639768986","No","Yes","No","100%",,"$2,500","$0","$4,600","$10","$0","$300","$2,800","$60","$1,500","$300","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC294P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070095","IHC Silver EPO Regional Preferred $30/$60","91762NJ007",,"NJN001","NJS001","NJF001","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.999",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070095-02","IHC Silver EPO Regional Preferred Zero Dollar","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHCZERO294P.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070095","IHC Silver EPO Regional Preferred $30/$60","91762NJ007",,"NJN001","NJS001","NJF001","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.999",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070095-03","IHC Silver EPO Regional Preferred $30/$60 Limited","Limited Cost Sharing Plan Variation",,"0.714577639768986","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC294PLTD.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070095","IHC Silver EPO Regional Preferred $30/$60","91762NJ007",,"NJN001","NJS001","NJF001","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.999",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070095-04","IHC Silver EPO Regional Preferred $30/$60","73% AV Level Silver Plan",,"0.739921324007984","No","Yes","No","100%",,"$2,500","$0","$3,400","$10","$0","$300","$2,800","$60","$1,500","$300","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC294P73.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070095","IHC Silver EPO Regional Preferred $30/$60","91762NJ007",,"NJN001","NJS001","NJF001","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.999",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070095-05","IHC Silver EPO Regional Preferred $15/$30","87% AV Level Silver Plan",,"0.861120411577838","No","Yes","No","100%",,"$1,000","$0","$1,300","$10","$0","$100","$2,100","$60","$1,000","$100","$100","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC294P87.pdf",
"2018","NJ","93627","HIOS","2017-05-16 02:20:17","Individual","Yes","13-5123390","93627NJ0140002","Guardian Essentials for Families and Individuals","93627NJ014",,"NJN002","NJS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","93627NJ0140002-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/new-jersey/","https://dentalexchange.guardianlife.com/our-plans/new-jersey/"
"2018","NJ","93627","HIOS","2017-05-16 02:20:17","SHOP (Small Group)","Yes","13-5123390","93627NJ0020002","Guardian Pediatric Advantage","93627NJ002",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","93627NJ0020002-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","93627","HIOS","2017-05-16 02:20:17","SHOP (Small Group)","Yes","13-5123390","93627NJ0030002","Guardian Pediatric Essentials","93627NJ003",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","93627NJ0030002-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NJ","93627","HIOS","2017-05-16 02:20:17","Individual","Yes","13-5123390","93627NJ0140002","Guardian Essentials for Families and Individuals","93627NJ014",,"NJN002","NJS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","93627NJ0140002-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/new-jersey/","https://dentalexchange.guardianlife.com/our-plans/new-jersey/"
"2018","NJ","93627","HIOS","2017-05-16 02:20:17","Individual","Yes","13-5123390","93627NJ0150002","Guardian Select for Families and Individuals","93627NJ015",,"NJN002","NJS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","93627NJ0150002-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/new-jersey/","https://dentalexchange.guardianlife.com/our-plans/new-jersey/"
"2018","NJ","93627","HIOS","2017-05-16 02:20:17","Individual","Yes","13-5123390","93627NJ0150002","Guardian Select for Families and Individuals","93627NJ015",,"NJN002","NJS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","93627NJ0150002-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/new-jersey/","https://dentalexchange.guardianlife.com/our-plans/new-jersey/"
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070095","IHC Silver EPO Regional Preferred $30/$60","91762NJ007",,"NJN001","NJS001","NJF001","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.999",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070095-06","IHC Silver EPO Regional Preferred $10/$20","94% AV Level Silver Plan",,"0.932284101869408","No","Yes","No","100%",,"$500","$0","$300","$10","$0","$60","$700","$60","$500","$40","$300","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC294P94.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070010","IHC Gold EPO Regional Preferred $30/$50/80% Coins","91762NJ007",,"NJN001","NJS001","NJF004","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070010-00","IHC Gold EPO Regional Preferred $30/$50/80% Coins","Standard Gold Off Exchange Plan",,"0.818775561349882","No","Yes","No","100%",,"$1,000","$80","$2,100","$10","$0","$500","$2,100","$60","$800","$300","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC303P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070010","IHC Gold EPO Regional Preferred $30/$50/80% Coins","91762NJ007",,"NJN001","NJS001","NJF004","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070010-01","IHC Gold EPO Regional Preferred $30/$50/80% Coins","Standard Gold On Exchange Plan",,"0.818775561349882","No","Yes","No","100%",,"$1,000","$80","$2,100","$10","$0","$500","$2,100","$60","$800","$300","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC303P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070010","IHC Gold EPO Regional Preferred $30/$50/80% Coins","91762NJ007",,"NJN001","NJS001","NJF004","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070010-02","IHC Gold EPO Regional Preferred Zero Dollar","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHCPZERO303.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070010","IHC Gold EPO Regional Preferred $30/$50/80% Coins","91762NJ007",,"NJN001","NJS001","NJF004","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070010-03","IHC Gold EPO Regional Preferred $30/$50/80% Coins Limited","Limited Cost Sharing Plan Variation",,"0.818775561349882","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0","$125","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC303PLTD.pdf",
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070014","IHC Local Value Simple Saver","91762NJ007",,"NJN002","NJS002","NJF005","Existing","EPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9989",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070014-00","IHC Local Value Simple Saver","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$6,700","$90","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC501VSMPS_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","91762","HIOS","2017-11-02 02:20:21","Individual","No","22-3338404","91762NJ0070014","IHC Local Value Simple Saver","91762NJ007",,"NJN002","NJS002","NJF005","Existing","EPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9989",,,"2018-01-01",,"No",,"Yes","Emergency Care is covered outside the service area.","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/formulary","91762NJ0070014-01","IHC Local Value Simple Saver","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$6,700","$90","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.amerihealthnj.com/Resources/pdfs/sbcs/2018_IHC501VSMPS.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2018.pdf"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","22-1896118","99708NJ0130017","Delta Dental -Basic PPO Pediatric Essential Health Benefit Addendum","99708NJ013",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0130017-00","Delta Dental -Basic PPO Pediatric Essential Health Benefit Addendum","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","Individual","Yes","22-1896118","99708NJ0120020","Delta Dental Individual-Basic PPO Pediatric Essential Health Benefit","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120020-00","Delta Dental Individual-Basic PPO Pediatric Essential Health Benefit","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_pedbasic.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","Individual","Yes","22-1896118","99708NJ0120020","Delta Dental Individual-Basic PPO Pediatric Essential Health Benefit","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120020-01","Delta Dental Individual-Basic PPO Pediatric Essential Health Benefit","Standard Low On Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_pedbasic.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","22-1896118","99708NJ0130018","Delta Dental-Enhanced PPO Pediatric Essential Health Benefit Addendum","99708NJ013",,"NJN002","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0130018-00","Delta Dental-Enhanced PPO Pediatric Essential Health Benefit Addendum","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","22-1896118","99708NJ0140013","Delta Dental -Basic PPO Plus Premier Pediatric Essential Health Benefit Addendum","99708NJ014",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0140013-00","Delta Dental -Basic PPO Plus Premier Pediatric Essential Health Benefit Addendum","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","Individual","Yes","22-1896118","99708NJ0120021","Delta Dental Individual-Enhanced PPO Pediatric Essential Health Benefit","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120021-00","Delta Dental Individual-Enhanced PPO Pediatric Essential Health Benefit","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_pedenh.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","Individual","Yes","22-1896118","99708NJ0120021","Delta Dental Individual-Enhanced PPO Pediatric Essential Health Benefit","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120021-01","Delta Dental Individual-Enhanced PPO Pediatric Essential Health Benefit","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_pedenh.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","22-1896118","99708NJ0140014","Delta Dental-Enhanced PPO Plus Premier Pediatric Essential Health Benefit Addendum","99708NJ014",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0140014-00","Delta Dental-Enhanced PPO Plus Premier Pediatric Essential Health Benefit Addendum","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","22-1896118","99708NJ0130022","Delta Dental-Basic PPO Pediatric Plan","99708NJ013",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0130022-00","Delta Dental-Basic PPO Pediatric Plan","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","22-1896118","99708NJ0130023","Delta Dental-Enhanced PPO Pediatric Plan","99708NJ013",,"NJN002","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0130023-00","Delta Dental-Enhanced PPO Pediatric Plan","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","22-1896118","99708NJ0140015","Delta Dental-Basic PPO Plus Premier Pediatric Plan","99708NJ014",,"NJN001","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0140015-00","Delta Dental-Basic PPO Plus Premier Pediatric Plan","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","22-1896118","99708NJ0140016","Delta Dental-Enhanced PPO Plus Premier Pediatric Plan","99708NJ014",,"NJN001","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0140016-00","Delta Dental-Enhanced PPO Plus Premier Pediatric Plan","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","22-1896118","99708NJ0130019","Delta Dental - Basic Family PPO Plan I","99708NJ013",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0130019-00","Delta Dental - Basic Family PPO Plan I","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","Individual","Yes","22-1896118","99708NJ0120022","Delta Dental Individual - Basic Family PPO Plan I","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120022-00","Delta Dental Individual - Basic Family PPO Plan I","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_famI.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","Individual","Yes","22-1896118","99708NJ0120022","Delta Dental Individual - Basic Family PPO Plan I","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120022-01","Delta Dental Individual - Basic Family PPO Plan I","Standard Low On Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_famI.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","Individual","Yes","22-1896118","99708NJ0120023","Delta Dental Individual - Basic Family PPO Plan II","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120023-00","Delta Dental Individual - Basic Family PPO Plan II","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_famII.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","22-1896118","99708NJ0130020","Delta Dental  - Basic Family PPO Plan II","99708NJ013",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0130020-00","Delta Dental  - Basic Family PPO Plan II","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","22-1896118","99708NJ0130021","Delta Dental  - Enhanced Family PPO Plan III","99708NJ013",,"NJN002","NJS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0130021-00","Delta Dental  - Enhanced Family PPO Plan III","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$135 per person","$405 per group",,,,,,"$35","$135 per person","$405 per group","$35","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","Individual","Yes","22-1896118","99708NJ0120023","Delta Dental Individual - Basic Family PPO Plan II","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120023-01","Delta Dental Individual - Basic Family PPO Plan II","Standard Low On Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$135","$135 per person","$405 per group",,,,,,"$135","$135 per person","$405 per group","$135","$135 per person","$405 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_famII.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","Individual","Yes","22-1896118","99708NJ0120024","Delta Dental Individual - Enhanced Family PPO Plan III","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120024-00","Delta Dental Individual - Enhanced Family PPO Plan III","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_famIII.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2018","NJ","99708","HIOS","2017-08-10 02:20:26","Individual","Yes","22-1896118","99708NJ0120024","Delta Dental Individual - Enhanced Family PPO Plan III","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120024-01","Delta Dental Individual - Enhanced Family PPO Plan III","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2017_famIII.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans"
"2018","OK","12513","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","12513OK0010001","TruAssure Basic Adult or Child Dental Plan","12513OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12513OK0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OK","https://www.truassure.com/brochure?state=OK"
"2018","OK","12513","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","12513OK0030001","TruAssure Dental Small Group Basic Plan","12513OK003",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","12513OK0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OK","12513","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","12513OK0040001","TruAssure Dental Small Group Preferred Plan","12513OK004",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","12513OK0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OK","12513","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","12513OK0010001","TruAssure Basic Adult or Child Dental Plan","12513OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12513OK0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OK","https://www.truassure.com/brochure?state=OK"
"2018","OK","12513","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","12513OK0020001","TruAssure Preferred Adult or Child Dental Plan","12513OK002",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12513OK0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OK","https://www.truassure.com/brochure?state=OK"
"2018","OK","12513","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","12513OK0020001","TruAssure Preferred Adult or Child Dental Plan","12513OK002",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12513OK0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OK","https://www.truassure.com/brochure?state=OK"
"2018","OK","13711","HIOS","2017-08-11 02:20:28","Individual","Yes","47-0397286","13711OK0020001","Renaissance Individual Dental PPO, EHB Certified","13711OK002",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","13711OK0020001-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OK","13711","HIOS","2017-08-11 02:20:28","Individual","Yes","47-0397286","13711OK0020002","Renaissance Individual Dental PPO, EHB Certified","13711OK002",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","13711OK0020002-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OK","13711","HIOS","2017-08-11 02:20:28","Individual","Yes","47-0397286","13711OK0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","13711OK004",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/13711","","13711OK0040001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/OK_EHB_High_2018","http://www.renaissancedental.com/OK_EHB_High_2018"
"2018","OK","13711","HIOS","2017-08-11 02:20:28","Individual","Yes","47-0397286","13711OK0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","13711OK004",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/13711","","13711OK0040002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/OK_EHB_Low_2018","http://www.renaissancedental.com/OK_EHB_Low_2018"
"2018","OK","13711","HIOS","2017-08-11 02:20:28","Individual","Yes","47-0397286","13711OK0050001","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified (Exchange)","13711OK005",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/13711","","13711OK0050001-01","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/OK_Ped_High_2018","http://www.renaissancedental.com/OK_Ped_High_2018"
"2018","OK","13711","HIOS","2017-08-11 02:20:28","Individual","Yes","47-0397286","13711OK0050002","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified (Exchange)","13711OK005",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/13711","","13711OK0050002-01","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/OK_Ped_Low_2018","http://www.renaissancedental.com/OK_Ped_Low_2018"
"2018","OK","13711","HIOS","2017-08-11 02:20:28","Individual","Yes","47-0397286","13711OK0060001","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified","13711OK006",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","13711OK0060001-00","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OK","13711","HIOS","2017-08-11 02:20:28","Individual","Yes","47-0397286","13711OK0060002","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified","13711OK006",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","13711OK0060002-00","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OK","40254","HIOS","2017-08-09 02:20:31","Individual","Yes","95-6042390","40254OK0020003","BESTOne Advantage Gold","40254OK002",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/current7/OK_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","OK","40254","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","40254OK0010007","BESTDental Premium","40254OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010007-00","BESTDental Premium","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/current/OK_BESTDental_Premium_Plan.pdf"
"2018","OK","40254","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","40254OK0010007","BESTDental Premium","40254OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010007-01","BESTDental Premium","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/current/OK_BESTDental_Premium_Plan.pdf"
"2018","OK","40254","HIOS","2017-08-09 02:20:31","Individual","Yes","95-6042390","40254OK0020003","BESTOne Advantage Gold","40254OK002",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/current7/OK_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","OK","40254","HIOS","2017-08-09 02:20:31","Individual","Yes","95-6042390","40254OK0020004","BESTOne Plus Gold","40254OK002",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/current/OK_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","OK","40254","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","40254OK0010008","BESTDental Standard - H","40254OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/current/OK_BESTDental_Standard-H_Plan.pdf"
"2018","OK","40254","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","40254OK0010008","BESTDental Standard - H","40254OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/current/OK_BESTDental_Standard-H_Plan.pdf"
"2018","OK","40254","HIOS","2017-08-09 02:20:31","Individual","Yes","95-6042390","40254OK0020004","BESTOne Plus Gold","40254OK002",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/current/OK_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","OK","40254","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","40254OK0010010","BESTDental Choice - H","40254OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/current/OK_BESTDental_Choice-H_Plan.pdf"
"2018","OK","40254","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","40254OK0010010","BESTDental Choice - H","40254OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/current/OK_BESTDental_Choice-H_Plan.pdf"
"2018","OK","40254","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","40254OK0010009","BESTDental Standard - L","40254OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/current/OK_BESTDental_Standard-L_Plan.pdf"
"2018","OK","40254","HIOS","2017-08-09 02:20:31","Individual","Yes","95-6042390","40254OK0020005","BESTOne Plus Silver","40254OK002",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/current/OK_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","OK","40254","HIOS","2017-08-09 02:20:31","Individual","Yes","95-6042390","40254OK0020005","BESTOne Plus Silver","40254OK002",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/current/OK_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","OK","40254","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","40254OK0010009","BESTDental Standard - L","40254OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/current/OK_BESTDental_Standard-L_Plan.pdf"
"2018","OK","40254","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","40254OK0010011","BESTDental Choice - L","40254OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/current/OK_BESTDental_Choice-L_Plan.pdf"
"2018","OK","40254","HIOS","2017-08-09 02:20:31","Individual","Yes","95-6042390","40254OK0020006","BESTOne Basic Silver","40254OK002",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/current/OK_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","OK","40254","HIOS","2017-08-09 02:20:31","Individual","Yes","95-6042390","40254OK0020006","BESTOne Basic Silver","40254OK002",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/current/OK_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","OK","40254","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","40254OK0010011","BESTDental Choice - L","40254OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/current/OK_BESTDental_Choice-L_Plan.pdf"
"2018","OK","40254","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","40254OK0010012","BESTDental Value","40254OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/CURRENT/OK_BESTDental_Value_Plan.pdf"
"2018","OK","40254","HIOS","2017-08-09 02:20:31","SHOP (Small Group)","Yes","95-6042390","40254OK0010012","BESTDental Value","40254OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ok/CURRENT/OK_BESTDental_Value_Plan.pdf"
"2018","OK","45689","HIOS","2017-08-12 02:21:25","Individual","Yes","75-1233841","45689OK0010001","Dentegra Dental PPO Pediatric Basic Plan","45689OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","45689OK0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ok/45689ok0010001-18"
"2018","OK","45689","HIOS","2017-08-12 02:21:25","Individual","Yes","75-1233841","45689OK0010008","Dentegra Dental PPO Family Preferred Plan","45689OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","45689OK0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$30","$30 per person","per group not applicable","$30","$30 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ok/45689ok0010008-18"
"2018","OK","45689","HIOS","2017-08-12 02:21:25","Individual","Yes","75-1233841","45689OK0010007","Dentegra Dental PPO Family Basic Plan","45689OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","45689OK0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ok/45689ok0010007-18"
"2018","OK","50184","HIOS","2017-05-17 02:20:17","SHOP (Small Group)","Yes","44-0308260","50184OK0010001","KCL EHB Low PPO","50184OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010001-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OK","50184","HIOS","2017-05-17 02:20:17","SHOP (Small Group)","Yes","44-0308260","50184OK0010003","KCL EHB Low MAC","50184OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010003-00","KCL EHB Low MAC","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OK","50184","HIOS","2017-05-17 02:20:17","SHOP (Small Group)","Yes","44-0308260","50184OK0010005","KCL Fam Low PPO","50184OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010005-00","KCL Fam Low PPO","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OK","50184","HIOS","2017-05-17 02:20:17","SHOP (Small Group)","Yes","44-0308260","50184OK0010007","KCL Fam Low MAC","50184OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010007-00","KCL Fam Low MAC","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OK","50184","HIOS","2017-05-17 02:20:17","SHOP (Small Group)","Yes","44-0308260","50184OK0010002","KCL EHB High PPO","50184OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010002-00","KCL EHB High PPO","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350094","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS052","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350094-02","Blue Advantage Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320088","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS011","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320088-02","Blue Preferred Gold PPO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350087","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS022","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350087-01","Blue Advantage Silver PPO? 204","Standard Silver On Exchange Plan",,"0.666260463091426","Yes","Yes","Yes","43%","57%","$1,400","$400","$5,300","$60","$1,400","$0","$2,100","$60","$1,400","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","$4,200","$4200 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350087","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS022","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350087-02","Blue Advantage Silver PPO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350090","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS052","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350090-03","Blue Advantage Silver PPO? 204","Limited Cost Sharing Plan Variation",,"0.666260463091426","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","$4,200","$4200 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350090","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS052","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350090-04","Blue Advantage Silver PPO? 204","73% AV Level Silver Plan",,"0.72838384242766","Yes","Yes","Yes","43%","57%","$650","$400","$4,800","$60","$650","$0","$2,300","$60","$650","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1950 per group","50.00%","$650","$650 per person","$1950 per group","50.00%","$1,950","$1950 per person","$5850 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-04.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350090","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS052","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350090-05","Blue Advantage Silver PPO? 204","87% AV Level Silver Plan",,"0.869322194606705","Yes","Yes","Yes","43%","57%","$25","$300","$2,200","$60","$25","$0","$1,800","$60","$25","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group","40.00%","$25","$25 per person","$75 per group","40.00%","$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-05.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","50184","HIOS","2017-05-17 02:20:17","SHOP (Small Group)","Yes","44-0308260","50184OK0010004","KCL EHB High MAC","50184OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010004-00","KCL EHB High MAC","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OK","50184","HIOS","2017-05-17 02:20:17","SHOP (Small Group)","Yes","44-0308260","50184OK0010006","KCL Fam High PPO","50184OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010006-00","KCL Fam High PPO","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OK","50184","HIOS","2017-05-17 02:20:17","SHOP (Small Group)","Yes","44-0308260","50184OK0010008","KCL Fam High MAC","50184OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010008-00","KCL Fam High MAC","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OK","60283","HIOS","2017-06-06 02:20:16","SHOP (Small Group)","Yes","13-5581829","60283OK0130001","EHB Basic Dental Plan (Low)","60283OK013",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","60283OK0130001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350070","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS012","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350070-03","Blue Advantage Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350084","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS032","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350084-00","Blue Advantage Bronze PPO? 203","Standard Bronze Off Exchange Plan",,"0.612640453129821","Yes","Yes","Yes","43%","57%","$2,850","$400","$3,300","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$8,550","$8550 per person","$25650 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/sbc/2018/OK0350068-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350088","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS032","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350088-03","Blue Advantage Silver PPO? 204","Limited Cost Sharing Plan Variation",,"0.666260463091426","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","$4,200","$4200 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350088","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS032","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350088-04","Blue Advantage Silver PPO? 204","73% AV Level Silver Plan",,"0.72838384242766","Yes","Yes","Yes","43%","57%","$650","$400","$4,800","$60","$650","$0","$2,300","$60","$650","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1950 per group","50.00%","$650","$650 per person","$1950 per group","50.00%","$1,950","$1950 per person","$5850 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-04.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","77760","HIOS","2017-08-08 02:20:26","Individual","Yes","23-7322578","77760OK0010005","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"For covered persons over the age 18 there is a 6 month wait on Basic services and 12 month wait on Major services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","77760OK0010005-00","Delta Dental PPO Plus Premier - Federally Compliant Plan","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/High2018","https://www.deltadentalok.org/client/marketplace/Brochure/Individual2018"
"2018","OK","77760","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","23-7322578","77760OK0020005","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK002",,"OKN002","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"For covered persons over the age 18 there is a 6 month wait on Type B services and 12 month wait on Type C services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes",,"","77760OK0020005-00","Delta Dental PPO Plus Premier - Federally Compliant Plan","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/SHOP/Combined/High2018","https://www.deltadentalok.org/client/marketplace/Brochure/SHOP2018"
"2018","OK","77760","HIOS","2017-08-08 02:20:26","Individual","Yes","23-7322578","77760OK0010005","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"For covered persons over the age 18 there is a 6 month wait on Basic services and 12 month wait on Major services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","77760OK0010005-01","Delta Dental PPO Plus Premier - Federally Compliant Plan","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/High2018","https://www.deltadentalok.org/client/marketplace/Brochure/Individual2018"
"2018","OK","77760","HIOS","2017-08-08 02:20:26","Individual","Yes","23-7322578","77760OK0010006","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"For covered persons over the age 18 there is a 6 month wait on Basic services and 12 month wait on Major services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","77760OK0010006-00","Delta Dental PPO Plus Premier - Federally Compliant Plan","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/Low2018","https://www.deltadentalok.org/client/marketplace/Brochure/Individual2018"
"2018","OK","77760","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","23-7322578","77760OK0020006","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK002",,"OKN002","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"For covered persons over the age 18 there is a 6 month wait on Type B services and 12 month wait on Type C services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes",,"","77760OK0020006-00","Delta Dental PPO Plus Premier - Federally Compliant Plan","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/SHOP/Combined/Low2018","https://www.deltadentalok.org/client/marketplace/Brochure/SHOP2018"
"2018","OK","77760","HIOS","2017-08-08 02:20:26","Individual","Yes","23-7322578","77760OK0010006","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK001",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"For covered persons over the age 18 there is a 6 month wait on Basic services and 12 month wait on Major services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","77760OK0010006-01","Delta Dental PPO Plus Premier - Federally Compliant Plan","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/Low2018","https://www.deltadentalok.org/client/marketplace/Brochure/Individual2018"
"2018","OK","77760","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","23-7322578","77760OK0040005","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK004",,"OKN002","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"This plan covers children ages 0-18 only.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes",,"","77760OK0040005-00","Delta Dental PPO Plus Premier - Federally Compliant Plan","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/SHOP/Pedo/High2018","https://www.deltadentalok.org/client/marketplace/SBC/SHOP/Pedo/High2018"
"2018","OK","77760","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","23-7322578","77760OK0040006","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK004",,"OKN002","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"This plan covers children ages 0-18 only.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes",,"","77760OK0040006-00","Delta Dental PPO Plus Premier - Federally Compliant Plan","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/SHOP/Pedo/Low2018","https://www.deltadentalok.org/client/marketplace/SBC/SHOP/Pedo/Low2018"
"2018","OK","81457","HIOS","2017-05-23 02:20:17","SHOP (Small Group)","Yes","13-5123390","81457OK0010003","Guardian Pediatric Advantage","81457OK001",,"OKN001","OKS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","81457OK0010003-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OK","81457","HIOS","2017-05-23 02:20:17","SHOP (Small Group)","Yes","13-5123390","81457OK0020003","Guardian Pediatric Essentials","81457OK002",,"OKN001","OKS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","81457OK0020003-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","Yes","36-1236610","87571OK0390001","BlueCare Dental? 1A","87571OK039",,"OKN004","OKS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390001-00","BlueCare Dental? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsok.com/static/ok/pdf/dental/2018/bluecare-dental-individuals-and-families-ok2018.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320079","Blue Preferred Security PPO? 200","87571OK032",,"OKN001","OKS011","OKF002","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320079-00","Blue Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320079-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320079","Blue Preferred Security PPO? 200","87571OK032",,"OKN001","OKS011","OKF002","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320079-01","Blue Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320079-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","Yes","36-1236610","87571OK0390001","BlueCare Dental? 1A","87571OK039",,"OKN004","OKS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390001-01","BlueCare Dental? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsok.com/static/ok/pdf/dental/2018/bluecare-dental-individuals-and-families-ok2018.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320084","Blue Preferred Security PPO? 200","87571OK032",,"OKN001","OKS021","OKF002","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320084-00","Blue Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320079-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320084","Blue Preferred Security PPO? 200","87571OK032",,"OKN001","OKS021","OKF002","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320084-01","Blue Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320079-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320085","Blue Preferred Security PPO? 200","87571OK032",,"OKN001","OKS031","OKF002","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320085-00","Blue Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320079-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320085","Blue Preferred Security PPO? 200","87571OK032",,"OKN001","OKS031","OKF002","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320085-01","Blue Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320079-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320086","Blue Preferred Security PPO? 200","87571OK032",,"OKN001","OKS041","OKF002","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320086-00","Blue Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320079-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320086","Blue Preferred Security PPO? 200","87571OK032",,"OKN001","OKS041","OKF002","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320086-01","Blue Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320079-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320087","Blue Preferred Security PPO? 200","87571OK032",,"OKN001","OKS051","OKF002","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320087-00","Blue Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320079-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320087","Blue Preferred Security PPO? 200","87571OK032",,"OKN001","OKS051","OKF002","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320087-01","Blue Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320079-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350070","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS012","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350070-00","Blue Advantage Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","Yes","36-1236610","87571OK0390003","BlueCare Dental 4 Kids? 1A","87571OK039",,"OKN004","OKS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390003-00","BlueCare Dental 4 Kids? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsok.com/static/ok/pdf/dental/2018/bluecare-dental-individuals-and-families-ok2018.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","Yes","36-1236610","87571OK0390003","BlueCare Dental 4 Kids? 1A","87571OK039",,"OKN004","OKS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390003-01","BlueCare Dental 4 Kids? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsok.com/static/ok/pdf/dental/2018/bluecare-dental-individuals-and-families-ok2018.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350070","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS012","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350070-01","Blue Advantage Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350070","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS012","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350070-02","Blue Advantage Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350091","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS022","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350091-00","Blue Advantage Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350091","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS022","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350091-01","Blue Advantage Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350091","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS022","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350091-02","Blue Advantage Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350091","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS022","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350091-03","Blue Advantage Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350092","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS032","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350092-00","Blue Advantage Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350092","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS032","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350092-01","Blue Advantage Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350092","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS032","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350092-02","Blue Advantage Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350092","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS032","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350092-03","Blue Advantage Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350093","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS042","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350093-00","Blue Advantage Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350093","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS042","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350093-01","Blue Advantage Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350093","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS042","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350093-02","Blue Advantage Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350093","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS042","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350093-03","Blue Advantage Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350094","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS052","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350094-00","Blue Advantage Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350094","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS052","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350094-01","Blue Advantage Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350094","Blue Advantage Bronze PPO? 202","87571OK035",,"OKN002","OKS052","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350094-03","Blue Advantage Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350070-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350068","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS012","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350068-00","Blue Advantage Bronze PPO? 203","Standard Bronze Off Exchange Plan",,"0.612640453129821","Yes","Yes","Yes","43%","57%","$2,850","$400","$3,300","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$8,550","$8550 per person","$25650 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/sbc/2018/OK0350068-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","Yes","36-1236610","87571OK0390002","BlueCare Dental? 1B","87571OK039",,"OKN004","OKS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390002-00","BlueCare Dental? 1B","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsok.com/static/ok/pdf/dental/2018/bluecare-dental-individuals-and-families-ok2018.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","Yes","36-1236610","87571OK0390002","BlueCare Dental? 1B","87571OK039",,"OKN004","OKS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390002-01","BlueCare Dental? 1B","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsok.com/static/ok/pdf/dental/2018/bluecare-dental-individuals-and-families-ok2018.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350068","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS012","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350068-01","Blue Advantage Bronze PPO? 203","Standard Bronze On Exchange Plan",,"0.612640453129821","Yes","Yes","Yes","43%","57%","$2,850","$400","$3,300","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$8,550","$8550 per person","$25650 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/sbc/2018/OK0350068-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350068","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS012","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350068-02","Blue Advantage Bronze PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0350068-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350068","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS012","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350068-03","Blue Advantage Bronze PPO? 203","Limited Cost Sharing Plan Variation",,"0.612640453129821","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$8,550","$8550 per person","$25650 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350068-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350083","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS022","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350083-00","Blue Advantage Bronze PPO? 203","Standard Bronze Off Exchange Plan",,"0.612640453129821","Yes","Yes","Yes","43%","57%","$2,850","$400","$3,300","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$8,550","$8550 per person","$25650 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/sbc/2018/OK0350068-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350083","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS022","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350083-01","Blue Advantage Bronze PPO? 203","Standard Bronze On Exchange Plan",,"0.612640453129821","Yes","Yes","Yes","43%","57%","$2,850","$400","$3,300","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$8,550","$8550 per person","$25650 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/sbc/2018/OK0350068-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350083","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS022","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350083-02","Blue Advantage Bronze PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0350068-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350083","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS022","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350083-03","Blue Advantage Bronze PPO? 203","Limited Cost Sharing Plan Variation",,"0.612640453129821","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$8,550","$8550 per person","$25650 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350068-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350084","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS032","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350084-01","Blue Advantage Bronze PPO? 203","Standard Bronze On Exchange Plan",,"0.612640453129821","Yes","Yes","Yes","43%","57%","$2,850","$400","$3,300","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$8,550","$8550 per person","$25650 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/sbc/2018/OK0350068-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350084","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS032","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350084-02","Blue Advantage Bronze PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0350068-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350084","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS032","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350084-03","Blue Advantage Bronze PPO? 203","Limited Cost Sharing Plan Variation",,"0.612640453129821","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$8,550","$8550 per person","$25650 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350068-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350085","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS042","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350085-00","Blue Advantage Bronze PPO? 203","Standard Bronze Off Exchange Plan",,"0.612640453129821","Yes","Yes","Yes","43%","57%","$2,850","$400","$3,300","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$8,550","$8550 per person","$25650 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/sbc/2018/OK0350068-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350085","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS042","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350085-01","Blue Advantage Bronze PPO? 203","Standard Bronze On Exchange Plan",,"0.612640453129821","Yes","Yes","Yes","43%","57%","$2,850","$400","$3,300","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$8,550","$8550 per person","$25650 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/sbc/2018/OK0350068-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350085","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS042","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350085-02","Blue Advantage Bronze PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0350068-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350085","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS042","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350085-03","Blue Advantage Bronze PPO? 203","Limited Cost Sharing Plan Variation",,"0.612640453129821","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$8,550","$8550 per person","$25650 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350068-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350086","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS052","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350086-00","Blue Advantage Bronze PPO? 203","Standard Bronze Off Exchange Plan",,"0.612640453129821","Yes","Yes","Yes","43%","57%","$2,850","$400","$3,300","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$8,550","$8550 per person","$25650 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/sbc/2018/OK0350068-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350086","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS052","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350086-01","Blue Advantage Bronze PPO? 203","Standard Bronze On Exchange Plan",,"0.612640453129821","Yes","Yes","Yes","43%","57%","$2,850","$400","$3,300","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$8,550","$8550 per person","$25650 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/sbc/2018/OK0350068-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350086","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS052","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350086-02","Blue Advantage Bronze PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0350068-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350086","Blue Advantage Bronze PPO? 203","87571OK035",,"OKN002","OKS052","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350086-03","Blue Advantage Bronze PPO? 203","Limited Cost Sharing Plan Variation",,"0.612640453129821","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$8,550","$8550 per person","$25650 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350068-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320088","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS011","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320088-00","Blue Preferred Gold PPO? 205","Standard Gold Off Exchange Plan",,"0.787259040540668","Yes","Yes","Yes","43%","57%","$200","$400","$4,600","$60","$200","$0","$1,800","$60","$200","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","40.00%","$200","$200 per person","$600 per group","40.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","Yes","36-1236610","87571OK0390004","BlueCare Dental 4 Kids? 1B","87571OK039",,"OKN004","OKS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390004-00","BlueCare Dental 4 Kids? 1B","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsok.com/static/ok/pdf/dental/2018/bluecare-dental-individuals-and-families-ok2018.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","Yes","36-1236610","87571OK0390004","BlueCare Dental 4 Kids? 1B","87571OK039",,"OKN004","OKS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390004-01","BlueCare Dental 4 Kids? 1B","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsok.com/static/ok/pdf/dental/2018/bluecare-dental-individuals-and-families-ok2018.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320088","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS011","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320088-01","Blue Preferred Gold PPO? 205","Standard Gold On Exchange Plan",,"0.787259040540668","Yes","Yes","Yes","43%","57%","$200","$400","$4,600","$60","$200","$0","$1,800","$60","$200","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","40.00%","$200","$200 per person","$600 per group","40.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320088","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS011","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320088-03","Blue Preferred Gold PPO? 205","Limited Cost Sharing Plan Variation",,"0.787259040540668","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","40.00%","$200","$200 per person","$600 per group","40.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320089","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS021","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320089-00","Blue Preferred Gold PPO? 205","Standard Gold Off Exchange Plan",,"0.787259040540668","Yes","Yes","Yes","43%","57%","$200","$400","$4,600","$60","$200","$0","$1,800","$60","$200","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","40.00%","$200","$200 per person","$600 per group","40.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320089","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS021","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320089-01","Blue Preferred Gold PPO? 205","Standard Gold On Exchange Plan",,"0.787259040540668","Yes","Yes","Yes","43%","57%","$200","$400","$4,600","$60","$200","$0","$1,800","$60","$200","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","40.00%","$200","$200 per person","$600 per group","40.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320089","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS021","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320089-02","Blue Preferred Gold PPO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320089","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS021","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320089-03","Blue Preferred Gold PPO? 205","Limited Cost Sharing Plan Variation",,"0.787259040540668","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","40.00%","$200","$200 per person","$600 per group","40.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320090","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS031","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320090-00","Blue Preferred Gold PPO? 205","Standard Gold Off Exchange Plan",,"0.787259040540668","Yes","Yes","Yes","43%","57%","$200","$400","$4,600","$60","$200","$0","$1,800","$60","$200","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","40.00%","$200","$200 per person","$600 per group","40.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320090","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS031","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320090-01","Blue Preferred Gold PPO? 205","Standard Gold On Exchange Plan",,"0.787259040540668","Yes","Yes","Yes","43%","57%","$200","$400","$4,600","$60","$200","$0","$1,800","$60","$200","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","40.00%","$200","$200 per person","$600 per group","40.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320090","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS031","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320090-02","Blue Preferred Gold PPO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320090","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS031","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320090-03","Blue Preferred Gold PPO? 205","Limited Cost Sharing Plan Variation",,"0.787259040540668","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","40.00%","$200","$200 per person","$600 per group","40.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320091","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS041","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320091-00","Blue Preferred Gold PPO? 205","Standard Gold Off Exchange Plan",,"0.787259040540668","Yes","Yes","Yes","43%","57%","$200","$400","$4,600","$60","$200","$0","$1,800","$60","$200","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","40.00%","$200","$200 per person","$600 per group","40.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320091","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS041","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320091-01","Blue Preferred Gold PPO? 205","Standard Gold On Exchange Plan",,"0.787259040540668","Yes","Yes","Yes","43%","57%","$200","$400","$4,600","$60","$200","$0","$1,800","$60","$200","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","40.00%","$200","$200 per person","$600 per group","40.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320091","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS041","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320091-02","Blue Preferred Gold PPO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320091","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS041","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320091-03","Blue Preferred Gold PPO? 205","Limited Cost Sharing Plan Variation",,"0.787259040540668","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","40.00%","$200","$200 per person","$600 per group","40.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320092","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS051","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320092-00","Blue Preferred Gold PPO? 205","Standard Gold Off Exchange Plan",,"0.787259040540668","Yes","Yes","Yes","43%","57%","$200","$400","$4,600","$60","$200","$0","$1,800","$60","$200","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","40.00%","$200","$200 per person","$600 per group","40.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320092","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS051","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320092-01","Blue Preferred Gold PPO? 205","Standard Gold On Exchange Plan",,"0.787259040540668","Yes","Yes","Yes","43%","57%","$200","$400","$4,600","$60","$200","$0","$1,800","$60","$200","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","40.00%","$200","$200 per person","$600 per group","40.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320092","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS051","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320092-02","Blue Preferred Gold PPO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320092","Blue Preferred Gold PPO? 205","87571OK032",,"OKN001","OKS051","OKF004","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320092-03","Blue Preferred Gold PPO? 205","Limited Cost Sharing Plan Variation",,"0.787259040540668","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","40.00%","$200","$200 per person","$600 per group","40.00%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320088-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350069","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS012","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350069-00","Blue Advantage Silver PPO? 204","Standard Silver Off Exchange Plan",,"0.666260463091426","Yes","Yes","Yes","43%","57%","$1,400","$400","$5,300","$60","$1,400","$0","$2,100","$60","$1,400","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","$4,200","$4200 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350069","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS012","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350069-01","Blue Advantage Silver PPO? 204","Standard Silver On Exchange Plan",,"0.666260463091426","Yes","Yes","Yes","43%","57%","$1,400","$400","$5,300","$60","$1,400","$0","$2,100","$60","$1,400","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","$4,200","$4200 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350069","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS012","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350069-02","Blue Advantage Silver PPO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350069","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS012","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350069-03","Blue Advantage Silver PPO? 204","Limited Cost Sharing Plan Variation",,"0.666260463091426","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","$4,200","$4200 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350069","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS012","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350069-04","Blue Advantage Silver PPO? 204","73% AV Level Silver Plan",,"0.72838384242766","Yes","Yes","Yes","43%","57%","$650","$400","$4,800","$60","$650","$0","$2,300","$60","$650","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1950 per group","50.00%","$650","$650 per person","$1950 per group","50.00%","$1,950","$1950 per person","$5850 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-04.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350069","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS012","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350069-05","Blue Advantage Silver PPO? 204","87% AV Level Silver Plan",,"0.869322194606705","Yes","Yes","Yes","43%","57%","$25","$300","$2,200","$60","$25","$0","$1,800","$60","$25","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group","40.00%","$25","$25 per person","$75 per group","40.00%","$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-05.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350069","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS012","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350069-06","Blue Advantage Silver PPO? 204","94% AV Level Silver Plan",,"0.937750314509759","Yes","Yes","Yes","43%","57%","$0","$0","$900","$60","$0","$0","$900","$60","$0","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$2700 per group","$900","$900 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-06.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350087","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS022","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350087-00","Blue Advantage Silver PPO? 204","Standard Silver Off Exchange Plan",,"0.666260463091426","Yes","Yes","Yes","43%","57%","$1,400","$400","$5,300","$60","$1,400","$0","$2,100","$60","$1,400","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","$4,200","$4200 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350087","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS022","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350087-03","Blue Advantage Silver PPO? 204","Limited Cost Sharing Plan Variation",,"0.666260463091426","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","$4,200","$4200 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350087","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS022","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350087-04","Blue Advantage Silver PPO? 204","73% AV Level Silver Plan",,"0.72838384242766","Yes","Yes","Yes","43%","57%","$650","$400","$4,800","$60","$650","$0","$2,300","$60","$650","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1950 per group","50.00%","$650","$650 per person","$1950 per group","50.00%","$1,950","$1950 per person","$5850 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-04.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350087","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS022","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350087-05","Blue Advantage Silver PPO? 204","87% AV Level Silver Plan",,"0.869322194606705","Yes","Yes","Yes","43%","57%","$25","$300","$2,200","$60","$25","$0","$1,800","$60","$25","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group","40.00%","$25","$25 per person","$75 per group","40.00%","$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-05.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350087","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS022","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350087-06","Blue Advantage Silver PPO? 204","94% AV Level Silver Plan",,"0.937750314509759","Yes","Yes","Yes","43%","57%","$0","$0","$900","$60","$0","$0","$900","$60","$0","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$2700 per group","$900","$900 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-06.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350088","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS032","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350088-00","Blue Advantage Silver PPO? 204","Standard Silver Off Exchange Plan",,"0.666260463091426","Yes","Yes","Yes","43%","57%","$1,400","$400","$5,300","$60","$1,400","$0","$2,100","$60","$1,400","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","$4,200","$4200 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350088","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS032","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350088-01","Blue Advantage Silver PPO? 204","Standard Silver On Exchange Plan",,"0.666260463091426","Yes","Yes","Yes","43%","57%","$1,400","$400","$5,300","$60","$1,400","$0","$2,100","$60","$1,400","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","$4,200","$4200 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350088","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS032","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350088-02","Blue Advantage Silver PPO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350088","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS032","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350088-05","Blue Advantage Silver PPO? 204","87% AV Level Silver Plan",,"0.869322194606705","Yes","Yes","Yes","43%","57%","$25","$300","$2,200","$60","$25","$0","$1,800","$60","$25","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group","40.00%","$25","$25 per person","$75 per group","40.00%","$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-05.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350088","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS032","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350088-06","Blue Advantage Silver PPO? 204","94% AV Level Silver Plan",,"0.937797784548604","Yes","Yes","Yes","43%","57%","$0","$0","$900","$60","$0","$0","$900","$60","$0","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$2700 per group","$900","$900 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-06.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320078","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS011","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320078-04","Blue Preferred Silver PPO? 201","73% AV Level Silver Plan",,"0.729156419094505","Yes","Yes","Yes","43%","57%","$1,000","$400","$4,400","$60","$1,000","$200","$1,700","$60","$1,000","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-04.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320078","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS011","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320078-05","Blue Preferred Silver PPO? 201","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,800","$60","$50","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$150","$150 per person","$450 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-05.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090004","CommunityCare PPO Platinum A Select","87698OK009","7912900140","OKN001","OKS001","OKF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090004-01","CommunityCare PPO Platinum A Select","Standard Platinum On Exchange Plan",,"0.897940768062609","Yes","Yes","No","100%",,"$500","$0","$1,200","$80","$0","$1,100","$200","$60","$500","$50","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201887698OK0090004-01&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090004-01"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090008","CommunityCare PPO Gold A Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090008-00","CommunityCare PPO Gold A Select","Standard Gold Off Exchange Plan",,"0.819941331434983","Yes","Yes","No","100%",,"$1,000","$0","$2,000","$80","$1,000","$1,100","$300","$60","$1,000","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","40.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201887698OK0090008-00&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090008-00"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090008","CommunityCare PPO Gold A Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090008-01","CommunityCare PPO Gold A Select","Standard Gold On Exchange Plan",,"0.819941331434983","Yes","Yes","No","100%",,"$1,000","$0","$2,000","$80","$1,000","$1,100","$300","$60","$1,000","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","40.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201887698OK0090008-01&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090008-01"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090007","CommunityCare PPO Gold B Select","87698OK009","7912900140","OKN001","OKS001","OKF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090007-00","CommunityCare PPO Gold B Select","Standard Gold Off Exchange Plan",,"0.819679618165854","Yes","Yes","No","100%",,"$1,500","$10","$3,300","$80","$0","$1,100","$300","$60","$1,500","$70","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201887698OK0090007-00&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090007-00"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350089","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS042","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350089-00","Blue Advantage Silver PPO? 204","Standard Silver Off Exchange Plan",,"0.666260463091426","Yes","Yes","Yes","43%","57%","$1,400","$400","$5,300","$60","$1,400","$0","$2,100","$60","$1,400","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","$4,200","$4200 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350089","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS042","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350089-01","Blue Advantage Silver PPO? 204","Standard Silver On Exchange Plan",,"0.666260463091426","Yes","Yes","Yes","43%","57%","$1,400","$400","$5,300","$60","$1,400","$0","$2,100","$60","$1,400","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","$4,200","$4200 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350089","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS042","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350089-02","Blue Advantage Silver PPO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350089","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS042","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350089-03","Blue Advantage Silver PPO? 204","Limited Cost Sharing Plan Variation",,"0.666260463091426","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","$4,200","$4200 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350089","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS042","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350089-04","Blue Advantage Silver PPO? 204","73% AV Level Silver Plan",,"0.72838384242766","Yes","Yes","Yes","43%","57%","$650","$400","$4,800","$60","$650","$0","$2,300","$60","$650","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1950 per group","50.00%","$650","$650 per person","$1950 per group","50.00%","$1,950","$1950 per person","$5850 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-04.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350089","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS042","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350089-05","Blue Advantage Silver PPO? 204","87% AV Level Silver Plan",,"0.869322194606705","Yes","Yes","Yes","43%","57%","$25","$300","$2,200","$60","$25","$0","$1,800","$60","$25","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group","40.00%","$25","$25 per person","$75 per group","40.00%","$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-05.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350089","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS042","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350089-06","Blue Advantage Silver PPO? 204","94% AV Level Silver Plan",,"0.937797784548604","Yes","Yes","Yes","43%","57%","$0","$0","$900","$60","$0","$0","$900","$60","$0","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$2700 per group","$900","$900 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-06.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350090","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS052","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350090-00","Blue Advantage Silver PPO? 204","Standard Silver Off Exchange Plan",,"0.666260463091426","Yes","Yes","Yes","43%","57%","$1,400","$400","$5,300","$60","$1,400","$0","$2,100","$60","$1,400","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","$4,200","$4200 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350090","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS052","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350090-01","Blue Advantage Silver PPO? 204","Standard Silver On Exchange Plan",,"0.666260463091426","Yes","Yes","Yes","43%","57%","$1,400","$400","$5,300","$60","$1,400","$0","$2,100","$60","$1,400","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","$4,200","$4200 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350090","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS052","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350090-02","Blue Advantage Silver PPO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0350090","Blue Advantage Silver PPO? 204","87571OK035",,"OKN002","OKS052","OKF007","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0350090-06","Blue Advantage Silver PPO? 204","94% AV Level Silver Plan",,"0.937797784548604","Yes","Yes","Yes","43%","57%","$0","$0","$900","$60","$0","$0","$900","$60","$0","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$2700 per group","$900","$900 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0350069-06.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320078","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS011","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320078-00","Blue Preferred Silver PPO? 201","Standard Silver Off Exchange Plan",,"0.687562676199793","Yes","Yes","Yes","43%","57%","$1,450","$500","$5,100","$60","$1,450","$200","$1,500","$60","$1,450","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$4,350","$4350 per person","$13050 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320082","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS041","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320082-00","Blue Preferred Silver PPO? 201","Standard Silver Off Exchange Plan",,"0.687562676199793","Yes","Yes","Yes","43%","57%","$1,450","$500","$5,100","$60","$1,450","$200","$1,500","$60","$1,450","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$4,350","$4350 per person","$13050 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320096","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS041","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320096-00","Blue Preferred  Bronze PPO? 206","Standard Bronze Off Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320096","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS041","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320096-01","Blue Preferred  Bronze PPO? 206","Standard Bronze On Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170030","CommunityCare Gold 6 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170030-00","CommunityCare Gold 6 Select","Standard Gold Off Exchange Plan",,"0.819346255152543","Yes","Yes","No","100%",,"$1,500","$10","$2,200","$80","$0","$1,200","$200","$60","$1,500","$100","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170030-00&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170030-00"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170030","CommunityCare Gold 6 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170030-01","CommunityCare Gold 6 Select","Standard Gold On Exchange Plan",,"0.819346255152543","Yes","Yes","No","100%",,"$1,500","$10","$2,200","$80","$0","$1,200","$200","$60","$1,500","$100","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170030-01&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170030-01"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170035","CommunityCare Gold 7 Select","98905OK017","7003819233","OKN001","OKS001","OKF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170035-00","CommunityCare Gold 7 Select","Standard Gold Off Exchange Plan",,"0.819620283070371","Yes","Yes","No","100%",,"$2,000","$500","$200","$80","$0","$1,200","$30","$60","$1,600","$200","$10","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170035-00&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170035-00"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320078","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS011","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320078-01","Blue Preferred Silver PPO? 201","Standard Silver On Exchange Plan",,"0.687562676199793","Yes","Yes","Yes","43%","57%","$1,450","$500","$5,100","$60","$1,450","$200","$1,500","$60","$1,450","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$4,350","$4350 per person","$13050 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320078","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS011","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320078-02","Blue Preferred Silver PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320078","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS011","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320078-03","Blue Preferred Silver PPO? 201","Limited Cost Sharing Plan Variation",,"0.687562676199793","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$4,350","$4350 per person","$13050 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320078","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS011","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320078-06","Blue Preferred Silver PPO? 201","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$150","$150 per person","$450 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-06.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320080","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS021","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320080-00","Blue Preferred Silver PPO? 201","Standard Silver Off Exchange Plan",,"0.687562676199793","Yes","Yes","Yes","43%","57%","$1,450","$500","$5,100","$60","$1,450","$200","$1,500","$60","$1,450","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$4,350","$4350 per person","$13050 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320080","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS021","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320080-01","Blue Preferred Silver PPO? 201","Standard Silver On Exchange Plan",,"0.687562676199793","Yes","Yes","Yes","43%","57%","$1,450","$500","$5,100","$60","$1,450","$200","$1,500","$60","$1,450","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$4,350","$4350 per person","$13050 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320080","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS021","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320080-02","Blue Preferred Silver PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320080","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS021","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320080-03","Blue Preferred Silver PPO? 201","Limited Cost Sharing Plan Variation",,"0.687562676199793","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$4,350","$4350 per person","$13050 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320080","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS021","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320080-04","Blue Preferred Silver PPO? 201","73% AV Level Silver Plan",,"0.729156419094505","Yes","Yes","Yes","43%","57%","$1,000","$400","$4,400","$60","$1,000","$200","$1,700","$60","$1,000","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-04.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320080","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS021","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320080-05","Blue Preferred Silver PPO? 201","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,800","$60","$50","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$150","$150 per person","$450 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-05.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320080","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS021","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320080-06","Blue Preferred Silver PPO? 201","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$150","$150 per person","$450 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-06.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320081","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS031","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320081-00","Blue Preferred Silver PPO? 201","Standard Silver Off Exchange Plan",,"0.687562676199793","Yes","Yes","Yes","43%","57%","$1,450","$500","$5,100","$60","$1,450","$200","$1,500","$60","$1,450","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$4,350","$4350 per person","$13050 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320081","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS031","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320081-01","Blue Preferred Silver PPO? 201","Standard Silver On Exchange Plan",,"0.687562676199793","Yes","Yes","Yes","43%","57%","$1,450","$500","$5,100","$60","$1,450","$200","$1,500","$60","$1,450","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$4,350","$4350 per person","$13050 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320081","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS031","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320081-02","Blue Preferred Silver PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320081","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS031","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320081-03","Blue Preferred Silver PPO? 201","Limited Cost Sharing Plan Variation",,"0.687562676199793","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$4,350","$4350 per person","$13050 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320081","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS031","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320081-04","Blue Preferred Silver PPO? 201","73% AV Level Silver Plan",,"0.729156419094505","Yes","Yes","Yes","43%","57%","$1,000","$400","$4,400","$60","$1,000","$200","$1,700","$60","$1,000","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-04.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320081","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS031","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320081-05","Blue Preferred Silver PPO? 201","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,800","$60","$50","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$150","$150 per person","$450 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-05.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320081","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS031","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320081-06","Blue Preferred Silver PPO? 201","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$150","$150 per person","$450 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-06.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320082","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS041","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320082-01","Blue Preferred Silver PPO? 201","Standard Silver On Exchange Plan",,"0.687562676199793","Yes","Yes","Yes","43%","57%","$1,450","$500","$5,100","$60","$1,450","$200","$1,500","$60","$1,450","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$4,350","$4350 per person","$13050 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320082","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS041","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320082-02","Blue Preferred Silver PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320082","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS041","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320082-03","Blue Preferred Silver PPO? 201","Limited Cost Sharing Plan Variation",,"0.687562676199793","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$4,350","$4350 per person","$13050 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320082","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS041","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320082-04","Blue Preferred Silver PPO? 201","73% AV Level Silver Plan",,"0.729156419094505","Yes","Yes","Yes","43%","57%","$1,000","$400","$4,400","$60","$1,000","$200","$1,700","$60","$1,000","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-04.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320082","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS041","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320082-05","Blue Preferred Silver PPO? 201","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,800","$60","$50","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$150","$150 per person","$450 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-05.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320082","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS041","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320082-06","Blue Preferred Silver PPO? 201","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$150","$150 per person","$450 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-06.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320083","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS051","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320083-00","Blue Preferred Silver PPO? 201","Standard Silver Off Exchange Plan",,"0.687562676199793","Yes","Yes","Yes","43%","57%","$1,450","$500","$5,100","$60","$1,450","$200","$1,500","$60","$1,450","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$4,350","$4350 per person","$13050 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320083","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS051","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320083-01","Blue Preferred Silver PPO? 201","Standard Silver On Exchange Plan",,"0.687562676199793","Yes","Yes","Yes","43%","57%","$1,450","$500","$5,100","$60","$1,450","$200","$1,500","$60","$1,450","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$4,350","$4350 per person","$13050 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320083","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS051","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320083-02","Blue Preferred Silver PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320083","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS051","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320083-03","Blue Preferred Silver PPO? 201","Limited Cost Sharing Plan Variation",,"0.687562676199793","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$4,350","$4350 per person","$13050 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320083","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS051","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320083-04","Blue Preferred Silver PPO? 201","73% AV Level Silver Plan",,"0.729156419094505","Yes","Yes","Yes","43%","57%","$1,000","$400","$4,400","$60","$1,000","$200","$1,700","$60","$1,000","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-04.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320083","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS051","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320083-05","Blue Preferred Silver PPO? 201","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,800","$60","$50","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$150","$150 per person","$450 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-05.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320083","Blue Preferred Silver PPO? 201","87571OK032",,"OKN001","OKS051","OKF005","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320083-06","Blue Preferred Silver PPO? 201","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$150","$150 per person","$450 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320078-06.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320093","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS011","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320093-00","Blue Preferred  Bronze PPO? 206","Standard Bronze Off Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320093","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS011","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320093-01","Blue Preferred  Bronze PPO? 206","Standard Bronze On Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320093","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS011","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320093-02","Blue Preferred  Bronze PPO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320093","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS011","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320093-03","Blue Preferred  Bronze PPO? 206","Limited Cost Sharing Plan Variation",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320094","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS021","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320094-00","Blue Preferred  Bronze PPO? 206","Standard Bronze Off Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320094","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS021","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320094-01","Blue Preferred  Bronze PPO? 206","Standard Bronze On Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320094","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS021","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320094-02","Blue Preferred  Bronze PPO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320094","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS021","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320094-03","Blue Preferred  Bronze PPO? 206","Limited Cost Sharing Plan Variation",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320095","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS031","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320095-00","Blue Preferred  Bronze PPO? 206","Standard Bronze Off Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320095","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS031","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320095-01","Blue Preferred  Bronze PPO? 206","Standard Bronze On Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320095","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS031","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320095-02","Blue Preferred  Bronze PPO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320095","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS031","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320095-03","Blue Preferred  Bronze PPO? 206","Limited Cost Sharing Plan Variation",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320096","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS041","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320096-02","Blue Preferred  Bronze PPO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320096","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS041","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320096-03","Blue Preferred  Bronze PPO? 206","Limited Cost Sharing Plan Variation",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320097","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS051","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320097-00","Blue Preferred  Bronze PPO? 206","Standard Bronze Off Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-00.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320097","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS051","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320097-01","Blue Preferred  Bronze PPO? 206","Standard Bronze On Exchange Plan",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$4,700","$400","$2,300","$60","$4,700","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-01.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320097","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS051","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320097-02","Blue Preferred  Bronze PPO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-02.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87571","HIOS","2017-08-17 02:20:39","Individual","No","36-1236610","87571OK0320097","Blue Preferred  Bronze PPO? 206","87571OK032",,"OKN001","OKS051","OKF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/OK_6T_EX.pdf","87571OK0320097-03","Blue Preferred  Bronze PPO? 206","Limited Cost Sharing Plan Variation",,"0.564590337413777","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$14100 per group","50.00%","$4,700","$4700 per person","$14100 per group","50.00%","$14,100","$14100 per person","$42300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/sbc/2018/OK0320093-03.pdf","http://www.bcbsok.com/brochure/2018/ok-plan-overview.pdf"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090004","CommunityCare PPO Platinum A Select","87698OK009","7912900140","OKN001","OKS001","OKF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090004-00","CommunityCare PPO Platinum A Select","Standard Platinum Off Exchange Plan",,"0.897940768062609","Yes","Yes","No","100%",,"$500","$0","$1,200","$80","$0","$1,100","$200","$60","$500","$50","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201887698OK0090004-00&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090004-00"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090007","CommunityCare PPO Gold B Select","87698OK009","7912900140","OKN001","OKS001","OKF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090007-01","CommunityCare PPO Gold B Select","Standard Gold On Exchange Plan",,"0.819679618165854","Yes","Yes","No","100%",,"$1,500","$10","$3,300","$80","$0","$1,100","$300","$60","$1,500","$70","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201887698OK0090007-01&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090007-01"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090006","CommunityCare PPO Gold C Select","87698OK009","7912900140","OKN001","OKS001","OKF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090006-00","CommunityCare PPO Gold C Select","Standard Gold Off Exchange Plan",,"0.812356213297824","Yes","Yes","No","100%",,"$2,000","$0","$2,000","$80","$0","$1,100","$300","$60","$1,600","$70","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201887698OK0090006-00&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090006-00"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090006","CommunityCare PPO Gold C Select","87698OK009","7912900140","OKN001","OKS001","OKF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090006-01","CommunityCare PPO Gold C Select","Standard Gold On Exchange Plan",,"0.812356213297824","Yes","Yes","No","100%",,"$2,000","$0","$2,000","$80","$0","$1,100","$300","$60","$1,600","$70","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201887698OK0090006-01&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090006-01"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090005","CommunityCare PPO Gold D Select","87698OK009","7912900140","OKN001","OKS001","OKF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090005-00","CommunityCare PPO Gold D Select","Standard Gold Off Exchange Plan",,"0.813873019656908","Yes","Yes","No","100%",,"$2,500","$0","$1,000","$80","$0","$1,100","$200","$60","$1,600","$90","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201887698OK0090005-00&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090005-00"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090005","CommunityCare PPO Gold D Select","87698OK009","7912900140","OKN001","OKS001","OKF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090005-01","CommunityCare PPO Gold D Select","Standard Gold On Exchange Plan",,"0.813873019656908","Yes","Yes","No","100%",,"$2,500","$0","$1,000","$80","$0","$1,100","$200","$60","$1,600","$90","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201887698OK0090005-01&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090005-01"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090011","CommunityCare PPO Silver B Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090011-00","CommunityCare PPO Silver B Select","Standard Silver Off Exchange Plan",,"0.713973658116807","Yes","Yes","No","100%",,"$4,000","$10","$2,600","$80","$3,600","$600","$300","$60","$1,600","$100","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201887698OK0090011-00&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090011-00"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090011","CommunityCare PPO Silver B Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090011-01","CommunityCare PPO Silver B Select","Standard Silver On Exchange Plan",,"0.713973658116807","Yes","Yes","No","100%",,"$4,000","$10","$2,600","$80","$3,600","$600","$300","$60","$1,600","$100","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201887698OK0090011-01&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090011-01"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090010","CommunityCare PPO Silver C Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090010-00","CommunityCare PPO Silver C Select","Standard Silver Off Exchange Plan",,"0.70422728943232","Yes","Yes","No","100%",,"$5,000","$0","$1,600","$80","$3,600","$600","$300","$60","$1,600","$100","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201887698OK0090010-00&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090010-00"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090010","CommunityCare PPO Silver C Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090010-01","CommunityCare PPO Silver C Select","Standard Silver On Exchange Plan",,"0.70422728943232","Yes","Yes","No","100%",,"$5,000","$0","$1,600","$80","$3,600","$600","$300","$60","$1,600","$100","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201887698OK0090010-01&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090010-01"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090014","CommunityCare PPO Bronze A Select","87698OK009","7912900140","OKN001","OKS001","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090014-00","CommunityCare PPO Bronze A Select","Standard Bronze Off Exchange Plan",,"0.608126682795238","Yes","Yes","No","100%",,"$6,000","$500","$0","$80","$6,000","$100","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201887698OK0090014-00&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090014-00"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090014","CommunityCare PPO Bronze A Select","87698OK009","7912900140","OKN001","OKS001","OKF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090014-01","CommunityCare PPO Bronze A Select","Standard Bronze On Exchange Plan",,"0.608126682795238","Yes","Yes","No","100%",,"$6,000","$500","$0","$80","$6,000","$100","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201887698OK0090014-01&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090014-01"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090020","CommunityCare PPO Silver E Select","87698OK009","7912900140","OKN001","OKS001","OKF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090020-00","CommunityCare PPO Silver E Select","Standard Silver Off Exchange Plan",,"0.719690395413499","Yes","Yes","No","100%",,"$2,600","$0","$1,700","$80","$2,600","$700","$100","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201887698OK0090020-00&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090020-00"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090020","CommunityCare PPO Silver E Select","87698OK009","7912900140","OKN001","OKS001","OKF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090020-01","CommunityCare PPO Silver E Select","Standard Silver On Exchange Plan",,"0.719690395413499","Yes","Yes","No","100%",,"$2,600","$0","$1,700","$80","$2,600","$700","$100","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201887698OK0090020-01&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090020-01"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090021","CommunityCare PPO Silver F Select","87698OK009","7912900140","OKN001","OKS001","OKF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090021-00","CommunityCare PPO Silver F Select","Standard Silver Off Exchange Plan",,"0.701004682652296","Yes","Yes","No","100%",,"$3,000","$0","$1,500","$80","$3,000","$700","$90","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201887698OK0090021-00&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090021-00"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090021","CommunityCare PPO Silver F Select","87698OK009","7912900140","OKN001","OKS001","OKF004","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090021-01","CommunityCare PPO Silver F Select","Standard Silver On Exchange Plan",,"0.701004682652296","Yes","Yes","No","100%",,"$3,000","$0","$1,500","$80","$3,000","$700","$90","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201887698OK0090021-01&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090021-01"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090023","CommunityCare PPO Bronze B Select","87698OK009","7912900140","OKN001","OKS001","OKF004","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090023-00","CommunityCare PPO Bronze B Select","Standard Bronze Off Exchange Plan",,"0.646924487899287","Yes","Yes","No","100%",,"$4,500","$10","$800","$80","$4,500","$400","$30","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","10.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201887698OK0090023-00&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090023-00"
"2018","OK","87698","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1580741","87698OK0090023","CommunityCare PPO Bronze B Select","87698OK009","7912900140","OKN001","OKS001","OKF004","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9954",,,"2018-01-01","2018-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","87698OK0090023-01","CommunityCare PPO Bronze B Select","Standard Bronze On Exchange Plan",,"0.646924487899287","Yes","Yes","No","100%",,"$4,500","$10","$800","$80","$4,500","$400","$30","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","10.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201887698OK0090023-01&type=sbc","http://marketplace.ccok.com?plan=201887698OK0090023-01"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170066","CommunityCare Platinum 2 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170066-00","CommunityCare Platinum 2 Select","Standard Platinum Off Exchange Plan",,"0.897928808976768","Yes","Yes","No","100%",,"$500","$0","$1,000","$80","$0","$1,100","$300","$60","$500","$300","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170066-00&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170066-00"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170066","CommunityCare Platinum 2 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170066-01","CommunityCare Platinum 2 Select","Standard Platinum On Exchange Plan",,"0.897928808976768","Yes","Yes","No","100%",,"$500","$0","$1,000","$80","$0","$1,100","$300","$60","$500","$300","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170066-01&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170066-01"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170026","CommunityCare Platinum 3 Select","98905OK017","7003819233","OKN001","OKS001","OKF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170026-00","CommunityCare Platinum 3 Select","Standard Platinum Off Exchange Plan",,"0.900778817319252","Yes","Yes","No","100%",,"$800","$400","$200","$80","$0","$1,100","$30","$60","$800","$200","$10","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170026-00&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170026-00"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170026","CommunityCare Platinum 3 Select","98905OK017","7003819233","OKN001","OKS001","OKF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170026-01","CommunityCare Platinum 3 Select","Standard Platinum On Exchange Plan",,"0.900778817319252","Yes","Yes","No","100%",,"$800","$400","$200","$80","$0","$1,100","$30","$60","$800","$200","$10","$0",,"3","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170026-01&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170026-01"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170034","CommunityCare Gold 2 Select","98905OK017","7003819233","OKN001","OKS001","OKF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170034-00","CommunityCare Gold 2 Select","Standard Gold Off Exchange Plan",,"0.819280340688722","Yes","Yes","No","100%",,"$1,000","$0","$2,000","$80","$0","$1,500","$300","$60","$1,000","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170034-00&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170034-00"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170034","CommunityCare Gold 2 Select","98905OK017","7003819233","OKN001","OKS001","OKF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170034-01","CommunityCare Gold 2 Select","Standard Gold On Exchange Plan",,"0.819280340688722","Yes","Yes","No","100%",,"$1,000","$0","$2,000","$80","$0","$1,500","$300","$60","$1,000","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170034-01&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170034-01"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170035","CommunityCare Gold 7 Select","98905OK017","7003819233","OKN001","OKS001","OKF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170035-01","CommunityCare Gold 7 Select","Standard Gold On Exchange Plan",,"0.819620283070371","Yes","Yes","No","100%",,"$2,000","$500","$200","$80","$0","$1,200","$30","$60","$1,600","$200","$10","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170035-01&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170035-01"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170092","CommunityCare Silver 4 Select","98905OK017","7003819233","OKN001","OKS001","OKF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170092-00","CommunityCare Silver 4 Select","Standard Silver Off Exchange Plan",,"0.701004682652296","Yes","Yes","No","100%",,"$3,000","$0","$1,500","$80","$3,000","$700","$90","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201898905OK0170092-00&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170092-00"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170092","CommunityCare Silver 4 Select","98905OK017","7003819233","OKN001","OKS001","OKF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170092-01","CommunityCare Silver 4 Select","Standard Silver On Exchange Plan",,"0.701004682652296","Yes","Yes","No","100%",,"$3,000","$0","$1,500","$80","$3,000","$700","$90","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201898905OK0170092-01&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170092-01"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170038","CommunityCare Silver 7 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170038-00","CommunityCare Silver 7 Select","Standard Silver Off Exchange Plan",,"0.719713109232472","Yes","Yes","No","100%",,"$4,500","$10","$0","$80","$100","$1,200","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170038-00&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170038-00"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170038","CommunityCare Silver 7 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170038-01","CommunityCare Silver 7 Select","Standard Silver On Exchange Plan",,"0.719713109232472","Yes","Yes","No","100%",,"$4,500","$10","$0","$80","$100","$1,200","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170038-01&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170038-01"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170070","CommunityCare Silver 9 Select","98905OK017","7003819233","OKN001","OKS001","OKF011","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170070-00","CommunityCare Silver 9 Select","Standard Silver Off Exchange Plan",,"0.719952466033788","Yes","Yes","No","100%",,"$5,000","$700","$200","$80","$0","$1,200","$30","$60","$1,600","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170070-00&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170070-00"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170070","CommunityCare Silver 9 Select","98905OK017","7003819233","OKN001","OKS001","OKF011","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170070-01","CommunityCare Silver 9 Select","Standard Silver On Exchange Plan",,"0.719952466033788","Yes","Yes","No","100%",,"$5,000","$700","$200","$80","$0","$1,200","$30","$60","$1,600","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170070-01&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170070-01"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170036","CommunityCare Silver 11 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170036-00","CommunityCare Silver 11 Select","Standard Silver Off Exchange Plan",,"0.711968488033118","Yes","Yes","No","100%",,"$6,000","$10","$0","$80","$100","$1,100","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170036-00&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170036-00"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170036","CommunityCare Silver 11 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170036-01","CommunityCare Silver 11 Select","Standard Silver On Exchange Plan",,"0.711968488033118","Yes","Yes","No","100%",,"$6,000","$10","$0","$80","$100","$1,100","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170036-01&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170036-01"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170042","CommunityCare Bronze 2 Select","98905OK017","7003819233","OKN001","OKS001","OKF013","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170042-00","CommunityCare Bronze 2 Select","Standard Bronze Off Exchange Plan",,"0.608126682795238","Yes","Yes","No","100%",,"$6,000","$500","$0","$80","$6,000","$100","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201898905OK0170042-00&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170042-00"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170042","CommunityCare Bronze 2 Select","98905OK017","7003819233","OKN001","OKS001","OKF013","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170042-01","CommunityCare Bronze 2 Select","Standard Bronze On Exchange Plan",,"0.608126682795238","Yes","Yes","No","100%",,"$6,000","$500","$0","$80","$6,000","$100","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201898905OK0170042-01&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170042-01"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170102","CommunityCare Gold 10 Select","98905OK017","7003819233","OKN001","OKS001","OKF006","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170102-00","CommunityCare Gold 10 Select","Standard Gold Off Exchange Plan",,"0.76241821175226","Yes","Yes","No","100%",,"$2,500","$10","$2,000","$80","$2,500","$800","$200","$60","$1,800","$50","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170102-00&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170102-00"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170102","CommunityCare Gold 10 Select","98905OK017","7003819233","OKN001","OKS001","OKF006","New","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170102-01","CommunityCare Gold 10 Select","Standard Gold On Exchange Plan",,"0.76241821175226","Yes","Yes","No","100%",,"$2,500","$10","$2,000","$80","$2,500","$800","$200","$60","$1,800","$50","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170102-01&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170102-01"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170104","CommunityCare Silver 12 Select","98905OK017","7003819233","OKN001","OKS001","OKF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170104-00","CommunityCare Silver 12 Select","Standard Silver Off Exchange Plan",,"0.719690395413499","Yes","Yes","No","100%",,"$2,600","$0","$1,700","$80","$2,600","$700","$100","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170104-00&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170104-00"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170104","CommunityCare Silver 12 Select","98905OK017","7003819233","OKN001","OKS001","OKF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170104-01","CommunityCare Silver 12 Select","Standard Silver On Exchange Plan",,"0.719690395413499","Yes","Yes","No","100%",,"$2,600","$0","$1,700","$80","$2,600","$700","$100","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170104-01&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170104-01"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170106","CommunityCare Silver 13 Select","98905OK017","7003819233","OKN001","OKS001","OKF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170106-00","CommunityCare Silver 13 Select","Standard Silver Off Exchange Plan",,"0.691178522823806","Yes","Yes","No","100%",,"$3,400","$10","$900","$80","$3,400","$600","$40","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201898905OK0170106-00&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170106-00"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170106","CommunityCare Silver 13 Select","98905OK017","7003819233","OKN001","OKS001","OKF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170106-01","CommunityCare Silver 13 Select","Standard Silver On Exchange Plan",,"0.691178522823806","Yes","Yes","No","100%",,"$3,400","$10","$900","$80","$3,400","$600","$40","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201898905OK0170106-01&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170106-01"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170110","CommunityCare Silver 14 Select","98905OK017","7003819233","OKN001","OKS001","OKF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170110-00","CommunityCare Silver 14 Select","Standard Silver Off Exchange Plan",,"0.662730573610174","Yes","Yes","No","100%",,"$6,000","$10","$700","$80","$3,700","$700","$70","$60","$1,900","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170110-00&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170110-00"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170110","CommunityCare Silver 14 Select","98905OK017","7003819233","OKN001","OKS001","OKF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170110-01","CommunityCare Silver 14 Select","Standard Silver On Exchange Plan",,"0.662730573610174","Yes","Yes","No","100%",,"$6,000","$10","$700","$80","$3,700","$700","$70","$60","$1,900","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170110-01&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170110-01"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170112","CommunityCare Bronze 3 Select","98905OK017","7003819233","OKN001","OKS001","OKF005","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170112-00","CommunityCare Bronze 3 Select","Standard Bronze Off Exchange Plan",,"0.646924487899287","Yes","Yes","No","100%",,"$4,500","$10","$800","$80","$4,500","$400","$30","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201898905OK0170112-00&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170112-00"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170112","CommunityCare Bronze 3 Select","98905OK017","7003819233","OKN001","OKS001","OKF005","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170112-01","CommunityCare Bronze 3 Select","Standard Bronze On Exchange Plan",,"0.646924487899287","Yes","Yes","No","100%",,"$4,500","$10","$800","$80","$4,500","$400","$30","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201898905OK0170112-01&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170112-01"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170116","CommunityCare Bronze 4 Select","98905OK017","7003819233","OKN001","OKS001","OKF014","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170116-00","CommunityCare Bronze 4 Select","Standard Bronze Off Exchange Plan",,"0.562924834175207","Yes","Yes","No","100%",,"$7,200","$10","$0","$80","$4,700","$1,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","100.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170116-00&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170116-00"
"2018","OK","98905","HIOS","2017-09-27 03:20:22","SHOP (Small Group)","No","73-1433979","98905OK0170116","CommunityCare Bronze 4 Select","98905OK017","7003819233","OKN001","OKS001","OKF014","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Emergency Services","No",,"http://marketplace.ccok.com?rxFormulary=2&planyear=2018","98905OK0170116-01","CommunityCare Bronze 4 Select","Standard Bronze On Exchange Plan",,"0.562924834175207","Yes","Yes","No","100%",,"$7,200","$10","$0","$80","$4,700","$1,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","100.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201898905OK0170116-01&type=sbc","http://marketplace.ccok.com?plan=201898905OK0170116-01"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380001","BlueEssentials Gold 1","26065SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9978",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380001-00","BlueEssentials Gold 1","Standard Gold Off Exchange Plan",,"0.794527602373266","No","Yes","No","100%",,"$2,000","$20","$2,480","$60","$1,489","$1,007","$372","$55","$1,305","$90","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Gold1","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380001","BlueEssentials Gold 1","26065SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9978",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380001-01","BlueEssentials Gold 1","Standard Gold On Exchange Plan",,"0.794527602373266","No","Yes","No","100%",,"$2,000","$20","$2,480","$60","$1,489","$1,007","$372","$55","$1,305","$90","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Gold1","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380020-02","BlueEssentials Silver 12","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver12_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380011-00","BlueEssentials HD Silver 6","Standard Silver Off Exchange Plan",,"0.688877757668837","Yes","Yes","No","100%",,"$4,300","$0","$0","$60","$4,300","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver6","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380011-01","BlueEssentials HD Silver 6","Standard Silver On Exchange Plan",,"0.688877757668837","Yes","Yes","No","100%",,"$4,300","$0","$0","$60","$4,300","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver6","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380011-02","BlueEssentials HD Silver 6","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver6_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380016-01","BlueEssentials Silver 8","Standard Silver On Exchange Plan",,"0.717682628370657","No","Yes","Yes","80%","20%","$4,840","$0","$1,860","$60","$1,582","$980","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","15.00%","$5,250","$5250 per person","$10500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver8","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380016-02","BlueEssentials Silver 8","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","80%","20%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver8_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","84939","HIOS","2017-08-04 02:20:25","Individual","Yes","13-5123390","84939SC0180001","Guardian Basics for Families and Individuals","84939SC018",,"SCN002","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","84939SC0180001-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/south-carolina/","https://dentalexchange.guardianlife.com/our-plans/south-carolina/"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380001","BlueEssentials Gold 1","26065SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9978",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380001-02","BlueEssentials Gold 1","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Gold1_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380001","BlueEssentials Gold 1","26065SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9978",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380001-03","BlueEssentials Gold 1","Limited Cost Sharing Plan Variation",,"0.794527602373266","No","Yes","No","100%",,"$2,000","$20","$2,480","$60","$1,489","$1,007","$372","$55","$1,305","$90","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Gold1_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380007","BlueEssentials Gold 2","26065SC038",,"SCN001","SCS001","SCF015","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9979",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380007-00","BlueEssentials Gold 2","Standard Gold Off Exchange Plan",,"0.797623319589441","No","Yes","No","100%",,"$1,000","$120","$3,720","$60","$1,000","$1,380","$558","$55","$1,000","$120","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Gold2","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380006","BlueEssentials HD Bronze 2","26065SC038",,"SCN001","SCS001","SCF014","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9966",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380006-03","BlueEssentials HD Bronze 2","Limited Cost Sharing Plan Variation",,"0.605142272205434","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDBronze2_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380012","BlueEssentials HD Bronze 3","26065SC038",,"SCN001","SCS001","SCF044","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9966",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380012-00","BlueEssentials HD Bronze 3","Standard Bronze Off Exchange Plan",,"0.612527460676527","Yes","Yes","No","100%",,"$2,830","$0","$3,720","$60","$4,560","$0","$1,990","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDBronze3","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380018-01","BlueEssentials Silver 10","Standard Silver On Exchange Plan",,"0.681672163864496","Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$2,135","$805","$0","$55","$1,925","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver10","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380018-02","BlueEssentials Silver 10","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver10_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380007","BlueEssentials Gold 2","26065SC038",,"SCN001","SCS001","SCF015","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9979",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380007-01","BlueEssentials Gold 2","Standard Gold On Exchange Plan",,"0.797623319589441","No","Yes","No","100%",,"$1,000","$120","$3,720","$60","$1,000","$1,380","$558","$55","$1,000","$120","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Gold2","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380007","BlueEssentials Gold 2","26065SC038",,"SCN001","SCS001","SCF015","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9979",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380007-02","BlueEssentials Gold 2","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Gold2_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380007","BlueEssentials Gold 2","26065SC038",,"SCN001","SCS001","SCF015","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9979",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380007-03","BlueEssentials Gold 2","Limited Cost Sharing Plan Variation",,"0.797623319589441","No","Yes","No","100%",,"$1,000","$120","$3,720","$60","$1,000","$1,380","$558","$55","$1,000","$120","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Gold2_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380002-00","BlueEssentials Silver 1","Standard Silver Off Exchange Plan",,"0.718141495659806","Yes","Yes","No","100%",,"$690","$180","$6,200","$60","$690","$2,070","$931","$55","$690","$180","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$690","$690 per person","$1380 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver1","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380002-01","BlueEssentials Silver 1","Standard Silver On Exchange Plan",,"0.718141495659806","Yes","Yes","No","100%",,"$690","$180","$6,200","$60","$690","$2,070","$931","$55","$690","$180","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$690","$690 per person","$1380 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver1","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380002-02","BlueEssentials Silver 1","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver1_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380002-03","BlueEssentials Silver 1","Limited Cost Sharing Plan Variation",,"0.718141495659806","Yes","Yes","No","100%",,"$690","$180","$6,200","$60","$690","$2,070","$931","$55","$690","$180","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$690","$690 per person","$1380 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver1_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380002-04","BlueEssentials Silver 1","73% AV Level Silver Plan",,"0.7399851523802","Yes","Yes","No","100%",,"$690","$0","$5,160","$60","$690","$2,070","$931","$55","$690","$180","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$690","$690 per person","$1380 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver1_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380002-05","BlueEssentials Silver 1","87% AV Level Silver Plan",,"0.871152785279114","Yes","Yes","No","100%",,"$0","$180","$1,860","$60","$0","$2,070","$279","$55","$0","$180","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver1_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380002-06","BlueEssentials Silver 1","94% AV Level Silver Plan",,"0.935997829297278","Yes","Yes","No","100%",,"$0","$60","$620","$60","$0","$765","$93","$55","$0","$75","$82","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver1_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380003-00","BlueEssentials Silver 2","Standard Silver Off Exchange Plan",,"0.699469831384333","Yes","Yes","No","100%",,"$2,064","$0","$4,536","$60","$3,000","$610","$2,177","$55","$979","$150","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver2","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380003-01","BlueEssentials Silver 2","Standard Silver On Exchange Plan",,"0.699469831384333","Yes","Yes","No","100%",,"$2,064","$0","$4,536","$60","$3,000","$610","$2,177","$55","$979","$150","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver2","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380003-02","BlueEssentials Silver 2","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver2_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380003-03","BlueEssentials Silver 2","Limited Cost Sharing Plan Variation",,"0.699469831384333","Yes","Yes","No","100%",,"$2,064","$0","$4,536","$60","$3,000","$610","$2,177","$55","$979","$150","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver2_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380003-04","BlueEssentials Silver 2","73% AV Level Silver Plan",,"0.737875631619926","Yes","Yes","No","100%",,"$1,800","$0","$3,900","$60","$1,800","$610","$2,177","$55","$979","$150","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver2_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380003-05","BlueEssentials Silver 2","87% AV Level Silver Plan",,"0.876157924004694","Yes","Yes","No","100%",,"$300","$0","$1,950","$60","$300","$570","$1,089","$55","$300","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver2_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380003-06","BlueEssentials Silver 2","94% AV Level Silver Plan",,"0.935336800774112","Yes","Yes","No","100%",,"$0","$80","$620","$60","$0","$570","$272","$55","$232","$0","$150","$82",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver2_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF047","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380004-00","BlueEssentials Silver 3","Standard Silver Off Exchange Plan",,"0.718705946784964","Yes","Yes","No","100%",,"$3,400","$0","$3,100","$60","$1,742","$1,252","$120","$55","$1,231","$180","$401","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver3","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF047","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380004-01","BlueEssentials Silver 3","Standard Silver On Exchange Plan",,"0.718705946784964","Yes","Yes","No","100%",,"$3,400","$0","$3,100","$60","$1,742","$1,252","$120","$55","$1,231","$180","$401","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver3","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF047","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380004-02","BlueEssentials Silver 3","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver3_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF047","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380004-03","BlueEssentials Silver 3","Limited Cost Sharing Plan Variation",,"0.718705946784964","Yes","Yes","No","100%",,"$3,400","$0","$3,100","$60","$1,742","$1,252","$120","$55","$1,231","$180","$401","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver3_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF047","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380004-04","BlueEssentials Silver 3","73% AV Level Silver Plan",,"0.739209585289568","Yes","Yes","No","100%",,"$2,750","$0","$3,100","$60","$1,396","$1,050","$465","$55","$1,224","$150","$408","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$3150 per person","$6300 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver3_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF047","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380004-05","BlueEssentials Silver 3","87% AV Level Silver Plan",,"0.876116559547362","Yes","Yes","No","100%",,"$300","$0","$1,980","$60","$300","$985","$372","$55","$300","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver3_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF047","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380004-06","BlueEssentials Silver 3","94% AV Level Silver Plan",,"0.935301104317439","Yes","Yes","No","100%",,"$0","$60","$620","$60","$0","$850","$93","$55","$0","$60","$82","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver3_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380009-00","BlueEssentials Silver 4","Standard Silver Off Exchange Plan",,"0.719926651033654","No","Yes","No","100%",,"$3,100","$108","$3,720","$60","$1,303","$1,187","$558","$55","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver4","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380009-01","BlueEssentials Silver 4","Standard Silver On Exchange Plan",,"0.719926651033654","No","Yes","No","100%",,"$3,100","$108","$3,720","$60","$1,303","$1,187","$558","$55","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver4","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380009-02","BlueEssentials Silver 4","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver4_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380009-03","BlueEssentials Silver 4","Limited Cost Sharing Plan Variation",,"0.719926651033654","No","Yes","No","100%",,"$3,100","$108","$3,720","$60","$1,303","$1,187","$558","$55","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver4_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380009-04","BlueEssentials Silver 4","73% AV Level Silver Plan",,"0.739980649481784","No","Yes","No","100%",,"$2,408","$0","$3,442","$60","$1,303","$1,087","$558","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,975","$2975 per person","$5950 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver4_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380009-05","BlueEssentials Silver 4","87% AV Level Silver Plan",,"0.877135837138503","No","Yes","No","100%",,"$150","$0","$2,100","$60","$150","$1,127","$465","$55","$150","$150","$408","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver4_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380009-06","BlueEssentials Silver 4","94% AV Level Silver Plan",,"0.935301104317439","No","Yes","No","100%",,"$0","$60","$620","$60","$0","$885","$93","$55","$0","$60","$82","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver4_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF048","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380015-00","BlueEssentials Silver 7","Standard Silver Off Exchange Plan",,"0.68858328329047","Yes","Yes","No","100%",,"$4,050","$0","$3,100","$60","$1,396","$1,112","$465","$55","$1,224","$165","$408","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver7","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF048","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380015-01","BlueEssentials Silver 7","Standard Silver On Exchange Plan",,"0.68858328329047","Yes","Yes","No","100%",,"$4,050","$0","$3,100","$60","$1,396","$1,112","$465","$55","$1,224","$165","$408","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver7","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF048","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380015-02","BlueEssentials Silver 7","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver7_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF048","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380015-03","BlueEssentials Silver 7","Limited Cost Sharing Plan Variation",,"0.68858328329047","Yes","Yes","No","100%",,"$4,050","$0","$3,100","$60","$1,396","$1,112","$465","$55","$1,224","$165","$408","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver7_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF048","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380015-04","BlueEssentials Silver 7","73% AV Level Silver Plan",,"0.732521197185566","Yes","Yes","No","100%",,"$3,220","$0","$2,480","$60","$1,489","$787","$372","$55","$1,305","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver7_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF048","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380015-05","BlueEssentials Silver 7","87% AV Level Silver Plan",,"0.863232671361268","Yes","Yes","No","100%",,"$1,000","$10","$1,240","$60","$1,000","$747","$186","$55","$1,000","$90","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver7_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF048","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380015-06","BlueEssentials Silver 7","94% AV Level Silver Plan",,"0.941059601995897","Yes","Yes","No","100%",,"$200","$0","$500","$60","$200","$403","$97","$55","$200","$90","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver7_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380019-00","BlueEssentials Silver 11","Standard Silver Off Exchange Plan",,"0.690088536522662","Yes","Yes","No","100%",,"$4,670","$0","$2,480","$60","$1,708","$925","$427","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver11","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380019-01","BlueEssentials Silver 11","Standard Silver On Exchange Plan",,"0.690088536522662","Yes","Yes","No","100%",,"$4,670","$0","$2,480","$60","$1,708","$925","$427","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver11","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380019-02","BlueEssentials Silver 11","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver11_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380019-03","BlueEssentials Silver 11","Limited Cost Sharing Plan Variation",,"0.690088536522662","Yes","Yes","No","100%",,"$4,670","$0","$2,480","$60","$1,708","$925","$427","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver11_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380019-04","BlueEssentials Silver 11","73% AV Level Silver Plan",,"0.728016459194752","Yes","Yes","No","100%",,"$2,970","$0","$2,480","$60","$1,708","$520","$427","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver11_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380019-05","BlueEssentials Silver 11","87% AV Level Silver Plan",,"0.86471415778868","Yes","Yes","No","100%",,"$1,000","$10","$1,240","$60","$1,000","$520","$213","$55","$1,000","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver11_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380019-06","BlueEssentials Silver 11","94% AV Level Silver Plan",,"0.935728601321976","Yes","Yes","No","100%",,"$0","$30","$1,240","$60","$0","$520","$213","$55","$0","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver11_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380020-00","BlueEssentials Silver 12","Standard Silver Off Exchange Plan",,"0.686242033183618","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$1,494","$1,080","$640","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver12","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380020-01","BlueEssentials Silver 12","Standard Silver On Exchange Plan",,"0.686242033183618","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$1,494","$1,080","$640","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver12","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380020-03","BlueEssentials Silver 12","Limited Cost Sharing Plan Variation",,"0.686242033183618","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$1,494","$1,080","$640","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver12_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380020-04","BlueEssentials Silver 12","73% AV Level Silver Plan",,"0.736301986897427","Yes","Yes","No","100%",,"$2,408","$0","$3,042","$60","$1,494","$910","$640","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver12_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380020-05","BlueEssentials Silver 12","87% AV Level Silver Plan",,"0.870438780312306","Yes","Yes","No","100%",,"$600","$0","$1,650","$60","$600","$625","$427","$55","$600","$0","$685","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver12_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380020-06","BlueEssentials Silver 12","94% AV Level Silver Plan",,"0.930713668694118","Yes","Yes","No","100%",,"$150","$40","$620","$60","$150","$625","$107","$55","$150","$0","$96","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver12_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380023","BlueEssentials Silver 14","26065SC038",,"SCN001","SCS001","SCF049","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380023-00","BlueEssentials Silver 14","Standard Silver Off Exchange Plan",,"0.683142331673521","Yes","Yes","No","100%",,"$5,290","$0","$1,860","$60","$1,582","$1,090","$279","$55","$1,387","$150","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver14","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380023","BlueEssentials Silver 14","26065SC038",,"SCN001","SCS001","SCF049","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380023-01","BlueEssentials Silver 14","Standard Silver On Exchange Plan",,"0.683142331673521","Yes","Yes","No","100%",,"$5,290","$0","$1,860","$60","$1,582","$1,090","$279","$55","$1,387","$150","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver14","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380023","BlueEssentials Silver 14","26065SC038",,"SCN001","SCS001","SCF049","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380023-02","BlueEssentials Silver 14","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver14_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380023","BlueEssentials Silver 14","26065SC038",,"SCN001","SCS001","SCF049","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380023-03","BlueEssentials Silver 14","Limited Cost Sharing Plan Variation",,"0.683142331673521","Yes","Yes","No","100%",,"$5,290","$0","$1,860","$60","$1,582","$1,090","$279","$55","$1,387","$150","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver14_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380023","BlueEssentials Silver 14","26065SC038",,"SCN001","SCS001","SCF049","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380023-04","BlueEssentials Silver 14","73% AV Level Silver Plan",,"0.727359452040337","Yes","Yes","No","100%",,"$3,840","$0","$1,860","$60","$1,582","$1,090","$279","$55","$1,387","$150","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver14_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380023","BlueEssentials Silver 14","26065SC038",,"SCN001","SCS001","SCF049","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380023-05","BlueEssentials Silver 14","87% AV Level Silver Plan",,"0.873607805346533","Yes","Yes","No","100%",,"$800","$0","$1,000","$60","$800","$755","$245","$55","$800","$150","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver14_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380023","BlueEssentials Silver 14","26065SC038",,"SCN001","SCS001","SCF049","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380023-06","BlueEssentials Silver 14","94% AV Level Silver Plan",,"0.936538704844545","Yes","Yes","No","100%",,"$250","$0","$450","$60","$250","$355","$95","$55","$250","$150","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver14_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380013","BlueEssentials Bronze 4","26065SC038",,"SCN001","SCS001","SCF017","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9967",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380013-00","BlueEssentials Bronze 4","Standard Bronze Off Exchange Plan",,"0.64972027124898","Yes","Yes","No","100%",,"$1,720","$0","$5,430","$60","$2,722","$560","$2,722","$55","$816","$135","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDBronze4","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380013","BlueEssentials Bronze 4","26065SC038",,"SCN001","SCS001","SCF017","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9967",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380013-01","BlueEssentials Bronze 4","Standard Bronze On Exchange Plan",,"0.64972027124898","Yes","Yes","No","100%",,"$1,720","$0","$5,430","$60","$2,722","$560","$2,722","$55","$816","$135","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDBronze4","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380013","BlueEssentials Bronze 4","26065SC038",,"SCN001","SCS001","SCF017","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9967",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380013-02","BlueEssentials Bronze 4","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDBronze4_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380013","BlueEssentials Bronze 4","26065SC038",,"SCN001","SCS001","SCF017","Existing","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9967",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380013-03","BlueEssentials Bronze 4","Limited Cost Sharing Plan Variation",,"0.64972027124898","Yes","Yes","No","100%",,"$1,720","$0","$5,430","$60","$2,722","$560","$2,722","$55","$816","$135","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDBronze4_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380008","BlueEssentials HD Gold 3","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9978",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380008-00","BlueEssentials HD Gold 3","Standard Gold Off Exchange Plan",,"0.766517927324221","Yes","Yes","No","100%",,"$2,700","$0","$0","$60","$2,700","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$5400 per person","$5400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDGold3","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380008","BlueEssentials HD Gold 3","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9978",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380008-01","BlueEssentials HD Gold 3","Standard Gold On Exchange Plan",,"0.766517927324221","Yes","Yes","No","100%",,"$2,700","$0","$0","$60","$2,700","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$5400 per person","$5400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDGold3","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380008","BlueEssentials HD Gold 3","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9978",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380008-02","BlueEssentials HD Gold 3","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDGold3_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380008","BlueEssentials HD Gold 3","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9978",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380008-03","BlueEssentials HD Gold 3","Limited Cost Sharing Plan Variation",,"0.766517927324221","Yes","Yes","No","100%",,"$2,700","$0","$0","$60","$2,700","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$5400 per person","$5400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDGold3_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380010-00","BlueEssentials HD Silver 5","Standard Silver Off Exchange Plan",,"0.687314134645238","Yes","Yes","No","100%",,"$2,752","$0","$2,248","$60","$3,300","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver5","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380010-01","BlueEssentials HD Silver 5","Standard Silver On Exchange Plan",,"0.687314134645238","Yes","Yes","No","100%",,"$2,752","$0","$2,248","$60","$3,300","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver5","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380010-02","BlueEssentials HD Silver 5","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver5_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380010-03","BlueEssentials HD Silver 5","Limited Cost Sharing Plan Variation",,"0.687314134645238","Yes","Yes","No","100%",,"$2,752","$0","$2,248","$60","$3,300","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver5_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380010-04","BlueEssentials HD Silver 5","73% AV Level Silver Plan",,"0.738943355333936","Yes","Yes","No","100%",,"$1,800","$0","$2,527","$60","$1,800","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver5_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380010-05","BlueEssentials HD Silver 5","87% AV Level Silver Plan",,"0.878065326363543","Yes","Yes","No","100%",,"$250","$0","$2,000","$60","$250","$0","$1,437","$55","$250","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver5_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380010-06","BlueEssentials HD Silver 5","94% AV Level Silver Plan",,"0.937654436975703","Yes","Yes","No","100%",,"$200","$0","$632","$60","$200","$0","$359","$55","$200","$0","$96","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver5_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380011-03","BlueEssentials HD Silver 6","Limited Cost Sharing Plan Variation",,"0.688877757668837","Yes","Yes","No","100%",,"$4,300","$0","$0","$60","$4,300","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver6_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380011-04","BlueEssentials HD Silver 6","73% AV Level Silver Plan",,"0.736771900647582","Yes","Yes","No","100%",,"$3,200","$0","$0","$60","$3,200","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver6_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380011-05","BlueEssentials HD Silver 6","87% AV Level Silver Plan",,"0.867137005624073","Yes","Yes","No","100%",,"$1,200","$0","$0","$60","$1,200","$0","$0","$55","$1,200","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver6_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380011-06","BlueEssentials HD Silver 6","94% AV Level Silver Plan",,"0.937977329745955","Yes","Yes","No","100%",,"$500","$0","$0","$60","$500","$0","$0","$55","$500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver6_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380022","BlueEssentials HD Silver 13","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380022-00","BlueEssentials HD Silver 13","Standard Silver Off Exchange Plan",,"0.679271763431924","Yes","Yes","No","100%",,"$4,550","$0","$0","$60","$4,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,550","$4550 per person","$9100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,550","$4550 per person","$9100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver13","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380022","BlueEssentials HD Silver 13","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380022-01","BlueEssentials HD Silver 13","Standard Silver On Exchange Plan",,"0.679271763431924","Yes","Yes","No","100%",,"$4,550","$0","$0","$60","$4,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,550","$4550 per person","$9100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,550","$4550 per person","$9100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver13","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380022","BlueEssentials HD Silver 13","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380022-02","BlueEssentials HD Silver 13","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver13_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380022","BlueEssentials HD Silver 13","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380022-03","BlueEssentials HD Silver 13","Limited Cost Sharing Plan Variation",,"0.679271763431924","Yes","Yes","No","100%",,"$4,550","$0","$0","$60","$4,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,550","$4550 per person","$9100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,550","$4550 per person","$9100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver13_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380022","BlueEssentials HD Silver 13","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380022-04","BlueEssentials HD Silver 13","73% AV Level Silver Plan",,"0.736771900647582","Yes","Yes","No","100%",,"$3,200","$0","$0","$60","$3,200","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver13_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380022","BlueEssentials HD Silver 13","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380022-05","BlueEssentials HD Silver 13","87% AV Level Silver Plan",,"0.867137005624073","Yes","Yes","No","100%",,"$1,200","$0","$0","$60","$1,200","$0","$0","$55","$1,200","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver13_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380022","BlueEssentials HD Silver 13","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380022-06","BlueEssentials HD Silver 13","94% AV Level Silver Plan",,"0.943356891821955","Yes","Yes","No","100%",,"$450","$0","$0","$60","$450","$0","$0","$55","$450","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDSilver13_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380006","BlueEssentials HD Bronze 2","26065SC038",,"SCN001","SCS001","SCF014","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9966",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380006-00","BlueEssentials HD Bronze 2","Standard Bronze Off Exchange Plan",,"0.605142272205434","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDBronze2","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380006","BlueEssentials HD Bronze 2","26065SC038",,"SCN001","SCS001","SCF014","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9966",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380006-01","BlueEssentials HD Bronze 2","Standard Bronze On Exchange Plan",,"0.605142272205434","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDBronze2","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380006","BlueEssentials HD Bronze 2","26065SC038",,"SCN001","SCS001","SCF014","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9966",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380006-02","BlueEssentials HD Bronze 2","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDBronze2_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380012","BlueEssentials HD Bronze 3","26065SC038",,"SCN001","SCS001","SCF044","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9966",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380012-01","BlueEssentials HD Bronze 3","Standard Bronze On Exchange Plan",,"0.612527460676527","Yes","Yes","No","100%",,"$2,830","$0","$3,720","$60","$4,560","$0","$1,990","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDBronze3","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380012","BlueEssentials HD Bronze 3","26065SC038",,"SCN001","SCS001","SCF044","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9966",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380012-02","BlueEssentials HD Bronze 3","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDBronze3_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380012","BlueEssentials HD Bronze 3","26065SC038",,"SCN001","SCS001","SCF044","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9966",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380012-03","BlueEssentials HD Bronze 3","Limited Cost Sharing Plan Variation",,"0.612527460676527","Yes","Yes","No","100%",,"$2,830","$0","$3,720","$60","$4,560","$0","$1,990","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDBronze3_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380014","BlueEssentials HD Bronze 5","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9966",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380014-00","BlueEssentials HD Bronze 5","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDBronze5","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380014","BlueEssentials HD Bronze 5","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9966",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380014-01","BlueEssentials HD Bronze 5","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDBronze5","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380014","BlueEssentials HD Bronze 5","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9966",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380014-02","BlueEssentials HD Bronze 5","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDBronze5_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380014","BlueEssentials HD Bronze 5","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9966",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0380014-03","BlueEssentials HD Bronze 5","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/HDBronze5_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380021","BlueEssentials Gold 4","26065SC038",,"SCN001","SCS001","SCF017","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380021-00","BlueEssentials Gold 4","Standard Gold Off Exchange Plan",,"0.761461031179975","No","Yes","Yes","80%","20%","$2,700","$92","$2,480","$60","$1,489","$1,088","$372","$55","$1,305","$120","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,700","$2700 per person","$5400 per group","20.00%","$2,700","$2700 per person","$5400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Gold4","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380021","BlueEssentials Gold 4","26065SC038",,"SCN001","SCS001","SCF017","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380021-01","BlueEssentials Gold 4","Standard Gold On Exchange Plan",,"0.761461031179975","No","Yes","Yes","80%","20%","$2,700","$92","$2,480","$60","$1,489","$1,088","$372","$55","$1,305","$120","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,700","$2700 per person","$5400 per group","20.00%","$2,700","$2700 per person","$5400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Gold4","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380021","BlueEssentials Gold 4","26065SC038",,"SCN001","SCS001","SCF017","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380021-02","BlueEssentials Gold 4","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","80%","20%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Gold4_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380021","BlueEssentials Gold 4","26065SC038",,"SCN001","SCS001","SCF017","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9977",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380021-03","BlueEssentials Gold 4","Limited Cost Sharing Plan Variation",,"0.761461031179975","No","Yes","Yes","80%","20%","$2,700","$92","$2,480","$60","$1,489","$1,088","$372","$55","$1,305","$120","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,700","$2700 per person","$5400 per group","20.00%","$2,700","$2700 per person","$5400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Gold4_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380016-00","BlueEssentials Silver 8","Standard Silver Off Exchange Plan",,"0.717682628370657","No","Yes","Yes","80%","20%","$4,840","$0","$1,860","$60","$1,582","$980","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","15.00%","$5,250","$5250 per person","$10500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver8","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380016-03","BlueEssentials Silver 8","Limited Cost Sharing Plan Variation",,"0.717682628370657","No","Yes","Yes","80%","20%","$4,840","$0","$1,860","$60","$1,582","$980","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","15.00%","$5,250","$5250 per person","$10500 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver8_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380016-04","BlueEssentials Silver 8","73% AV Level Silver Plan",,"0.738714166422383","No","Yes","Yes","80%","20%","$3,990","$0","$1,860","$60","$1,582","$920","$279","$55","$1,387","$90","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","15.00%","$4,500","$4500 per person","$9000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver8_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380016-05","BlueEssentials Silver 8","87% AV Level Silver Plan",,"0.871798100819353","No","Yes","Yes","80%","20%","$850","$80","$1,240","$60","$850","$920","$186","$55","$850","$90","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10.00%","$850","$850 per person","$1700 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver8_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380016-06","BlueEssentials Silver 8","94% AV Level Silver Plan",,"0.930050594360624","No","Yes","Yes","80%","20%","$0","$80","$620","$60","$0","$920","$93","$55","$0","$90","$82","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5.00%","$0","$0 per person","$0 per group","5.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver8_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF046","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380017-00","BlueEssentials Silver 9","Standard Silver Off Exchange Plan",,"0.687619006576695","No","Yes","No","100%",,"$1,720","$0","$5,130","$60","$931","$1,630","$931","$55","$816","$180","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver9","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF046","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380017-01","BlueEssentials Silver 9","Standard Silver On Exchange Plan",,"0.687619006576695","No","Yes","No","100%",,"$1,720","$0","$5,130","$60","$931","$1,630","$931","$55","$816","$180","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver9","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF046","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380017-02","BlueEssentials Silver 9","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver9_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF046","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380017-03","BlueEssentials Silver 9","Limited Cost Sharing Plan Variation",,"0.687619006576695","No","Yes","No","100%",,"$1,720","$0","$5,130","$60","$931","$1,630","$931","$55","$816","$180","$816","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver9_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF046","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380017-04","BlueEssentials Silver 9","73% AV Level Silver Plan",,"0.729722280305189","No","Yes","No","100%",,"$1,720","$0","$3,730","$60","$931","$595","$931","$55","$816","$75","$816","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver9_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF046","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380017-05","BlueEssentials Silver 9","87% AV Level Silver Plan",,"0.869796368830519","No","Yes","No","100%",,"$1,000","$0","$1,250","$60","$1,000","$325","$372","$55","$1,000","$60","$326","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver9_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF046","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380017-06","BlueEssentials Silver 9","94% AV Level Silver Plan",,"0.934602859660606","No","Yes","No","100%",,"$200","$20","$620","$60","$200","$325","$93","$55","$200","$60","$82","$0",,"0","4","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver9_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380018-00","BlueEssentials Silver 10","Standard Silver Off Exchange Plan",,"0.681672163864496","Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$2,135","$805","$0","$55","$1,925","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver10","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380018-03","BlueEssentials Silver 10","Limited Cost Sharing Plan Variation",,"0.681672163864496","Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$2,135","$805","$0","$55","$1,925","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver10_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380018-04","BlueEssentials Silver 10","73% AV Level Silver Plan",,"0.724573194306227","Yes","Yes","No","100%",,"$5,200","$0","$0","$60","$2,135","$805","$0","$55","$1,925","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver10_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380018-05","BlueEssentials Silver 10","87% AV Level Silver Plan",,"0.861190710617174","Yes","Yes","No","100%",,"$1,600","$0","$0","$60","$1,235","$365","$0","$55","$1,600","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver10_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9976",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380018-06","BlueEssentials Silver 10","94% AV Level Silver Plan",,"0.931950691694995","Yes","Yes","No","100%",,"$500","$20","$0","$60","$500","$200","$0","$55","$500","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Silver10_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380005","BlueEssentials Bronze 1","26065SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9965",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380005-00","BlueEssentials Bronze 1","Standard Bronze Off Exchange Plan",,"0.586975874219923","Yes","Yes","No","100%",,"$1,720","$0","$5,630","$60","$2,815","$1,590","$2,722","$55","$856","$270","$816","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Bronze1","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380005","BlueEssentials Bronze 1","26065SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9965",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380005-01","BlueEssentials Bronze 1","Standard Bronze On Exchange Plan",,"0.586975874219923","Yes","Yes","No","100%",,"$1,720","$0","$5,630","$60","$2,815","$1,590","$2,722","$55","$856","$270","$816","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Bronze1","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380005","BlueEssentials Bronze 1","26065SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9965",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380005-02","BlueEssentials Bronze 1","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Bronze1_L300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0380005","BlueEssentials Bronze 1","26065SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9965",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BlueEssentials","26065SC0380005-03","BlueEssentials Bronze 1","Limited Cost Sharing Plan Variation",,"0.586975874219923","Yes","Yes","No","100%",,"$1,720","$0","$5,630","$60","$2,815","$1,590","$2,722","$55","$856","$270","$816","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Bronze1_G300","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0390001","BlueEssentials Catastrophic 1","26065SC039",,"SCN001","SCS001","SCF006","Existing","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Depression","0.995",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0390001-00","BlueEssentials Catastrophic 1","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,393","$200","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Catastrophic1","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","26065","HIOS","2017-11-02 02:20:21","Individual","No","57-0287419","26065SC0390001","BlueEssentials Catastrophic 1","26065SC039",,"SCN001","SCS001","SCF006","Existing","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Depression","0.995",,,"2018-01-01","2018-12-31","Yes","Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.","Yes","Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.","No",,"https://www.southcarolinablues.com/links/pharmacy/BusinessBlueEssentials","26065SC0390001-01","BlueEssentials Catastrophic 1","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,393","$200","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.southcarolinablues.com/links/metallic/2018/individual/Catastrophic1","https://www.SouthCarolinaBlues.com/links/metallic/2018/individual/brochure"
"2018","SC","84939","HIOS","2017-08-04 02:20:25","Individual","Yes","13-5123390","84939SC0190001","Guardian Essentials for Families and Individuals","84939SC019",,"SCN002","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","84939SC0190001-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/south-carolina/","https://dentalexchange.guardianlife.com/our-plans/south-carolina/"
"2018","SC","84939","HIOS","2017-08-04 02:20:25","Individual","Yes","13-5123390","84939SC0190001","Guardian Essentials for Families and Individuals","84939SC019",,"SCN002","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","84939SC0190001-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/south-carolina/","https://dentalexchange.guardianlife.com/our-plans/south-carolina/"
"2018","SC","84939","HIOS","2017-08-04 02:20:25","Individual","Yes","13-5123390","84939SC0170001","Guardian Select for Families and Individuals","84939SC017",,"SCN002","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","84939SC0170001-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/south-carolina/","https://dentalexchange.guardianlife.com/our-plans/south-carolina/"
"2018","SC","84939","HIOS","2017-08-04 02:20:25","Individual","Yes","13-5123390","84939SC0170001","Guardian Select for Families and Individuals","84939SC017",,"SCN002","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","84939SC0170001-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/south-carolina/","https://dentalexchange.guardianlife.com/our-plans/south-carolina/"
"2018","SC","84939","HIOS","2017-08-04 02:20:25","Individual","Yes","13-5123390","84939SC0180001","Guardian Basics for Families and Individuals","84939SC018",,"SCN002","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","84939SC0180001-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/south-carolina/","https://dentalexchange.guardianlife.com/our-plans/south-carolina/"
"2018","SC","84966","HIOS","2017-06-09 02:20:26","SHOP (Small Group)","Yes","13-5581829","84966SC0120001","EHB Basic Dental Plan (Low)","84966SC012",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","84966SC0120001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","SC","89281","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","89281SC0010007","BESTDental Premium","89281SC001",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010007-00","BESTDental Premium","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/current/SC_BESTDental_Premium_Plan.pdf"
"2018","SC","89281","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","89281SC0020003","BESTOne Advantage Gold","89281SC002",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/SC/current/SC_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","SC","89281","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","89281SC0020003","BESTOne Advantage Gold","89281SC002",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/SC/current/SC_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","SC","89281","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","89281SC0010007","BESTDental Premium","89281SC001",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010007-01","BESTDental Premium","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/current/SC_BESTDental_Premium_Plan.pdf"
"2018","SC","89281","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","89281SC0010008","BESTDental Standard - H","89281SC001",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/current/SC_BESTDental_Standard-H_Plan.pdf"
"2018","SC","89281","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","89281SC0020004","BESTOne Plus Gold","89281SC002",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/SC/current/SC_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","SC","89281","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","89281SC0020004","BESTOne Plus Gold","89281SC002",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/SC/current/SC_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","SC","89281","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","89281SC0010008","BESTDental Standard - H","89281SC001",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/current/SC_BESTDental_Standard-H_Plan.pdf"
"2018","SC","89281","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","89281SC0010010","BESTDental Choice - H","89281SC001",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/current/SC_BESTDental_Choice-H_Plan.pdf"
"2018","SC","89281","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","89281SC0010010","BESTDental Choice - H","89281SC001",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/current/SC_BESTDental_Choice-H_Plan.pdf"
"2018","SC","89281","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","89281SC0010009","BESTDental Standard - L","89281SC001",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/sc/current/SC_BESTDental_Standard-L_Plan.pdf"
"2018","SC","89281","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","89281SC0020005","BESTOne Plus Silver","89281SC002",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/SC/current/SC_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","SC","89281","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","89281SC0020005","BESTOne Plus Silver","89281SC002",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/SC/current/SC_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","SC","89281","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","89281SC0010009","BESTDental Standard - L","89281SC001",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/sc/current/SC_BESTDental_Standard-L_Plan.pdf"
"2018","SC","89281","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","89281SC0010011","BESTDental Choice - L","89281SC001",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/current/SC_BESTDental_Choice-L_Plan.pdf"
"2018","SC","89281","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","89281SC0020006","BESTOne Basic Silver","89281SC002",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/SC/current/SC_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","SC","89281","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","89281SC0020006","BESTOne Basic Silver","89281SC002",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://bestlife.com/SC/current/SC_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","SC","89281","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","89281SC0010011","BESTDental Choice - L","89281SC001",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/current/SC_BESTDental_Choice-L_Plan.pdf"
"2018","SC","89281","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","89281SC0010012","BESTDental Value","89281SC001",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/current/SC_BESTDental_Value_Plan.pdf"
"2018","SC","89281","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","89281SC0010012","BESTDental Value","89281SC001",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/current/SC_BESTDental_Value_Plan.pdf"
"2018","SC","92498","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","92498SC0010007","Dentegra Dental PPO Pediatric Basic Plan","92498SC001",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","92498SC0010007-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sc/92498sc0010007-18"
"2018","SC","92498","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","92498SC0010012","Dentegra Dental PPO Family Preferred Plan","92498SC001",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","92498SC0010012-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","$45 per person","per group not applicable",,,,,,"$45","$45 per person","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sc/92498sc0010012-18"
"2018","SC","92498","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","92498SC0010011","Dentegra Dental PPO Family Basic Plan","92498SC001",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","92498SC0010011-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sc/92498sc0010011-18"
"2018","SC","97325","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","97325SC0020001","Renaissance Individual Dental PPO, EHB Certified","97325SC002",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","97325SC0020001-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","SC","97325","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","97325SC0020002","Renaissance Individual Dental PPO, EHB Certified","97325SC002",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","97325SC0020002-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","SC","97325","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","97325SC0060001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","97325SC006",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325","","97325SC0060001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_EHB_High_2018","http://www.renaissancedental.com/SC_EHB_High_2018"
"2018","SC","97325","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","97325SC0060002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","97325SC006",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325","","97325SC0060002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_EHB_Low_2018","http://www.renaissancedental.com/SC_EHB_Low_2018"
"2018","SC","97325","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","97325SC0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified","97325SC005",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","97325SC0050001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","SC","97325","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","97325SC0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified","97325SC005",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","97325SC0050002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","SC","97325","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","97325SC0070001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","97325SC007",,"SCN001","SCS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325","","97325SC0070001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_Ped_High_2018","http://www.renaissancedental.com/SC_Ped_High_2018"
"2018","SC","97325","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","97325SC0070002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","97325SC007",,"SCN001","SCS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325","","97325SC0070002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_Ped_Low_2018","http://www.renaissancedental.com/SC_Ped_Low_2018"
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330172","Bronze B07S, Network S","14002TN033",,"TNN002","TNS001","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330172-00","Bronze B07S, Network S","Standard Bronze Off Exchange Plan",,"0.605054383853865","Yes","Yes","No","100%",,"$5,650","$0","$1,000","$60","$5,650","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","50.00%",,,,,"$11,300","$11300 per person","$22600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2018/129800/B07S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330172","Bronze B07S, Network S","14002TN033",,"TNN002","TNS001","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330172-01","Bronze B07S, Network S","Standard Bronze On Exchange Plan",,"0.605054383853865","Yes","Yes","No","100%",,"$5,650","$0","$1,000","$60","$5,650","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","50.00%",,,,,"$11,300","$11300 per person","$22600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2018/127600/B07S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330172","Bronze B07S, Network S","14002TN033",,"TNN002","TNS001","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330172-02","Bronze B07S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2018/127600/B07S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330172","Bronze B07S, Network S","14002TN033",,"TNN002","TNS001","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330172-03","Bronze B07S, Network S","Limited Cost Sharing Plan Variation",,"0.605054383853865","Yes","Yes","No","100%",,"$5,650","$0","$1,000","$60","$5,650","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","50.00%",,,,,"$11,300","$11300 per person","$22600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/B07S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330173","Bronze B07S, Network S","14002TN033",,"TNN002","TNS002","TNF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330173-00","Bronze B07S, Network S","Standard Bronze Off Exchange Plan",,"0.605054383853865","Yes","Yes","No","100%",,"$5,650","$0","$1,000","$60","$5,650","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","50.00%",,,,,"$11,300","$11300 per person","$22600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2018/129800/B07S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330173","Bronze B07S, Network S","14002TN033",,"TNN002","TNS002","TNF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330173-01","Bronze B07S, Network S","Standard Bronze On Exchange Plan",,"0.605054383853865","Yes","Yes","No","100%",,"$5,650","$0","$1,000","$60","$5,650","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","50.00%",,,,,"$11,300","$11300 per person","$22600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2018/127600/B07S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330173","Bronze B07S, Network S","14002TN033",,"TNN002","TNS002","TNF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330173-02","Bronze B07S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2018/127600/B07S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330173","Bronze B07S, Network S","14002TN033",,"TNN002","TNS002","TNF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330173-03","Bronze B07S, Network S","Limited Cost Sharing Plan Variation",,"0.605054383853865","Yes","Yes","No","100%",,"$5,650","$0","$1,000","$60","$5,650","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","50.00%",,,,,"$11,300","$11300 per person","$22600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/B07S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330174","Bronze B07S, Network S","14002TN033",,"TNN002","TNS003","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330174-00","Bronze B07S, Network S","Standard Bronze Off Exchange Plan",,"0.605054383853865","Yes","Yes","No","100%",,"$5,650","$0","$1,000","$60","$5,650","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","50.00%",,,,,"$11,300","$11300 per person","$22600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2018/129800/B07S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330174","Bronze B07S, Network S","14002TN033",,"TNN002","TNS003","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330174-01","Bronze B07S, Network S","Standard Bronze On Exchange Plan",,"0.605054383853865","Yes","Yes","No","100%",,"$5,650","$0","$1,000","$60","$5,650","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","50.00%",,,,,"$11,300","$11300 per person","$22600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2018/127600/B07S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330174","Bronze B07S, Network S","14002TN033",,"TNN002","TNS003","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330174-02","Bronze B07S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2018/127600/B07S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330174","Bronze B07S, Network S","14002TN033",,"TNN002","TNS003","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330174-03","Bronze B07S, Network S","Limited Cost Sharing Plan Variation",,"0.605054383853865","Yes","Yes","No","100%",,"$5,650","$0","$1,000","$60","$5,650","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","50.00%",,,,,"$11,300","$11300 per person","$22600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/B07S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330175","Bronze B07S, Network S","14002TN033",,"TNN002","TNS005","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330175-00","Bronze B07S, Network S","Standard Bronze Off Exchange Plan",,"0.605054383853865","Yes","Yes","No","100%",,"$5,650","$0","$1,000","$60","$5,650","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","50.00%",,,,,"$11,300","$11300 per person","$22600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2018/129800/B07S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330175","Bronze B07S, Network S","14002TN033",,"TNN002","TNS005","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330175-01","Bronze B07S, Network S","Standard Bronze On Exchange Plan",,"0.605054383853865","Yes","Yes","No","100%",,"$5,650","$0","$1,000","$60","$5,650","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","50.00%",,,,,"$11,300","$11300 per person","$22600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2018/127600/B07S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330175","Bronze B07S, Network S","14002TN033",,"TNN002","TNS005","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330175-02","Bronze B07S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2018/127600/B07S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330175","Bronze B07S, Network S","14002TN033",,"TNN002","TNS005","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330175-03","Bronze B07S, Network S","Limited Cost Sharing Plan Variation",,"0.605054383853865","Yes","Yes","No","100%",,"$5,650","$0","$1,000","$60","$5,650","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","50.00%",,,,,"$11,300","$11300 per person","$22600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/B07S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330177","Bronze B07S, Network S","14002TN033",,"TNN002","TNS007","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330177-00","Bronze B07S, Network S","Standard Bronze Off Exchange Plan",,"0.605054383853865","Yes","Yes","No","100%",,"$5,650","$0","$1,000","$60","$5,650","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","50.00%",,,,,"$11,300","$11300 per person","$22600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2018/129800/B07S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330177","Bronze B07S, Network S","14002TN033",,"TNN002","TNS007","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330177-01","Bronze B07S, Network S","Standard Bronze On Exchange Plan",,"0.605054383853865","Yes","Yes","No","100%",,"$5,650","$0","$1,000","$60","$5,650","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","50.00%",,,,,"$11,300","$11300 per person","$22600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2018/127600/B07S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330177","Bronze B07S, Network S","14002TN033",,"TNN002","TNS007","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330177-02","Bronze B07S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2018/127600/B07S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330177","Bronze B07S, Network S","14002TN033",,"TNN002","TNS007","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330177-03","Bronze B07S, Network S","Limited Cost Sharing Plan Variation",,"0.605054383853865","Yes","Yes","No","100%",,"$5,650","$0","$1,000","$60","$5,650","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","50.00%",,,,,"$11,300","$11300 per person","$22600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/B07S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330178","Bronze B07S, Network S","14002TN033",,"TNN002","TNS008","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330178-00","Bronze B07S, Network S","Standard Bronze Off Exchange Plan",,"0.605054383853865","Yes","Yes","No","100%",,"$5,650","$0","$1,000","$60","$5,650","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","50.00%",,,,,"$11,300","$11300 per person","$22600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2018/129800/B07S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330178","Bronze B07S, Network S","14002TN033",,"TNN002","TNS008","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330178-01","Bronze B07S, Network S","Standard Bronze On Exchange Plan",,"0.605054383853865","Yes","Yes","No","100%",,"$5,650","$0","$1,000","$60","$5,650","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","50.00%",,,,,"$11,300","$11300 per person","$22600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2018/127600/B07S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330178","Bronze B07S, Network S","14002TN033",,"TNN002","TNS008","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330178-02","Bronze B07S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2018/127600/B07S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330178","Bronze B07S, Network S","14002TN033",,"TNN002","TNS008","TNF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330178-03","Bronze B07S, Network S","Limited Cost Sharing Plan Variation",,"0.605054383853865","Yes","Yes","No","100%",,"$5,650","$0","$1,000","$60","$5,650","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","50.00%",,,,,"$11,300","$11300 per person","$22600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/B07S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330208","Silver S01S, Network S","14002TN033",,"TNN002","TNS001","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330208-00","Silver S01S, Network S","Standard Silver Off Exchange Plan",,"0.717268336142493","Yes","Yes","No","100%",,"$250","$0","$6,200","$60","$250","$0","$3,500","$60","$250","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/129800/S01S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330208","Silver S01S, Network S","14002TN033",,"TNN002","TNS001","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330208-01","Silver S01S, Network S","Standard Silver On Exchange Plan",,"0.717268336142493","Yes","Yes","No","100%",,"$250","$0","$6,200","$60","$250","$0","$3,500","$60","$250","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330208","Silver S01S, Network S","14002TN033",,"TNN002","TNS001","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330208-02","Silver S01S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330208","Silver S01S, Network S","14002TN033",,"TNN002","TNS001","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330208-03","Silver S01S, Network S","Limited Cost Sharing Plan Variation",,"0.717268336142493","Yes","Yes","No","100%",,"$250","$0","$6,200","$60","$250","$0","$3,500","$60","$250","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330208","Silver S01S, Network S","14002TN033",,"TNN002","TNS001","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330208-04","Silver S01S, Network S","73% AV Level Silver Plan",,"0.739429504386355","Yes","Yes","No","100%",,"$200","$0","$5,600","$60","$200","$0","$3,500","$60","$200","$0","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$210","$210 per person","$420 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-A_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330208","Silver S01S, Network S","14002TN033",,"TNN002","TNS001","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330208-05","Silver S01S, Network S","87% AV Level Silver Plan",,"0.865475453916894","Yes","Yes","No","100%",,"$0","$0","$1,700","$60","$0","$0","$1,700","$60","$0","$0","$1,000","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-B_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330208","Silver S01S, Network S","14002TN033",,"TNN002","TNS001","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330208-06","Silver S01S, Network S","94% AV Level Silver Plan",,"0.930909981116427","Yes","Yes","No","100%",,"$0","$0","$700","$60","$0","$0","$700","$60","$0","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-C_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330209","Silver S01S, Network S","14002TN033",,"TNN002","TNS002","TNF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330209-00","Silver S01S, Network S","Standard Silver Off Exchange Plan",,"0.717268336142493","Yes","Yes","No","100%",,"$250","$0","$6,200","$60","$250","$0","$3,500","$60","$250","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/129800/S01S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330209","Silver S01S, Network S","14002TN033",,"TNN002","TNS002","TNF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330209-01","Silver S01S, Network S","Standard Silver On Exchange Plan",,"0.717268336142493","Yes","Yes","No","100%",,"$250","$0","$6,200","$60","$250","$0","$3,500","$60","$250","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330209","Silver S01S, Network S","14002TN033",,"TNN002","TNS002","TNF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330209-02","Silver S01S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330209","Silver S01S, Network S","14002TN033",,"TNN002","TNS002","TNF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330209-03","Silver S01S, Network S","Limited Cost Sharing Plan Variation",,"0.717268336142493","Yes","Yes","No","100%",,"$250","$0","$6,200","$60","$250","$0","$3,500","$60","$250","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330209","Silver S01S, Network S","14002TN033",,"TNN002","TNS002","TNF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330209-04","Silver S01S, Network S","73% AV Level Silver Plan",,"0.739429504386355","Yes","Yes","No","100%",,"$200","$0","$5,600","$60","$200","$0","$3,500","$60","$200","$0","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$210","$210 per person","$420 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-A_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330209","Silver S01S, Network S","14002TN033",,"TNN002","TNS002","TNF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330209-05","Silver S01S, Network S","87% AV Level Silver Plan",,"0.865475453916894","Yes","Yes","No","100%",,"$0","$0","$1,700","$60","$0","$0","$1,700","$60","$0","$0","$1,000","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-B_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330209","Silver S01S, Network S","14002TN033",,"TNN002","TNS002","TNF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330209-06","Silver S01S, Network S","94% AV Level Silver Plan",,"0.930909981116427","Yes","Yes","No","100%",,"$0","$0","$700","$60","$0","$0","$700","$60","$0","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-C_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330210","Silver S01S, Network S","14002TN033",,"TNN002","TNS003","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330210-00","Silver S01S, Network S","Standard Silver Off Exchange Plan",,"0.717268336142493","Yes","Yes","No","100%",,"$250","$0","$6,200","$60","$250","$0","$3,500","$60","$250","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/129800/S01S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330210","Silver S01S, Network S","14002TN033",,"TNN002","TNS003","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330210-01","Silver S01S, Network S","Standard Silver On Exchange Plan",,"0.717268336142493","Yes","Yes","No","100%",,"$250","$0","$6,200","$60","$250","$0","$3,500","$60","$250","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330210","Silver S01S, Network S","14002TN033",,"TNN002","TNS003","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330210-02","Silver S01S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330210","Silver S01S, Network S","14002TN033",,"TNN002","TNS003","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330210-03","Silver S01S, Network S","Limited Cost Sharing Plan Variation",,"0.717268336142493","Yes","Yes","No","100%",,"$250","$0","$6,200","$60","$250","$0","$3,500","$60","$250","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330210","Silver S01S, Network S","14002TN033",,"TNN002","TNS003","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330210-04","Silver S01S, Network S","73% AV Level Silver Plan",,"0.739429504386355","Yes","Yes","No","100%",,"$200","$0","$5,600","$60","$200","$0","$3,500","$60","$200","$0","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$210","$210 per person","$420 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-A_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330210","Silver S01S, Network S","14002TN033",,"TNN002","TNS003","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330210-05","Silver S01S, Network S","87% AV Level Silver Plan",,"0.865475453916894","Yes","Yes","No","100%",,"$0","$0","$1,700","$60","$0","$0","$1,700","$60","$0","$0","$1,000","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-B_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330210","Silver S01S, Network S","14002TN033",,"TNN002","TNS003","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330210-06","Silver S01S, Network S","94% AV Level Silver Plan",,"0.930909981116427","Yes","Yes","No","100%",,"$0","$0","$700","$60","$0","$0","$700","$60","$0","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-C_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330211","Silver S01S, Network S","14002TN033",,"TNN002","TNS005","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330211-00","Silver S01S, Network S","Standard Silver Off Exchange Plan",,"0.717268336142493","Yes","Yes","No","100%",,"$250","$0","$6,200","$60","$250","$0","$3,500","$60","$250","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/129800/S01S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330211","Silver S01S, Network S","14002TN033",,"TNN002","TNS005","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330211-01","Silver S01S, Network S","Standard Silver On Exchange Plan",,"0.717268336142493","Yes","Yes","No","100%",,"$250","$0","$6,200","$60","$250","$0","$3,500","$60","$250","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330211","Silver S01S, Network S","14002TN033",,"TNN002","TNS005","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330211-02","Silver S01S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330211","Silver S01S, Network S","14002TN033",,"TNN002","TNS005","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330211-03","Silver S01S, Network S","Limited Cost Sharing Plan Variation",,"0.717268336142493","Yes","Yes","No","100%",,"$250","$0","$6,200","$60","$250","$0","$3,500","$60","$250","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330211","Silver S01S, Network S","14002TN033",,"TNN002","TNS005","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330211-04","Silver S01S, Network S","73% AV Level Silver Plan",,"0.739429504386355","Yes","Yes","No","100%",,"$200","$0","$5,600","$60","$200","$0","$3,500","$60","$200","$0","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$210","$210 per person","$420 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-A_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330211","Silver S01S, Network S","14002TN033",,"TNN002","TNS005","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330211-05","Silver S01S, Network S","87% AV Level Silver Plan",,"0.865475453916894","Yes","Yes","No","100%",,"$0","$0","$1,700","$60","$0","$0","$1,700","$60","$0","$0","$1,000","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-B_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330211","Silver S01S, Network S","14002TN033",,"TNN002","TNS005","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330211-06","Silver S01S, Network S","94% AV Level Silver Plan",,"0.930909981116427","Yes","Yes","No","100%",,"$0","$0","$700","$60","$0","$0","$700","$60","$0","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-C_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330213","Silver S01S, Network S","14002TN033",,"TNN002","TNS007","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330213-00","Silver S01S, Network S","Standard Silver Off Exchange Plan",,"0.717268336142493","Yes","Yes","No","100%",,"$250","$0","$6,200","$60","$250","$0","$3,500","$60","$250","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/129800/S01S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330213","Silver S01S, Network S","14002TN033",,"TNN002","TNS007","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330213-01","Silver S01S, Network S","Standard Silver On Exchange Plan",,"0.717268336142493","Yes","Yes","No","100%",,"$250","$0","$6,200","$60","$250","$0","$3,500","$60","$250","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330213","Silver S01S, Network S","14002TN033",,"TNN002","TNS007","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330213-02","Silver S01S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330213","Silver S01S, Network S","14002TN033",,"TNN002","TNS007","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330213-03","Silver S01S, Network S","Limited Cost Sharing Plan Variation",,"0.717268336142493","Yes","Yes","No","100%",,"$250","$0","$6,200","$60","$250","$0","$3,500","$60","$250","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330213","Silver S01S, Network S","14002TN033",,"TNN002","TNS007","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330213-04","Silver S01S, Network S","73% AV Level Silver Plan",,"0.739429504386355","Yes","Yes","No","100%",,"$200","$0","$5,600","$60","$200","$0","$3,500","$60","$200","$0","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$210","$210 per person","$420 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-A_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330213","Silver S01S, Network S","14002TN033",,"TNN002","TNS007","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330213-05","Silver S01S, Network S","87% AV Level Silver Plan",,"0.865475453916894","Yes","Yes","No","100%",,"$0","$0","$1,700","$60","$0","$0","$1,700","$60","$0","$0","$1,000","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-B_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330213","Silver S01S, Network S","14002TN033",,"TNN002","TNS007","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330213-06","Silver S01S, Network S","94% AV Level Silver Plan",,"0.930909981116427","Yes","Yes","No","100%",,"$0","$0","$700","$60","$0","$0","$700","$60","$0","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-C_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330214","Silver S01S, Network S","14002TN033",,"TNN002","TNS008","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330214-00","Silver S01S, Network S","Standard Silver Off Exchange Plan",,"0.717268336142493","Yes","Yes","No","100%",,"$250","$0","$6,200","$60","$250","$0","$3,500","$60","$250","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/129800/S01S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330214","Silver S01S, Network S","14002TN033",,"TNN002","TNS008","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330214-01","Silver S01S, Network S","Standard Silver On Exchange Plan",,"0.717268336142493","Yes","Yes","No","100%",,"$250","$0","$6,200","$60","$250","$0","$3,500","$60","$250","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330214","Silver S01S, Network S","14002TN033",,"TNN002","TNS008","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330214-02","Silver S01S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330214","Silver S01S, Network S","14002TN033",,"TNN002","TNS008","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330214-05","Silver S01S, Network S","87% AV Level Silver Plan",,"0.865475453916894","Yes","Yes","No","100%",,"$0","$0","$1,700","$60","$0","$0","$1,700","$60","$0","$0","$1,000","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-B_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330214","Silver S01S, Network S","14002TN033",,"TNN002","TNS008","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330214-06","Silver S01S, Network S","94% AV Level Silver Plan",,"0.930909981116427","Yes","Yes","No","100%",,"$0","$0","$700","$60","$0","$0","$700","$60","$0","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-C_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330240","Silver S04S, Network S","14002TN033",,"TNN002","TNS001","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330240-00","Silver S04S, Network S","Standard Silver Off Exchange Plan",,"0.660473178255119","Yes","Yes","No","100%",,"$2,500","$0","$3,500","$60","$2,500","$0","$2,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/129800/S04S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330240","Silver S04S, Network S","14002TN033",,"TNN002","TNS001","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330240-01","Silver S04S, Network S","Standard Silver On Exchange Plan",,"0.660473178255119","Yes","Yes","No","100%",,"$2,500","$0","$3,500","$60","$2,500","$0","$2,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330240","Silver S04S, Network S","14002TN033",,"TNN002","TNS001","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330240-02","Silver S04S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330240","Silver S04S, Network S","14002TN033",,"TNN002","TNS001","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330240-03","Silver S04S, Network S","Limited Cost Sharing Plan Variation",,"0.660473178255119","Yes","Yes","No","100%",,"$2,500","$0","$3,500","$60","$2,500","$0","$2,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330240","Silver S04S, Network S","14002TN033",,"TNN002","TNS001","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330240-04","Silver S04S, Network S","73% AV Level Silver Plan",,"0.727089500192422","Yes","Yes","No","100%",,"$1,350","$0","$2,900","$60","$1,350","$0","$2,900","$60","$1,350","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-A_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330240","Silver S04S, Network S","14002TN033",,"TNN002","TNS001","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330240-05","Silver S04S, Network S","87% AV Level Silver Plan",,"0.861989598194452","Yes","Yes","No","100%",,"$175","$0","$1,400","$60","$175","$0","$1,400","$60","$175","$0","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-B_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330240","Silver S04S, Network S","14002TN033",,"TNN002","TNS001","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330240-06","Silver S04S, Network S","94% AV Level Silver Plan",,"0.930267454878277","Yes","Yes","No","100%",,"$20","$0","$700","$60","$20","$0","$700","$60","$20","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$20","$20 per person","$40 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-C_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330241","Silver S04S, Network S","14002TN033",,"TNN002","TNS002","TNF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330241-00","Silver S04S, Network S","Standard Silver Off Exchange Plan",,"0.660473178255119","Yes","Yes","No","100%",,"$2,500","$0","$3,500","$60","$2,500","$0","$2,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/129800/S04S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330241","Silver S04S, Network S","14002TN033",,"TNN002","TNS002","TNF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330241-01","Silver S04S, Network S","Standard Silver On Exchange Plan",,"0.660473178255119","Yes","Yes","No","100%",,"$2,500","$0","$3,500","$60","$2,500","$0","$2,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330241","Silver S04S, Network S","14002TN033",,"TNN002","TNS002","TNF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330241-02","Silver S04S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330243","Silver S04S, Network S","14002TN033",,"TNN002","TNS005","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330243-03","Silver S04S, Network S","Limited Cost Sharing Plan Variation",,"0.660473178255119","Yes","Yes","No","100%",,"$2,500","$0","$3,500","$60","$2,500","$0","$2,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330243","Silver S04S, Network S","14002TN033",,"TNN002","TNS005","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330243-04","Silver S04S, Network S","73% AV Level Silver Plan",,"0.727089500192422","Yes","Yes","No","100%",,"$1,350","$0","$2,900","$60","$1,350","$0","$2,900","$60","$1,350","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-A_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330243","Silver S04S, Network S","14002TN033",,"TNN002","TNS005","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330243-05","Silver S04S, Network S","87% AV Level Silver Plan",,"0.861989598194452","Yes","Yes","No","100%",,"$175","$0","$1,400","$60","$175","$0","$1,400","$60","$175","$0","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-B_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330243","Silver S04S, Network S","14002TN033",,"TNN002","TNS005","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330243-06","Silver S04S, Network S","94% AV Level Silver Plan",,"0.930267454878277","Yes","Yes","No","100%",,"$20","$0","$700","$60","$20","$0","$700","$60","$20","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$20","$20 per person","$40 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-C_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330245","Silver S04S, Network S","14002TN033",,"TNN002","TNS007","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330245-00","Silver S04S, Network S","Standard Silver Off Exchange Plan",,"0.660473178255119","Yes","Yes","No","100%",,"$2,500","$0","$3,500","$60","$2,500","$0","$2,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/129800/S04S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330245","Silver S04S, Network S","14002TN033",,"TNN002","TNS007","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330245-01","Silver S04S, Network S","Standard Silver On Exchange Plan",,"0.660473178255119","Yes","Yes","No","100%",,"$2,500","$0","$3,500","$60","$2,500","$0","$2,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330245","Silver S04S, Network S","14002TN033",,"TNN002","TNS007","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330245-02","Silver S04S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330245","Silver S04S, Network S","14002TN033",,"TNN002","TNS007","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330245-03","Silver S04S, Network S","Limited Cost Sharing Plan Variation",,"0.660473178255119","Yes","Yes","No","100%",,"$2,500","$0","$3,500","$60","$2,500","$0","$2,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330245","Silver S04S, Network S","14002TN033",,"TNN002","TNS007","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330245-04","Silver S04S, Network S","73% AV Level Silver Plan",,"0.727089500192422","Yes","Yes","No","100%",,"$1,350","$0","$2,900","$60","$1,350","$0","$2,900","$60","$1,350","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-A_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330245","Silver S04S, Network S","14002TN033",,"TNN002","TNS007","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330245-05","Silver S04S, Network S","87% AV Level Silver Plan",,"0.861989598194452","Yes","Yes","No","100%",,"$175","$0","$1,400","$60","$175","$0","$1,400","$60","$175","$0","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-B_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330245","Silver S04S, Network S","14002TN033",,"TNN002","TNS007","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330245-06","Silver S04S, Network S","94% AV Level Silver Plan",,"0.930267454878277","Yes","Yes","No","100%",,"$20","$0","$700","$60","$20","$0","$700","$60","$20","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$20","$20 per person","$40 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-C_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330246","Silver S04S, Network S","14002TN033",,"TNN002","TNS008","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330246-00","Silver S04S, Network S","Standard Silver Off Exchange Plan",,"0.660473178255119","Yes","Yes","No","100%",,"$2,500","$0","$3,500","$60","$2,500","$0","$2,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/129800/S04S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330214","Silver S01S, Network S","14002TN033",,"TNN002","TNS008","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330214-03","Silver S01S, Network S","Limited Cost Sharing Plan Variation",,"0.717268336142493","Yes","Yes","No","100%",,"$250","$0","$6,200","$60","$250","$0","$3,500","$60","$250","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330214","Silver S01S, Network S","14002TN033",,"TNN002","TNS008","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330214-04","Silver S01S, Network S","73% AV Level Silver Plan",,"0.739429504386355","Yes","Yes","No","100%",,"$200","$0","$5,600","$60","$200","$0","$3,500","$60","$200","$0","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$210","$210 per person","$420 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S01S-A_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330241","Silver S04S, Network S","14002TN033",,"TNN002","TNS002","TNF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330241-03","Silver S04S, Network S","Limited Cost Sharing Plan Variation",,"0.660473178255119","Yes","Yes","No","100%",,"$2,500","$0","$3,500","$60","$2,500","$0","$2,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330241","Silver S04S, Network S","14002TN033",,"TNN002","TNS002","TNF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330241-04","Silver S04S, Network S","73% AV Level Silver Plan",,"0.727089500192422","Yes","Yes","No","100%",,"$1,350","$0","$2,900","$60","$1,350","$0","$2,900","$60","$1,350","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-A_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330241","Silver S04S, Network S","14002TN033",,"TNN002","TNS002","TNF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330241-05","Silver S04S, Network S","87% AV Level Silver Plan",,"0.861989598194452","Yes","Yes","No","100%",,"$175","$0","$1,400","$60","$175","$0","$1,400","$60","$175","$0","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-B_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330241","Silver S04S, Network S","14002TN033",,"TNN002","TNS002","TNF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330241-06","Silver S04S, Network S","94% AV Level Silver Plan",,"0.930267454878277","Yes","Yes","No","100%",,"$20","$0","$700","$60","$20","$0","$700","$60","$20","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$20","$20 per person","$40 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-C_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330242","Silver S04S, Network S","14002TN033",,"TNN002","TNS003","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330242-00","Silver S04S, Network S","Standard Silver Off Exchange Plan",,"0.660473178255119","Yes","Yes","No","100%",,"$2,500","$0","$3,500","$60","$2,500","$0","$2,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/129800/S04S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330242","Silver S04S, Network S","14002TN033",,"TNN002","TNS003","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330242-01","Silver S04S, Network S","Standard Silver On Exchange Plan",,"0.660473178255119","Yes","Yes","No","100%",,"$2,500","$0","$3,500","$60","$2,500","$0","$2,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330242","Silver S04S, Network S","14002TN033",,"TNN002","TNS003","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330242-02","Silver S04S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330242","Silver S04S, Network S","14002TN033",,"TNN002","TNS003","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330242-03","Silver S04S, Network S","Limited Cost Sharing Plan Variation",,"0.660473178255119","Yes","Yes","No","100%",,"$2,500","$0","$3,500","$60","$2,500","$0","$2,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330242","Silver S04S, Network S","14002TN033",,"TNN002","TNS003","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330242-04","Silver S04S, Network S","73% AV Level Silver Plan",,"0.727089500192422","Yes","Yes","No","100%",,"$1,350","$0","$2,900","$60","$1,350","$0","$2,900","$60","$1,350","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-A_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330242","Silver S04S, Network S","14002TN033",,"TNN002","TNS003","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330242-05","Silver S04S, Network S","87% AV Level Silver Plan",,"0.861989598194452","Yes","Yes","No","100%",,"$175","$0","$1,400","$60","$175","$0","$1,400","$60","$175","$0","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-B_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330242","Silver S04S, Network S","14002TN033",,"TNN002","TNS003","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330242-06","Silver S04S, Network S","94% AV Level Silver Plan",,"0.930267454878277","Yes","Yes","No","100%",,"$20","$0","$700","$60","$20","$0","$700","$60","$20","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$20","$20 per person","$40 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-C_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330243","Silver S04S, Network S","14002TN033",,"TNN002","TNS005","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330243-00","Silver S04S, Network S","Standard Silver Off Exchange Plan",,"0.660473178255119","Yes","Yes","No","100%",,"$2,500","$0","$3,500","$60","$2,500","$0","$2,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/129800/S04S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330243","Silver S04S, Network S","14002TN033",,"TNN002","TNS005","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330243-01","Silver S04S, Network S","Standard Silver On Exchange Plan",,"0.660473178255119","Yes","Yes","No","100%",,"$2,500","$0","$3,500","$60","$2,500","$0","$2,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330243","Silver S04S, Network S","14002TN033",,"TNN002","TNS005","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330243-02","Silver S04S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330246","Silver S04S, Network S","14002TN033",,"TNN002","TNS008","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330246-01","Silver S04S, Network S","Standard Silver On Exchange Plan",,"0.660473178255119","Yes","Yes","No","100%",,"$2,500","$0","$3,500","$60","$2,500","$0","$2,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330246","Silver S04S, Network S","14002TN033",,"TNN002","TNS008","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330246-02","Silver S04S, Network S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330246","Silver S04S, Network S","14002TN033",,"TNN002","TNS008","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330246-03","Silver S04S, Network S","Limited Cost Sharing Plan Variation",,"0.660473178255119","Yes","Yes","No","100%",,"$2,500","$0","$3,500","$60","$2,500","$0","$2,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330246","Silver S04S, Network S","14002TN033",,"TNN002","TNS008","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330246-04","Silver S04S, Network S","73% AV Level Silver Plan",,"0.727089500192422","Yes","Yes","No","100%",,"$1,350","$0","$2,900","$60","$1,350","$0","$2,900","$60","$1,350","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-A_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330246","Silver S04S, Network S","14002TN033",,"TNN002","TNS008","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330246-05","Silver S04S, Network S","87% AV Level Silver Plan",,"0.861989598194452","Yes","Yes","No","100%",,"$175","$0","$1,400","$60","$175","$0","$1,400","$60","$175","$0","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-B_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330246","Silver S04S, Network S","14002TN033",,"TNN002","TNS008","TNF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330246-06","Silver S04S, Network S","94% AV Level Silver Plan",,"0.930267454878277","Yes","Yes","No","100%",,"$20","$0","$700","$60","$20","$0","$700","$60","$20","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$20","$20 per person","$40 per group","50.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2018/127600/S04S-C_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330336","Gold G06S, Network S","14002TN033",,"TNN002","TNS001","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330336-00","Gold G06S, Network S","Standard Gold Off Exchange Plan",,"0.819816914376403","No","Yes","No","100%",,"$1,500","$100","$2,000","$60","$1,500","$1,600","$0","$60","$1,500","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/129800/G06S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330336","Gold G06S, Network S","14002TN033",,"TNN002","TNS001","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330336-01","Gold G06S, Network S","Standard Gold On Exchange Plan",,"0.819816914376403","No","Yes","No","100%",,"$1,500","$100","$2,000","$60","$1,500","$1,600","$0","$60","$1,500","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/127600/G06S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330336","Gold G06S, Network S","14002TN033",,"TNN002","TNS001","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330336-02","Gold G06S, Network S","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/127600/G06S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330336","Gold G06S, Network S","14002TN033",,"TNN002","TNS001","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330336-03","Gold G06S, Network S","Limited Cost Sharing Plan Variation",,"0.819816914376403","No","Yes","No","100%",,"$1,500","$100","$2,000","$60","$1,500","$1,600","$0","$60","$1,500","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/127600/G06S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330337","Gold G06S, Network S","14002TN033",,"TNN002","TNS002","TNF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330337-00","Gold G06S, Network S","Standard Gold Off Exchange Plan",,"0.819816914376403","No","Yes","No","100%",,"$1,500","$100","$2,000","$60","$1,500","$1,600","$0","$60","$1,500","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/129800/G06S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330337","Gold G06S, Network S","14002TN033",,"TNN002","TNS002","TNF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330337-01","Gold G06S, Network S","Standard Gold On Exchange Plan",,"0.819816914376403","No","Yes","No","100%",,"$1,500","$100","$2,000","$60","$1,500","$1,600","$0","$60","$1,500","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/127600/G06S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330337","Gold G06S, Network S","14002TN033",,"TNN002","TNS002","TNF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330337-02","Gold G06S, Network S","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/127600/G06S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330337","Gold G06S, Network S","14002TN033",,"TNN002","TNS002","TNF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330337-03","Gold G06S, Network S","Limited Cost Sharing Plan Variation",,"0.819816914376403","No","Yes","No","100%",,"$1,500","$100","$2,000","$60","$1,500","$1,600","$0","$60","$1,500","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/127600/G06S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330338","Gold G06S, Network S","14002TN033",,"TNN002","TNS003","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330338-00","Gold G06S, Network S","Standard Gold Off Exchange Plan",,"0.819816914376403","No","Yes","No","100%",,"$1,500","$100","$2,000","$60","$1,500","$1,600","$0","$60","$1,500","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/129800/G06S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330339","Gold G06S, Network S","14002TN033",,"TNN002","TNS005","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330339-01","Gold G06S, Network S","Standard Gold On Exchange Plan",,"0.819816914376403","No","Yes","No","100%",,"$1,500","$100","$2,000","$60","$1,500","$1,600","$0","$60","$1,500","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/127600/G06S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330339","Gold G06S, Network S","14002TN033",,"TNN002","TNS005","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330339-02","Gold G06S, Network S","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/127600/G06S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330339","Gold G06S, Network S","14002TN033",,"TNN002","TNS005","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330339-03","Gold G06S, Network S","Limited Cost Sharing Plan Variation",,"0.819816914376403","No","Yes","No","100%",,"$1,500","$100","$2,000","$60","$1,500","$1,600","$0","$60","$1,500","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/127600/G06S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330341","Gold G06S, Network S","14002TN033",,"TNN002","TNS007","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330341-00","Gold G06S, Network S","Standard Gold Off Exchange Plan",,"0.819816914376403","No","Yes","No","100%",,"$1,500","$100","$2,000","$60","$1,500","$1,600","$0","$60","$1,500","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/129800/G06S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330341","Gold G06S, Network S","14002TN033",,"TNN002","TNS007","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330341-01","Gold G06S, Network S","Standard Gold On Exchange Plan",,"0.819816914376403","No","Yes","No","100%",,"$1,500","$100","$2,000","$60","$1,500","$1,600","$0","$60","$1,500","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/127600/G06S_SBC.pdf",
"2018","TN","21535","HIOS","2017-06-09 02:20:26","SHOP (Small Group)","Yes","13-5581829","21535TN0120001","EHB Basic Dental Plan (Low)","21535TN012",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","21535TN0120001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TN","22384","HIOS","2017-08-10 02:20:26","Individual","Yes","62-0812197","22384TN0010001","Delta Dental FFM Individual Product","22384TN001",,"TNN002","TNS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Benefits allowed as 'Non Participating","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/alias/22384","","22384TN0010001-01","Delta Dental FFM Individual Product","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentaltn.com/Understand-My-Benefits/Affordable-Healthcare/ACA-Individuals/Individual-Pediatric-Plan-for-2018/Pediatric-Plan-Low-Option.aspx","https://www.deltadentaltn.com/Understand-My-Benefits/Affordable-Healthcare/ACA-Individuals/Individual-Pediatric-Plan-for-2018.aspx"
"2018","TN","22384","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","62-0812197","22384TN0040001","Delta Dental Small Group Product","22384TN004",,"TNN001","TNS001",,"Existing","POS","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits allowed as 'Non Participating'","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes",,"","22384TN0040001-00","Delta Dental Small Group Product","Standard Low Off Exchange Plan","70.00%",,,,"Yes","60%","40%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TN","22384","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","62-0812197","22384TN0040002","Delta Dental Small Group Product","22384TN004",,"TNN001","TNS001",,"Existing","POS","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits allowed as 'Non Participating'","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes",,"","22384TN0040002-00","Delta Dental Small Group Product","Standard High Off Exchange Plan","85.00%",,,,"Yes","60%","40%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TN","22384","HIOS","2017-08-10 02:20:26","Individual","Yes","62-0812197","22384TN0010002","Delta Dental FFM Individual Product","22384TN001",,"TNN002","TNS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Benefits allowed as 'Non Participating","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/alias/22384","","22384TN0010002-01","Delta Dental FFM Individual Product","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentaltn.com/Understand-My-Benefits/Affordable-Healthcare/ACA-Individuals/Individual-Pediatric-Plan-for-2018/Pediatric-Plan-High-Option.aspx","https://www.deltadentaltn.com/Understand-My-Benefits/Affordable-Healthcare/ACA-Individuals/Individual-Pediatric-Plan-for-2018.aspx"
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330338","Gold G06S, Network S","14002TN033",,"TNN002","TNS003","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330338-01","Gold G06S, Network S","Standard Gold On Exchange Plan",,"0.819816914376403","No","Yes","No","100%",,"$1,500","$100","$2,000","$60","$1,500","$1,600","$0","$60","$1,500","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/127600/G06S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330338","Gold G06S, Network S","14002TN033",,"TNN002","TNS003","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330338-02","Gold G06S, Network S","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/127600/G06S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330338","Gold G06S, Network S","14002TN033",,"TNN002","TNS003","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330338-03","Gold G06S, Network S","Limited Cost Sharing Plan Variation",,"0.819816914376403","No","Yes","No","100%",,"$1,500","$100","$2,000","$60","$1,500","$1,600","$0","$60","$1,500","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/127600/G06S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330339","Gold G06S, Network S","14002TN033",,"TNN002","TNS005","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330339-00","Gold G06S, Network S","Standard Gold Off Exchange Plan",,"0.819816914376403","No","Yes","No","100%",,"$1,500","$100","$2,000","$60","$1,500","$1,600","$0","$60","$1,500","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/129800/G06S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330341","Gold G06S, Network S","14002TN033",,"TNN002","TNS007","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330341-02","Gold G06S, Network S","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/127600/G06S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330341","Gold G06S, Network S","14002TN033",,"TNN002","TNS007","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330341-03","Gold G06S, Network S","Limited Cost Sharing Plan Variation",,"0.819816914376403","No","Yes","No","100%",,"$1,500","$100","$2,000","$60","$1,500","$1,600","$0","$60","$1,500","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/127600/G06S-AI2_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330342","Gold G06S, Network S","14002TN033",,"TNN002","TNS008","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330342-00","Gold G06S, Network S","Standard Gold Off Exchange Plan",,"0.819816914376403","No","Yes","No","100%",,"$1,500","$100","$2,000","$60","$1,500","$1,600","$0","$60","$1,500","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/129800/G06S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330342","Gold G06S, Network S","14002TN033",,"TNN002","TNS008","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330342-01","Gold G06S, Network S","Standard Gold On Exchange Plan",,"0.819816914376403","No","Yes","No","100%",,"$1,500","$100","$2,000","$60","$1,500","$1,600","$0","$60","$1,500","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/127600/G06S_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330342","Gold G06S, Network S","14002TN033",,"TNN002","TNS008","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330342-02","Gold G06S, Network S","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/127600/G06S-AI1_SBC.pdf",
"2018","TN","14002","HIOS","2017-10-17 02:20:15","Individual","No","62-0427913","14002TN0330342","Gold G06S, Network S","14002TN033",,"TNN002","TNS008","TNF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Blue Cross Blue Shield Global Core","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2018/index.page?","14002TN0330342-03","Gold G06S, Network S","Limited Cost Sharing Plan Variation",,"0.819816914376403","No","Yes","No","100%",,"$1,500","$100","$2,000","$60","$1,500","$1,600","$0","$60","$1,500","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2018/127600/G06S-AI2_SBC.pdf",
"2018","TN","22384","HIOS","2017-08-10 02:20:26","Individual","Yes","62-0812197","22384TN0030001","Delta Dental Individual Plan","22384TN003",,"TNN002","TNS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Benefits allowed as 'Non Participating","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes",,"","22384TN0030001-00","Delta Dental Individual Plan","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TN","22384","HIOS","2017-08-10 02:20:26","Individual","Yes","62-0812197","22384TN0030002","Delta Dental Individual Plan","22384TN003",,"TNN002","TNS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Benefits allowed as 'Non Participating","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes",,"","22384TN0030002-00","Delta Dental Individual Plan","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TN","22384","HIOS","2017-08-10 02:20:26","Individual","Yes","62-0812197","22384TN0010003","Delta Dental FFM Individual Product","22384TN001",,"TNN002","TNS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/alias/22384","","22384TN0010003-01","Delta Dental FFM Individual Product","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentaltn.com/Understand-My-Benefits/Affordable-Healthcare/ACA-Individuals/Individual-Family-Plan-for-2018/Family-Plan-Low-Option.aspx","https://www.deltadentaltn.com/Understand-My-Benefits/Affordable-Healthcare/ACA-Individuals/Individual-Family-Plan-for-2018.aspx"
"2018","TN","22384","HIOS","2017-08-10 02:20:26","Individual","Yes","62-0812197","22384TN0010004","Delta Dental FFM Individual Product","22384TN001",,"TNN002","TNS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/alias/22384","","22384TN0010004-01","Delta Dental FFM Individual Product","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentaltn.com/Understand-My-Benefits/Affordable-Healthcare/ACA-Individuals/Individual-Family-Plan-for-2018/Family-Plan-High-Option.aspx","https://www.deltadentaltn.com/Understand-My-Benefits/Affordable-Healthcare/ACA-Individuals/Individual-Family-Plan-for-2018.aspx"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0010001","Simple Secure","23552TN001",,"TNN001","TNS001","TNF001","New","EPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9949197",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0010001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF001","23552TN0010001-00","Simple Secure","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","3","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0010001-00","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0010001-00"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0010001","Simple Secure","23552TN001",,"TNN001","TNS001","TNF001","New","EPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9949197",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0010001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF001","23552TN0010001-01","Simple Secure","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","3","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0010001-01","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0010001-01"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0020001","Simple Bronze","23552TN002",,"TNN001","TNS001","TNF002","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9948387",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0020001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF002","23552TN0020001-00","Simple Bronze","Standard Bronze Off Exchange Plan","58.54%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0020001-00","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0020001-00"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0020001","Simple Bronze","23552TN002",,"TNN001","TNS001","TNF002","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9948387",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0020001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF002","23552TN0020001-01","Simple Bronze","Standard Bronze On Exchange Plan","58.54%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0020001-01","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0020001-01"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0020001","Simple Bronze","23552TN002",,"TNN001","TNS001","TNF002","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9948387",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0020001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF002","23552TN0020001-02","Simple Bronze","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0020001-02","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0020001-02"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0020001","Simple Bronze","23552TN002",,"TNN001","TNS001","TNF002","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9948387",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0020001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF002","23552TN0020001-03","Simple Bronze","Limited Cost Sharing Plan Variation","58.54%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0020001-03","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0020001-03"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0030001","Simple Silver","23552TN003",,"TNN001","TNS001","TNF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0030001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF003","23552TN0030001-00","Simple Silver","Standard Silver Off Exchange Plan","66.18%",,"Yes","Yes","No","100%",,"$5,800","$100","$0","$200","$0","$1,900","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0030001-00","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0030001-00"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0030001","Simple Silver","23552TN003",,"TNN001","TNS001","TNF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0030001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF003","23552TN0030001-01","Simple Silver","Standard Silver On Exchange Plan","66.18%",,"Yes","Yes","No","100%",,"$5,800","$100","$0","$200","$0","$1,900","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0030001-01","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0030001-01"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0030001","Simple Silver","23552TN003",,"TNN001","TNS001","TNF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0030001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF003","23552TN0030001-02","Simple Silver","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0030001-02","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0030001-02"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0030001","Simple Silver","23552TN003",,"TNN001","TNS001","TNF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0030001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF003","23552TN0030001-03","Simple Silver","Limited Cost Sharing Plan Variation","66.18%",,"Yes","Yes","No","100%",,"$5,800","$100","$0","$200","$0","$1,900","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0030001-03","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0030001-03"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0030001","Simple Silver","23552TN003",,"TNN001","TNS001","TNF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0030001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF003","23552TN0030001-04","Simple Silver CSR 250","73% AV Level Silver Plan","73.72%",,"Yes","Yes","No","100%",,"$4,900","$90","$0","$200","$0","$1,600","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0030001-04","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0030001-04"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0030001","Simple Silver","23552TN003",,"TNN001","TNS001","TNF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0030001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF003","23552TN0030001-05","Simple Silver CSR 200","87% AV Level Silver Plan","87.05%",,"Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$0","$700","$0","$80","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0030001-05","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0030001-05"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0030001","Simple Silver","23552TN003",,"TNN001","TNS001","TNF003","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0030001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF003","23552TN0030001-06","Simple Silver CSR 150","94% AV Level Silver Plan","93.18%",,"Yes","Yes","No","100%",,"$800","$0","$0","$200","$0","$700","$0","$80","$800","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0030001-06","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0030001-06"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0040001","Classic Bronze","23552TN004",,"TNN001","TNS001","TNF004","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9949364",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0040001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF004","23552TN0040001-00","Classic Bronze","Standard Bronze Off Exchange Plan","61.22%","0.612190381721046","Yes","Yes","No","100%",,"$3,500","$0","$1,400","$200","$3,500","$0","$800","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0040001-00","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0040001-00"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0040001","Classic Bronze","23552TN004",,"TNN001","TNS001","TNF004","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9949364",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0040001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF004","23552TN0040001-01","Classic Bronze","Standard Bronze On Exchange Plan","61.22%","0.612190381721046","Yes","Yes","No","100%",,"$3,500","$0","$1,400","$200","$3,500","$0","$800","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0040001-01","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0040001-01"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0040001","Classic Bronze","23552TN004",,"TNN001","TNS001","TNF004","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9949364",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0040001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF004","23552TN0040001-02","Classic Bronze","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0040001-02","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0040001-02"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0040001","Classic Bronze","23552TN004",,"TNN001","TNS001","TNF004","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9949364",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0040001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF004","23552TN0040001-03","Classic Bronze","Limited Cost Sharing Plan Variation","61.22%","0.612190381721046","Yes","Yes","No","100%",,"$3,500","$0","$1,400","$200","$3,500","$0","$800","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0040001-03","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0040001-03"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0050001","Classic Silver","23552TN005",,"TNN001","TNS001","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0050001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF005","23552TN0050001-00","Classic Silver","Standard Silver Off Exchange Plan","66.38%","0.66376381163397","Yes","Yes","No","100%",,"$5,000","$100","$400","$200","$0","$2,000","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0050001-00","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0050001-00"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0050001","Classic Silver","23552TN005",,"TNN001","TNS001","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0050001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF005","23552TN0050001-01","Classic Silver","Standard Silver On Exchange Plan","66.38%","0.66376381163397","Yes","Yes","No","100%",,"$5,000","$100","$400","$200","$0","$2,000","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0050001-01","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0050001-01"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0050001","Classic Silver","23552TN005",,"TNN001","TNS001","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0050001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF005","23552TN0050001-02","Classic Silver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0050001-02","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0050001-02"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0050001","Classic Silver","23552TN005",,"TNN001","TNS001","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0050001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF005","23552TN0050001-03","Classic Silver","Limited Cost Sharing Plan Variation","66.38%","0.66376381163397","Yes","Yes","No","100%",,"$5,000","$100","$400","$200","$0","$2,000","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0050001-03","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0050001-03"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0050001","Classic Silver","23552TN005",,"TNN001","TNS001","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0050001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF005","23552TN0050001-04","Classic Silver CSR 250","73% AV Level Silver Plan","73.50%","0.735044068661851","Yes","Yes","No","100%",,"$3,000","$10","$1,000","$200","$100","$1,500","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0050001-04","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0050001-04"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0050001","Classic Silver","23552TN005",,"TNN001","TNS001","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0050001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF005","23552TN0050001-05","Classic Silver CSR 200","87% AV Level Silver Plan","87.97%","0.879704869298274","Yes","Yes","No","100%",,"$800","$40","$1,000","$200","$0","$800","$0","$80","$800","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0050001-05","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0050001-05"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0050001","Classic Silver","23552TN005",,"TNN001","TNS001","TNF005","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0050001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF005","23552TN0050001-06","Classic Silver CSR 150","94% AV Level Silver Plan","93.65%","0.93652363749541","Yes","Yes","No","100%",,"$300","$0","$600","$200","$0","$700","$0","$80","$300","$100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0050001-06","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0050001-06"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0060001","Classic Gold","23552TN006",,"TNN001","TNS001","TNF006","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968561",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0060001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF006","23552TN0060001-00","Classic Gold","Standard Gold Off Exchange Plan","76.02%","0.760216081874643","Yes","Yes","No","100%",,"$1,500","$100","$900","$200","$0","$1,700","$0","$80","$1,500","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0060001-00","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0060001-00"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0060001","Classic Gold","23552TN006",,"TNN001","TNS001","TNF006","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968561",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0060001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF006","23552TN0060001-01","Classic Gold","Standard Gold On Exchange Plan","76.02%","0.760216081874643","Yes","Yes","No","100%",,"$1,500","$100","$900","$200","$0","$1,700","$0","$80","$1,500","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0060001-01","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0060001-01"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0060001","Classic Gold","23552TN006",,"TNN001","TNS001","TNF006","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968561",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0060001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF006","23552TN0060001-02","Classic Gold","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0060001-02","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0060001-02"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0060001","Classic Gold","23552TN006",,"TNN001","TNS001","TNF006","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968561",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0060001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF006","23552TN0060001-03","Classic Gold","Limited Cost Sharing Plan Variation","76.02%","0.760216081874643","Yes","Yes","No","100%",,"$1,500","$100","$900","$200","$0","$1,700","$0","$80","$1,500","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0060001-03","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0060001-03"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0070001","Backup Bronze","23552TN007",,"TNN001","TNS001","TNF007","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9949364",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0070001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF007","23552TN0070001-00","Backup Bronze","Standard Bronze Off Exchange Plan","60.63%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0070001-00","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0070001-00"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0070001","Backup Bronze","23552TN007",,"TNN001","TNS001","TNF007","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9949364",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0070001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF007","23552TN0070001-01","Backup Bronze","Standard Bronze On Exchange Plan","60.63%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0070001-01","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0070001-01"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0070001","Backup Bronze","23552TN007",,"TNN001","TNS001","TNF007","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9949364",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0070001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF007","23552TN0070001-02","Backup Bronze","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0070001-02","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0070001-02"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0070001","Backup Bronze","23552TN007",,"TNN001","TNS001","TNF007","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9949364",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0070001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF007","23552TN0070001-03","Backup Bronze","Limited Cost Sharing Plan Variation","60.63%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0070001-03","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0070001-03"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0080001","Backup Silver","23552TN008",,"TNN001","TNS001","TNF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0080001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF008","23552TN0080001-00","Backup Silver","Standard Silver Off Exchange Plan","66.16%",,"Yes","Yes","No","100%",,"$3,000","$0","$1,000","$200","$3,000","$0","$600","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0080001-00","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0080001-00"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0080001","Backup Silver","23552TN008",,"TNN001","TNS001","TNF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0080001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF008","23552TN0080001-01","Backup Silver","Standard Silver On Exchange Plan","66.16%",,"Yes","Yes","No","100%",,"$3,000","$0","$1,000","$200","$3,000","$0","$600","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0080001-01","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0080001-01"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0080001","Backup Silver","23552TN008",,"TNN001","TNS001","TNF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0080001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF008","23552TN0080001-02","Backup Silver","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0080001-02","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0080001-02"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0080001","Backup Silver","23552TN008",,"TNN001","TNS001","TNF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0080001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF008","23552TN0080001-03","Backup Silver","Limited Cost Sharing Plan Variation","66.16%",,"Yes","Yes","No","100%",,"$3,000","$0","$1,000","$200","$3,000","$0","$600","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0080001-03","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0080001-03"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0080001","Backup Silver","23552TN008",,"TNN001","TNS001","TNF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0080001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF008","23552TN0080001-04","Backup Silver CSR 250","73% AV Level Silver Plan","73.01%",,"Yes","Yes","No","100%",,"$2,000","$0","$900","$200","$2,000","$0","$600","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0080001-04","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0080001-04"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0080001","Backup Silver","23552TN008",,"TNN001","TNS001","TNF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0080001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF008","23552TN0080001-05","Backup Silver CSR 200","87% AV Level Silver Plan","87.60%",,"Yes","Yes","No","100%",,"$600","$0","$600","$200","$600","$0","$500","$80","$600","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0080001-05","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0080001-05"
"2018","TN","23552","HIOS","2017-11-01 02:20:20","Individual","No","11-1111111","23552TN0080001","Backup Silver","23552TN008",,"TNN001","TNS001","TNF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9958028",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tn&year=2018&hios=23552TN0080001","https://www.hioscar.com/search/TN/drugs?year=2018&formulary=TNF008","23552TN0080001-06","Backup Silver CSR 150","94% AV Level Silver Plan","94.35%",,"Yes","Yes","No","100%",,"$100","$0","$600","$200","$100","$0","$500","$80","$100","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tn&year=2018&hios=23552TN0080001-06","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=23552TN0080001-06"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","24601TN0020003","BESTOne Advantage Gold","24601TN002",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/TN/current/TN_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","24601TN0010007","BESTDental Premium","24601TN001",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010007-00","BESTDental Premium","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/current/TN_BESTDental_Premium_Plan.pdf"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","24601TN0010007","BESTDental Premium","24601TN001",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010007-01","BESTDental Premium","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/current/TN_BESTDental_Premium_Plan.pdf"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","24601TN0020003","BESTOne Advantage Gold","24601TN002",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/TN/current/TN_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","24601TN0020004","BESTOne Plus Gold","24601TN002",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/TN/current/TN_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","24601TN0010008","BESTDental Standard - H","24601TN001",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/current/TN_BESTDental_Standard-H_Plan.pdf"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","24601TN0010008","BESTDental Standard - H","24601TN001",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/current/TN_BESTDental_Standard-H_Plan.pdf"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","24601TN0020004","BESTOne Plus Gold","24601TN002",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/TN/current/TN_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","24601TN0010010","BESTDental Choice - H","24601TN001",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/current/TN_BESTDental_Choice-H_Plan.pdf"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","24601TN0010010","BESTDental Choice - H","24601TN001",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/current/TN_BESTDental_Choice-H_Plan.pdf"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","24601TN0010009","BESTDental Standard - L","24601TN001",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/current/TN_BESTDental_Standard-L_Plan.pdf"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","24601TN0020005","BESTOne Plus Silver","24601TN002",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tn/current/TN_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","24601TN0020005","BESTOne Plus Silver","24601TN002",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tn/current/TN_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","24601TN0010009","BESTDental Standard - L","24601TN001",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/current/TN_BESTDental_Standard-L_Plan.pdf"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","24601TN0010011","BESTDental Choice - L","24601TN001",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/current/TN_BESTDental_Choice-L_Plan.pdf"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","24601TN0020006","BESTOne Basic Silver","24601TN002",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tn/current/TN_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","24601TN0020006","BESTOne Basic Silver","24601TN002",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tn/current/TN_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","24601TN0010011","BESTDental Choice - L","24601TN001",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/current/TN_BESTDental_Choice-L_Plan.pdf"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","24601TN0010012","BESTDental Value","24601TN001",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/current/TN_BESTDental_Value_Plan.pdf"
"2018","TN","24601","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","24601TN0010012","BESTDental Value","24601TN001",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/current/TN_BESTDental_Value_Plan.pdf"
"2018","TN","28398","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","28398TN0010001","TruAssure Basic Adult or Child Dental Plan","28398TN001",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","28398TN0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","68.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TN","https://www.truassure.com/brochure?state=TN"
"2018","TN","28398","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","28398TN0030001","TruAssure Dental Small Group Basic Plan","28398TN003",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","28398TN0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TN","28398","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","28398TN0040001","TruAssure Dental Small Group Preferred Plan","28398TN004",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","28398TN0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TN","28398","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","28398TN0010001","TruAssure Basic Adult or Child Dental Plan","28398TN001",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","28398TN0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","68.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TN","https://www.truassure.com/brochure?state=TN"
"2018","TN","28398","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","28398TN0020001","TruAssure Preferred Adult or Child Dental Plan","28398TN002",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","28398TN0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TN","https://www.truassure.com/brochure?state=TN"
"2018","TN","28398","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","28398TN0020001","TruAssure Preferred Adult or Child Dental Plan","28398TN002",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","28398TN0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TN","https://www.truassure.com/brochure?state=TN"
"2018","TN","38886","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","38886TN0080003","DentaSpan Family High Option","38886TN008","7083617077","TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0080003-00","DentaSpan Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdstn.dentalcareplus.com","http://hiopbdstn.dentalcareplus.com"
"2018","TN","38886","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","38886TN0070001","DentaTrust - PPO Pediatric High Option","38886TN007","7083617077","TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0070001-00","DentaTrust - PPO Pediatric High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdttn.dentalcareplus.com","http://hixpbdttn.dentalcareplus.com"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060030","Cigna Connect 2000","99248TN006","7730182962","TNN001","TNS001","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060030-00","Cigna Connect 2000","Standard Silver Off Exchange Plan","71.03%","0.716261295516725","Yes","Yes","No","100%",,"$2,000","$40","$5,300","$10","$130","$800","$0","$200","$1,590","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-2000-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-2000-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","Yes","59-1031071","99248TN0030002","Cigna Dental Family + Pediatric","99248TN003","7730182962","TNN003","TNS004",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Services","Yes","All Services","Yes",,"","99248TN0030002-01","Cigna Dental Family + Pediatric","Standard Low On Exchange Plan","68.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2018/sob/cigna-dental-family-pediatric-fedvip"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060030","Cigna Connect 2000","99248TN006","7730182962","TNN001","TNS001","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060030-01","Cigna Connect 2000","Standard Silver On Exchange Plan","71.03%","0.716261295516725","Yes","Yes","No","100%",,"$2,000","$40","$5,300","$10","$130","$800","$0","$200","$1,590","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-2000-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-2000-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060030","Cigna Connect 2000","99248TN006","7730182962","TNN001","TNS001","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060030-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-0-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060030","Cigna Connect 2000","99248TN006","7730182962","TNN001","TNS001","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060030-03","Cigna Connect 2000-1","Limited Cost Sharing Plan Variation","71.03%","0.716261295516725","Yes","Yes","No","100%",,"$2,000","$40","$5,300","$10","$130","$800","$0","$200","$1,590","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-2000-1-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-2000-1-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060030","Cigna Connect 2000","99248TN006","7730182962","TNN001","TNS001","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060030-04","Cigna Connect 2000-2","73% AV Level Silver Plan","73.23%","0.737669697470468","Yes","Yes","No","100%",,"$2,000","$30","$3,800","$10","$130","$800","$0","$200","$1,590","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-2000-2-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-2000-2-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060030","Cigna Connect 2000","99248TN006","7730182962","TNN001","TNS001","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060030-05","Cigna Connect 550-3","87% AV Level Silver Plan","86.11%","0.867843574433002","Yes","Yes","No","100%",,"$550","$20","$1,800","$10","$130","$700","$0","$200","$550","$20","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-550-3-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-550-3-mem-tn"
"2018","TN","38886","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","38886TN0070001","DentaTrust - PPO Pediatric High Option","38886TN007","7083617077","TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0070001-01","DentaTrust - PPO Pediatric High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdttn.dentalcareplus.com","http://hixpbdttn.dentalcareplus.com"
"2018","TN","38886","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","38886TN0080003","DentaSpan Family High Option","38886TN008","7083617077","TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0080003-01","DentaSpan Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdstn.dentalcareplus.com","http://hixpbdstn.dentalcareplus.com"
"2018","TN","38886","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","38886TN0080004","DentaSpan Family Low Option","38886TN008","7083617077","TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0080004-00","DentaSpan Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdstn.dentalcareplus.com","http://hiopbdstn.dentalcareplus.com"
"2018","TN","38886","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","38886TN0070002","DentaTrust - PPO Pediatric Low Option","38886TN007","7083617077","TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0070002-00","DentaTrust - PPO Pediatric Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdttn.dentalcareplus.com","http://hixpbdttn.dentalcareplus.com"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060014","Cigna Connect 4500","99248TN006","7730182962","TNN002","TNS003","TNF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060014-04","Cigna Connect 3000-2","73% AV Level Silver Plan","72.13%","0.73038488642926","Yes","Yes","No","100%",,"$3,000","$40","$1,900","$10","$130","$900","$0","$200","$1,590","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-3000-2-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-3000-2-tc-tn"
"2018","TN","38886","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","38886TN0070002","DentaTrust - PPO Pediatric Low Option","38886TN007","7083617077","TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0070002-01","DentaTrust - PPO Pediatric Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdttn.dentalcareplus.com","http://hixpbdttn.dentalcareplus.com"
"2018","TN","38886","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","38886TN0080004","DentaSpan Family Low Option","38886TN008","7083617077","TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0080004-01","DentaSpan Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdstn.dentalcareplus.com","http://hixpbdstn.dentalcareplus.com"
"2018","TN","38886","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","38886TN0090003","DentaSpan Family High Option- Off Exchange","38886TN009","7083617077","TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0090003-00","DentaSpan Family High Option- Off Exchange","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdstn.dentalcareplus.com","http://hiopbdstn.dentalcareplus.com"
"2018","TN","38886","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","38886TN0090004","DentaSpan Family Low Option- Off Exchange","38886TN009","7083617077","TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0090004-00","DentaSpan Family Low Option- Off Exchange","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdstn.dentalcareplus.com","http://hiopbdstn.dentalcareplus.com"
"2018","TN","38886","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","38886TN0090001","DentaSpan Pediatric High Option- Off Exchange","38886TN009","7083617077","TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0090001-00","DentaSpan Pediatric High Option- Off Exchange","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdstn.dentalcareplus.com","http://hiopbdstn.dentalcareplus.com"
"2018","TN","38886","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","38886TN0070003","DentaTrust-PPO Family High Option","38886TN007","7083617077","TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0070003-00","DentaTrust-PPO Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdttn.dentalcareplus.com","http://hixpbdttn.dentalcareplus.com"
"2018","TN","38886","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","38886TN0070003","DentaTrust-PPO Family High Option","38886TN007","7083617077","TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0070003-01","DentaTrust-PPO Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdttn.dentalcareplus.com","http://hixpbdttn.dentalcareplus.com"
"2018","TN","38886","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","38886TN0090002","DentaSpan Pediatric Low Option- Off Exchange","38886TN009","7083617077","TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0090002-00","DentaSpan Pediatric Low Option- Off Exchange","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdstn.dentalcareplus.com","http://hiopbdstn.dentalcareplus.com"
"2018","TN","38886","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","38886TN0070004","DentaTrust-PPO Family Low Option","38886TN007","7083617077","TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0070004-00","DentaTrust-PPO Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdttn.dentalcareplus.com","http://hixpbdttn.dentalcareplus.com"
"2018","TN","38886","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","38886TN0070004","DentaTrust-PPO Family Low Option","38886TN007","7083617077","TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","38886TN0070004-01","DentaTrust-PPO Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdttn.dentalcareplus.com","http://hixpbdttn.dentalcareplus.com"
"2018","TN","43878","HIOS","2017-08-10 02:20:26","Individual","Yes","20-2970185","43878TN0010001","DentaQuest EPO  Pediatric High","43878TN001",,"TNN001","TNS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","43878TN0010001-00","DentaQuest EPO  Pediatric High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/"
"2018","TN","43878","HIOS","2017-08-10 02:20:26","Individual","Yes","20-2970185","43878TN0010001","DentaQuest EPO  Pediatric High","43878TN001",,"TNN001","TNS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","43878TN0010001-01","DentaQuest EPO  Pediatric High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/"
"2018","TN","43878","HIOS","2017-08-10 02:20:26","Individual","Yes","20-2970185","43878TN0010003","DentaQuest EPO Family High","43878TN001",,"TNN001","TNS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","43878TN0010003-00","DentaQuest EPO Family High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/"
"2018","TN","43878","HIOS","2017-08-10 02:20:26","Individual","Yes","20-2970185","43878TN0010003","DentaQuest EPO Family High","43878TN001",,"TNN001","TNS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","43878TN0010003-01","DentaQuest EPO Family High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/"
"2018","TN","43878","HIOS","2017-08-10 02:20:26","Individual","Yes","20-2970185","43878TN0010004","DentaQuest EPO Family Low","43878TN001",,"TNN001","TNS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","43878TN0010004-00","DentaQuest EPO Family Low","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/"
"2018","TN","43878","HIOS","2017-08-10 02:20:26","Individual","Yes","20-2970185","43878TN0010004","DentaQuest EPO Family Low","43878TN001",,"TNN001","TNS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","43878TN0010004-01","DentaQuest EPO Family Low","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/"
"2018","TN","78859","HIOS","2017-08-03 02:20:23","SHOP (Small Group)","Yes","57-0523959","78859TN0020001","Group Dental Policy","78859TN002",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","traditional with inside maximum","Yes","traditional with inside maximum","Yes",,"","78859TN0020001-00","Group Dental Policy","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TN","79913","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","79913TN0010007","Dentegra Dental PPO Pediatric Basic Plan","79913TN001",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","79913TN0010007-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tn/79913tn0010007-18"
"2018","TN","79913","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","79913TN0010012","Dentegra Dental PPO Family Preferred Plan","79913TN001",,"TNN001","TNS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","79913TN0010012-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$40","$40 per person","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tn/79913tn0010012-18"
"2018","TN","79913","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","79913TN0010011","Dentegra Dental PPO Family Basic Plan","79913TN001",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","79913TN0010011-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tn/79913tn0010011-18"
"2018","TN","82120","HIOS","2017-08-08 02:20:26","Individual","Yes","39-1263473","82120TN0630002","Humana Dental Smart Choice - Low","82120TN063",,"TNN001","TNS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9908","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","82120TN0630002-01","Humana Dental Smart Choice - Low","Standard Low On Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","per person not applicable","per group not applicable",,,,,,"$30","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110432"
"2018","TN","82120","HIOS","2017-08-08 02:20:26","Individual","Yes","39-1263473","82120TN0630003","Humana Dental Smart Choice - High","82120TN063",,"TNN001","TNS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.986","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","82120TN0630003-01","Humana Dental Smart Choice - High","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110419"
"2018","TN","90402","HIOS","2017-05-16 02:20:17","Individual","Yes","13-5123390","90402TN0090002","Guardian Essentials for Families and Individuals","90402TN009",,"TNN001","TNS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","90402TN0090002-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/tennessee/","https://dentalexchange.guardianlife.com/our-plans/tennessee/"
"2018","TN","90402","HIOS","2017-05-16 02:20:17","Individual","Yes","13-5123390","90402TN0090002","Guardian Essentials for Families and Individuals","90402TN009",,"TNN001","TNS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","90402TN0090002-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/tennessee/","https://dentalexchange.guardianlife.com/our-plans/tennessee/"
"2018","TN","90402","HIOS","2017-05-16 02:20:17","Individual","Yes","13-5123390","90402TN0070002","Guardian Select for Families and Individuals","90402TN007",,"TNN001","TNS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","90402TN0070002-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/tennessee/","https://dentalexchange.guardianlife.com/our-plans/tennessee/"
"2018","TN","90402","HIOS","2017-05-16 02:20:17","Individual","Yes","13-5123390","90402TN0070002","Guardian Select for Families and Individuals","90402TN007",,"TNN001","TNS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","90402TN0070002-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/tennessee/","https://dentalexchange.guardianlife.com/our-plans/tennessee/"
"2018","TN","90402","HIOS","2017-05-16 02:20:17","Individual","Yes","13-5123390","90402TN0080002","Guardian Basics for Families and Individuals","90402TN008",,"TNN001","TNS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","90402TN0080002-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/tennessee/","https://dentalexchange.guardianlife.com/our-plans/tennessee/"
"2018","TN","90402","HIOS","2017-05-16 02:20:17","Individual","Yes","13-5123390","90402TN0080002","Guardian Basics for Families and Individuals","90402TN008",,"TNN001","TNS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","90402TN0080002-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/tennessee/","https://dentalexchange.guardianlife.com/our-plans/tennessee/"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060014","Cigna Connect 4500","99248TN006","7730182962","TNN002","TNS003","TNF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060014-00","Cigna Connect 4500","Standard Silver Off Exchange Plan","68.30%","0.690360451050805","Yes","Yes","No","100%",,"$4,500","$40","$1,600","$10","$130","$900","$0","$200","$1,590","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4500-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-4500-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","Yes","59-1031071","99248TN0030001","Cigna Dental Pediatric","99248TN003","7730182962","TNN003","TNS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Services","Yes","All Services","Yes",,"","99248TN0030001-00","Cigna Dental Pediatric","Standard Low Off Exchange Plan","68.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2018/sob/cigna-dental-pediatric-fedvip"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","Yes","59-1031071","99248TN0030001","Cigna Dental Pediatric","99248TN003","7730182962","TNN003","TNS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Services","Yes","All Services","Yes",,"","99248TN0030001-01","Cigna Dental Pediatric","Standard Low On Exchange Plan","68.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2018/sob/cigna-dental-pediatric-fedvip"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060014","Cigna Connect 4500","99248TN006","7730182962","TNN002","TNS003","TNF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060014-01","Cigna Connect 4500","Standard Silver On Exchange Plan","68.30%","0.690360451050805","Yes","Yes","No","100%",,"$4,500","$40","$1,600","$10","$130","$900","$0","$200","$1,590","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4500-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-4500-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060014","Cigna Connect 4500","99248TN006","7730182962","TNN002","TNS003","TNF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060014-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-0-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060014","Cigna Connect 4500","99248TN006","7730182962","TNN002","TNS003","TNF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060014-03","Cigna Connect 4500-1","Limited Cost Sharing Plan Variation","68.30%","0.690360451050805","Yes","Yes","No","100%",,"$4,500","$40","$1,600","$10","$130","$900","$0","$200","$1,590","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4500-1-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-4500-1-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060014","Cigna Connect 4500","99248TN006","7730182962","TNN002","TNS003","TNF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060014-05","Cigna Connect 500-3A","87% AV Level Silver Plan","86.53%","0.870502495698894","Yes","Yes","No","100%",,"$500","$30","$1,800","$10","$130","$800","$0","$200","$500","$20","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-500-3a-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-500-3a-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060014","Cigna Connect 4500","99248TN006","7730182962","TNN002","TNS003","TNF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060014-06","Cigna Connect 200-4","94% AV Level Silver Plan","93.19%","0.935418055225421","Yes","Yes","No","100%",,"$200","$20","$600","$10","$130","$400","$0","$200","$200","$10","$70","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-200-4-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-200-4-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060030","Cigna Connect 2000","99248TN006","7730182962","TNN001","TNS001","TNF004","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060030-06","Cigna Connect 50-4","94% AV Level Silver Plan","93.30%","0.936855928622668","Yes","Yes","No","100%",,"$50","$10","$1,200","$10","$50","$400","$10","$200","$50","$10","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-50-4-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-50-4-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060023","Cigna Connect 1200","99248TN006","7730182962","TNN001","TNS001","TNF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060023-00","Cigna Connect 1200","Standard Gold Off Exchange Plan","78.06%","0.786270183973848","Yes","Yes","No","100%",,"$1,200","$30","$2,300","$10","$130","$700","$0","$200","$1,200","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1200-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-1200-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060023","Cigna Connect 1200","99248TN006","7730182962","TNN001","TNS001","TNF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060023-01","Cigna Connect 1200","Standard Gold On Exchange Plan","78.06%","0.786270183973848","Yes","Yes","No","100%",,"$1,200","$30","$2,300","$10","$130","$700","$0","$200","$1,200","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1200-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-1200-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060023","Cigna Connect 1200","99248TN006","7730182962","TNN001","TNS001","TNF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060023-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-0-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060023","Cigna Connect 1200","99248TN006","7730182962","TNN001","TNS001","TNF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060023-03","Cigna Connect 1200-1","Limited Cost Sharing Plan Variation","78.06%","0.786270183973848","Yes","Yes","No","100%",,"$1,200","$30","$2,300","$10","$130","$700","$0","$200","$1,200","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1200-1-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-1200-1-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060006","Cigna Connect 1200","99248TN006","7730182962","TNN002","TNS002","TNF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060006-00","Cigna Connect 1200","Standard Gold Off Exchange Plan","78.06%","0.786270183973848","Yes","Yes","No","100%",,"$1,200","$30","$2,300","$10","$130","$700","$0","$200","$1,200","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1200-nash-tn","http://www.cigna.com/2018/sob/cigna-connect-1200-nash-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060006","Cigna Connect 1200","99248TN006","7730182962","TNN002","TNS002","TNF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060006-01","Cigna Connect 1200","Standard Gold On Exchange Plan","78.06%","0.786270183973848","Yes","Yes","No","100%",,"$1,200","$30","$2,300","$10","$130","$700","$0","$200","$1,200","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1200-nash-tn","http://www.cigna.com/2018/sob/cigna-connect-1200-nash-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060006","Cigna Connect 1200","99248TN006","7730182962","TNN002","TNS002","TNF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060006-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-nash-tn","http://www.cigna.com/2018/sob/cigna-connect-0-nash-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060006","Cigna Connect 1200","99248TN006","7730182962","TNN002","TNS002","TNF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060006-03","Cigna Connect 1200-1","Limited Cost Sharing Plan Variation","78.06%","0.786270183973848","Yes","Yes","No","100%",,"$1,200","$30","$2,300","$10","$130","$700","$0","$200","$1,200","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1200-1-nash-tn","http://www.cigna.com/2018/sob/cigna-connect-1200-1-nash-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060016","Cigna Connect 1200","99248TN006","7730182962","TNN002","TNS003","TNF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060016-00","Cigna Connect 1200","Standard Gold Off Exchange Plan","78.06%","0.786270183973848","Yes","Yes","No","100%",,"$1,200","$30","$2,300","$10","$130","$700","$0","$200","$1,200","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1200-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-1200-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060016","Cigna Connect 1200","99248TN006","7730182962","TNN002","TNS003","TNF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060016-01","Cigna Connect 1200","Standard Gold On Exchange Plan","78.06%","0.786270183973848","Yes","Yes","No","100%",,"$1,200","$30","$2,300","$10","$130","$700","$0","$200","$1,200","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1200-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-1200-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060016","Cigna Connect 1200","99248TN006","7730182962","TNN002","TNS003","TNF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060016-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-0-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060016","Cigna Connect 1200","99248TN006","7730182962","TNN002","TNS003","TNF005","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060016-03","Cigna Connect 1200-1","Limited Cost Sharing Plan Variation","78.06%","0.786270183973848","Yes","Yes","No","100%",,"$1,200","$30","$2,300","$10","$130","$700","$0","$200","$1,200","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1200-1-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-1200-1-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060028","Cigna Connect 5250","99248TN006","7730182962","TNN002","TNS003","TNF006","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060028-00","Cigna Connect 5250","Standard Bronze Off Exchange Plan","61.58%","0.632210654329452","Yes","Yes","No","100%",,"$5,250","$40","$2,100","$10","$810","$800","$0","$200","$1,590","$80","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-5250-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-5250-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060028","Cigna Connect 5250","99248TN006","7730182962","TNN002","TNS003","TNF006","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060028-01","Cigna Connect 5250","Standard Bronze On Exchange Plan","61.58%","0.632210654329452","Yes","Yes","No","100%",,"$5,250","$40","$2,100","$10","$810","$800","$0","$200","$1,590","$80","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-5250-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-5250-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060028","Cigna Connect 5250","99248TN006","7730182962","TNN002","TNS003","TNF006","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060028-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-0-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060028","Cigna Connect 5250","99248TN006","7730182962","TNN002","TNS003","TNF006","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060028-03","Cigna Connect 5250-1","Limited Cost Sharing Plan Variation","61.58%","0.632210654329452","Yes","Yes","No","100%",,"$5,250","$40","$2,100","$10","$810","$800","$0","$200","$1,590","$80","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-5250-1-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-5250-1-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060031","Cigna Connect 7000","99248TN006","7730182962","TNN001","TNS001","TNF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060031-00","Cigna Connect 7000","Standard Bronze Off Exchange Plan","58.58%","0.585771630390215","Yes","Yes","No","100%",,"$7,000","$0","$400","$10","$6,910","$0","$0","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-7000-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-7000-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060031","Cigna Connect 7000","99248TN006","7730182962","TNN001","TNS001","TNF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060031-01","Cigna Connect 7000","Standard Bronze On Exchange Plan","58.58%","0.585771630390215","Yes","Yes","No","100%",,"$7,000","$0","$400","$10","$6,910","$0","$0","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-7000-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-7000-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060031","Cigna Connect 7000","99248TN006","7730182962","TNN001","TNS001","TNF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060031-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-0-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060031","Cigna Connect 7000","99248TN006","7730182962","TNN001","TNS001","TNF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060031-03","Cigna Connect 7000-1","Limited Cost Sharing Plan Variation","58.58%","0.585771630390215","Yes","Yes","No","100%",,"$7,000","$0","$400","$10","$6,910","$0","$0","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-7000-1-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-7000-1-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060033","Cigna Connect 7000","99248TN006","7730182962","TNN002","TNS002","TNF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060033-00","Cigna Connect 7000","Standard Bronze Off Exchange Plan","58.58%","0.585771630390215","Yes","Yes","No","100%",,"$7,000","$0","$400","$10","$6,910","$0","$0","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-7000-nash-tn","http://www.cigna.com/2018/sob/cigna-connect-7000-nash-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060033","Cigna Connect 7000","99248TN006","7730182962","TNN002","TNS002","TNF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060033-01","Cigna Connect 7000","Standard Bronze On Exchange Plan","58.58%","0.585771630390215","Yes","Yes","No","100%",,"$7,000","$0","$400","$10","$6,910","$0","$0","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-7000-nash-tn","http://www.cigna.com/2018/sob/cigna-connect-7000-nash-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060033","Cigna Connect 7000","99248TN006","7730182962","TNN002","TNS002","TNF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060033-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-nash-tn","http://www.cigna.com/2018/sob/cigna-connect-0-nash-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060033","Cigna Connect 7000","99248TN006","7730182962","TNN002","TNS002","TNF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060033-03","Cigna Connect 7000-1","Limited Cost Sharing Plan Variation","58.58%","0.585771630390215","Yes","Yes","No","100%",,"$7,000","$0","$400","$10","$6,910","$0","$0","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-7000-1-nash-tn","http://www.cigna.com/2018/sob/cigna-connect-7000-1-nash-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060035","Cigna Connect 7000","99248TN006","7730182962","TNN002","TNS003","TNF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060035-00","Cigna Connect 7000","Standard Bronze Off Exchange Plan","58.58%","0.585771630390215","Yes","Yes","No","100%",,"$7,000","$0","$400","$10","$6,910","$0","$0","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-7000-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-7000-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060035","Cigna Connect 7000","99248TN006","7730182962","TNN002","TNS003","TNF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060035-01","Cigna Connect 7000","Standard Bronze On Exchange Plan","58.58%","0.585771630390215","Yes","Yes","No","100%",,"$7,000","$0","$400","$10","$6,910","$0","$0","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-7000-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-7000-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060035","Cigna Connect 7000","99248TN006","7730182962","TNN002","TNS003","TNF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060035-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-0-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060035","Cigna Connect 7000","99248TN006","7730182962","TNN002","TNS003","TNF001","New","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060035-03","Cigna Connect 7000-1","Limited Cost Sharing Plan Variation","58.58%","0.585771630390215","Yes","Yes","No","100%",,"$7,000","$0","$400","$10","$6,910","$0","$0","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-7000-1-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-7000-1-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060021","Cigna Connect 4750","99248TN006","7730182962","TNN001","TNS001","TNF002","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060021-00","Cigna Connect 4750","Standard Silver Off Exchange Plan","66.06%","0.6697487781165","Yes","Yes","No","100%",,"$4,750","$40","$2,600","$10","$130","$1,000","$200","$200","$1,590","$70","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4750-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-4750-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060021","Cigna Connect 4750","99248TN006","7730182962","TNN001","TNS001","TNF002","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060021-01","Cigna Connect 4750","Standard Silver On Exchange Plan","66.06%","0.6697487781165","Yes","Yes","No","100%",,"$4,750","$40","$2,600","$10","$130","$1,000","$200","$200","$1,590","$70","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4750-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-4750-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060021","Cigna Connect 4750","99248TN006","7730182962","TNN001","TNS001","TNF002","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060021-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-0-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060021","Cigna Connect 4750","99248TN006","7730182962","TNN001","TNS001","TNF002","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060021-03","Cigna Connect 4750-1","Limited Cost Sharing Plan Variation","66.06%","0.6697487781165","Yes","Yes","No","100%",,"$4,750","$40","$2,600","$10","$130","$1,000","$200","$200","$1,590","$70","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4750-1-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-4750-1-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060021","Cigna Connect 4750","99248TN006","7730182962","TNN001","TNS001","TNF002","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060021-04","Cigna Connect 2500-2","73% AV Level Silver Plan","72.70%","0.736050810164905","Yes","Yes","No","100%",,"$2,500","$40","$2,000","$10","$130","$900","$0","$200","$1,590","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-2500-2-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-2500-2-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060021","Cigna Connect 4750","99248TN006","7730182962","TNN001","TNS001","TNF002","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060021-05","Cigna Connect 800-3","87% AV Level Silver Plan","86.20%","0.864244273981593","Yes","Yes","No","100%",,"$800","$30","$1,200","$10","$130","$500","$0","$200","$800","$300","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-800-3-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-800-3-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060021","Cigna Connect 4750","99248TN006","7730182962","TNN001","TNS001","TNF002","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060021-06","Cigna Connect 125-4","94% AV Level Silver Plan","93.60%","0.938491077664299","Yes","Yes","No","100%",,"$125","$20","$600","$10","$125","$400","$0","$200","$125","$200","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-125-4-mem-tn","http://www.cigna.com/2018/sob/cigna-connect-125-4-mem-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060036","Cigna Connect 4750","99248TN006","7730182962","TNN002","TNS003","TNF002","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060036-00","Cigna Connect 4750","Standard Silver Off Exchange Plan","66.06%","0.6697487781165","Yes","Yes","No","100%",,"$4,750","$40","$2,600","$10","$130","$1,000","$200","$200","$1,590","$70","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4750-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-4750-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060036","Cigna Connect 4750","99248TN006","7730182962","TNN002","TNS003","TNF002","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060036-01","Cigna Connect 4750","Standard Silver On Exchange Plan","66.06%","0.6697487781165","Yes","Yes","No","100%",,"$4,750","$40","$2,600","$10","$130","$1,000","$200","$200","$1,590","$70","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4750-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-4750-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060036","Cigna Connect 4750","99248TN006","7730182962","TNN002","TNS003","TNF002","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060036-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-0-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060036","Cigna Connect 4750","99248TN006","7730182962","TNN002","TNS003","TNF002","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060036-03","Cigna Connect 4750-1","Limited Cost Sharing Plan Variation","66.06%","0.6697487781165","Yes","Yes","No","100%",,"$4,750","$40","$2,600","$10","$130","$1,000","$200","$200","$1,590","$70","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4750-1-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-4750-1-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060036","Cigna Connect 4750","99248TN006","7730182962","TNN002","TNS003","TNF002","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060036-04","Cigna Connect 2500-2","73% AV Level Silver Plan","72.70%","0.736050810164905","Yes","Yes","No","100%",,"$2,500","$40","$2,000","$10","$130","$900","$0","$200","$1,590","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-2500-2-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-2500-2-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060036","Cigna Connect 4750","99248TN006","7730182962","TNN002","TNS003","TNF002","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060036-05","Cigna Connect 800-3","87% AV Level Silver Plan","86.20%","0.864244273981593","Yes","Yes","No","100%",,"$800","$30","$1,200","$10","$130","$500","$0","$200","$800","$300","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-800-3-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-800-3-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060036","Cigna Connect 4750","99248TN006","7730182962","TNN002","TNS003","TNF002","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060036-06","Cigna Connect 125-4","94% AV Level Silver Plan","93.60%","0.938491077664299","Yes","Yes","No","100%",,"$125","$20","$600","$10","$125","$400","$0","$200","$125","$200","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-125-4-tc-tn","http://www.cigna.com/2018/sob/cigna-connect-125-4-tc-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060005","Cigna Connect 4750","99248TN006","7730182962","TNN002","TNS002","TNF002","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-00","Cigna Connect 4750","Standard Silver Off Exchange Plan","66.06%","0.6697487781165","Yes","Yes","No","100%",,"$4,750","$40","$2,600","$10","$130","$1,000","$200","$200","$1,590","$70","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4750-nash-tn","http://www.cigna.com/2018/sob/cigna-connect-4750-nash-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060005","Cigna Connect 4750","99248TN006","7730182962","TNN002","TNS002","TNF002","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-01","Cigna Connect 4750","Standard Silver On Exchange Plan","66.06%","0.6697487781165","Yes","Yes","No","100%",,"$4,750","$40","$2,600","$10","$130","$1,000","$200","$200","$1,590","$70","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4750-nash-tn","http://www.cigna.com/2018/sob/cigna-connect-4750-nash-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060005","Cigna Connect 4750","99248TN006","7730182962","TNN002","TNS002","TNF002","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-nash-tn","http://www.cigna.com/2018/sob/cigna-connect-0-nash-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060005","Cigna Connect 4750","99248TN006","7730182962","TNN002","TNS002","TNF002","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-03","Cigna Connect 4750-1","Limited Cost Sharing Plan Variation","66.06%","0.6697487781165","Yes","Yes","No","100%",,"$4,750","$40","$2,600","$10","$130","$1,000","$200","$200","$1,590","$70","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4750-1-nash-tn","http://www.cigna.com/2018/sob/cigna-connect-4750-1-nash-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060005","Cigna Connect 4750","99248TN006","7730182962","TNN002","TNS002","TNF002","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-04","Cigna Connect 2500-2","73% AV Level Silver Plan","72.70%","0.736050810164905","Yes","Yes","No","100%",,"$2,500","$40","$2,000","$10","$130","$900","$0","$200","$1,590","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-2500-2-nash-tn","http://www.cigna.com/2018/sob/cigna-connect-2500-2-nash-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060005","Cigna Connect 4750","99248TN006","7730182962","TNN002","TNS002","TNF002","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-05","Cigna Connect 800-3","87% AV Level Silver Plan","86.20%","0.864244273981593","Yes","Yes","No","100%",,"$800","$30","$1,200","$10","$130","$500","$0","$200","$800","$300","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-800-3-nash-tn","http://www.cigna.com/2018/sob/cigna-connect-800-3-nash-tn"
"2018","TN","99248","HIOS","2017-08-17 02:20:39","Individual","No","59-1031071","99248TN0060005","Cigna Connect 4750","99248TN006","7730182962","TNN002","TNS002","TNF002","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-06","Cigna Connect 125-4","94% AV Level Silver Plan","93.60%","0.938491077664299","Yes","Yes","No","100%",,"$125","$20","$600","$10","$125","$400","$0","$200","$125","$200","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-125-4-nash-tn","http://www.cigna.com/2018/sob/cigna-connect-125-4-nash-tn"
"2018","TX","12846","HIOS","2017-05-18 02:20:21","SHOP (Small Group)","Yes","13-5123390","12846TX0200002","Guardian Pediatric Advantage","12846TX020",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","12846TX0200002-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TX","12846","HIOS","2017-05-18 02:20:21","SHOP (Small Group)","Yes","13-5123390","12846TX0210003","Guardian Pediatric Essentials","12846TX021",,"TXN001","TXS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","12846TX0210003-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","68.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TX","19312","HIOS","2017-05-20 02:20:32","Individual","Yes","91-1857813","19312TX0010011","Guardian Choice","19312TX001",,"TXN001","TXS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes",,"","19312TX0010011-00","Guardian Choice","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/texas/","https://dentalexchange.guardianlife.com/our-plans/texas/"
"2018","TX","19312","HIOS","2017-05-20 02:20:32","Individual","Yes","91-1857813","19312TX0010011","Guardian Choice","19312TX001",,"TXN001","TXS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes",,"","19312TX0010011-01","Guardian Choice","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/texas/","https://dentalexchange.guardianlife.com/our-plans/texas/"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0010001","Simple Secure","20069TX001",,"TXN001","TXS001","TXF001","Existing","EPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.989105",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0010001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF001","20069TX0010001-00","Simple Secure","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","3","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","100.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0010001-00","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0010001-00"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0010001","Simple Secure","20069TX001",,"TXN001","TXS001","TXF001","Existing","EPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.989105",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0010001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF001","20069TX0010001-01","Simple Secure","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","3","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","100.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0010001-01","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0010001-01"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0310001","Classic Bronze","20069TX031",,"TXN001","TXS001","TXF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.99052032",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0310001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF002","20069TX0310001-00","Classic Bronze","Standard Bronze Off Exchange Plan","61.22%",,"Yes","Yes","No","100%",,"$3,500","$0","$2,400","$200","$3,500","$0","$800","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0310001-00","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0310001-00"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0310001","Classic Bronze","20069TX031",,"TXN001","TXS001","TXF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.99052032",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0310001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF002","20069TX0310001-01","Classic Bronze","Standard Bronze On Exchange Plan","61.22%",,"Yes","Yes","No","100%",,"$3,500","$0","$2,400","$200","$3,500","$0","$800","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0310001-01","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0310001-01"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0310001","Classic Bronze","20069TX031",,"TXN001","TXS001","TXF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.99052032",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0310001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF002","20069TX0310001-02","Classic Bronze","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0310001-02","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0310001-02"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0310001","Classic Bronze","20069TX031",,"TXN001","TXS001","TXF002","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.99052032",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0310001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF002","20069TX0310001-03","Classic Bronze","Limited Cost Sharing Plan Variation","61.22%",,"Yes","Yes","No","100%",,"$3,500","$0","$2,400","$200","$3,500","$0","$800","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0310001-03","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0310001-03"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0320001","Classic Silver","20069TX032",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990765",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0320001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF003","20069TX0320001-00","Classic Silver","Standard Silver Off Exchange Plan","66.19%",,"Yes","Yes","No","100%",,"$4,500","$10","$900","$200","$3,100","$500","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0320001-00","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0320001-00"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0320001","Classic Silver","20069TX032",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990765",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0320001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF003","20069TX0320001-01","Classic Silver","Standard Silver On Exchange Plan","66.19%",,"Yes","Yes","No","100%",,"$4,500","$10","$900","$200","$3,100","$500","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0320001-01","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0320001-01"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0320001","Classic Silver","20069TX032",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990765",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0320001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF003","20069TX0320001-02","Classic Silver","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0320001-02","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0320001-02"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0320001","Classic Silver","20069TX032",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990765",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0320001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF003","20069TX0320001-03","Classic Silver","Limited Cost Sharing Plan Variation","66.19%",,"Yes","Yes","No","100%",,"$4,500","$10","$900","$200","$3,100","$500","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0320001-03","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0320001-03"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0320001","Classic Silver","20069TX032",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990765",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0320001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF003","20069TX0320001-04","Classic Silver - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","73% AV Level Silver Plan","73.99%",,"Yes","Yes","No","100%",,"$300","$10","$1,000","$200","$100","$1,500","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0320001-04","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0320001-04"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0320001","Classic Silver","20069TX032",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990765",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0320001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF003","20069TX0320001-05","Classic Silver - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","87% AV Level Silver Plan","87.60%",,"Yes","Yes","No","100%",,"$800","$0","$1,100","$200","$0","$800","$0","$80","$800","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0320001-05","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0320001-05"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0320001","Classic Silver","20069TX032",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990765",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0320001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF003","20069TX0320001-06","Classic Silver - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","94% AV Level Silver Plan","93.44%",,"Yes","Yes","No","100%",,"$300","$0","$600","$200","$0","$700","$0","$80","$300","$100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0320001-06","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0320001-06"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0330001","Classic Gold","20069TX033",,"TXN001","TXS001","TXF004","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.992167",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0330001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF004","20069TX0330001-00","Classic Gold","Standard Gold Off Exchange Plan","76.02%",,"Yes","Yes","No","100%",,"$1,500","$10","$1,000","$200","$0","$1,700","$0","$80","$1,500","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0330001-00","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0330001-00"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0330001","Classic Gold","20069TX033",,"TXN001","TXS001","TXF004","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.992167",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0330001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF004","20069TX0330001-01","Classic Gold","Standard Gold On Exchange Plan","76.02%",,"Yes","Yes","No","100%",,"$1,500","$10","$1,000","$200","$0","$1,700","$0","$80","$1,500","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0330001-01","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0330001-01"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0330001","Classic Gold","20069TX033",,"TXN001","TXS001","TXF004","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.992167",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0330001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF004","20069TX0330001-02","Classic Gold","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0330001-02","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0330001-02"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0330001","Classic Gold","20069TX033",,"TXN001","TXS001","TXF004","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.992167",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0330001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF004","20069TX0330001-03","Classic Gold","Limited Cost Sharing Plan Variation","76.02%",,"Yes","Yes","No","100%",,"$1,500","$10","$1,000","$200","$0","$1,700","$0","$80","$1,500","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0330001-03","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0330001-03"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0100001","Simple Bronze","20069TX010",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990393",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0100001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF005","20069TX0100001-00","Simple Bronze","Standard Bronze Off Exchange Plan","58.54%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0100001-00","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0100001-00"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0100001","Simple Bronze","20069TX010",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990393",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0100001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF005","20069TX0100001-01","Simple Bronze","Standard Bronze On Exchange Plan","58.54%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0100001-01","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0100001-01"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0100001","Simple Bronze","20069TX010",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990393",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0100001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF005","20069TX0100001-02","Simple Bronze","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0100001-02","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0100001-02"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0100001","Simple Bronze","20069TX010",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990393",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0100001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF005","20069TX0100001-03","Simple Bronze","Limited Cost Sharing Plan Variation","58.54%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0100001-03","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0100001-03"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0110001","Simple Silver","20069TX011",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990765",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0110001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF006","20069TX0110001-00","Simple Silver","Standard Silver Off Exchange Plan","66.18%",,"Yes","Yes","No","100%",,"$6,300","$10","$0","$200","$3,000","$400","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0110001-00","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0110001-00"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0110001","Simple Silver","20069TX011",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990765",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0110001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF006","20069TX0110001-01","Simple Silver","Standard Silver On Exchange Plan","66.18%",,"Yes","Yes","No","100%",,"$6,300","$10","$0","$200","$3,000","$400","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0110001-01","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0110001-01"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0110001","Simple Silver","20069TX011",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990765",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0110001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF006","20069TX0110001-02","Simple Silver","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0110001-02","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0110001-02"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0110001","Simple Silver","20069TX011",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990765",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0110001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF006","20069TX0110001-03","Simple Silver","Limited Cost Sharing Plan Variation","66.18%",,"Yes","Yes","No","100%",,"$6,300","$10","$0","$200","$3,000","$400","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0110001-03","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0110001-03"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0110001","Simple Silver","20069TX011",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990765",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0110001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF006","20069TX0110001-04","Simple Silver CSR 250","73% AV Level Silver Plan","73.72%",,"Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$0","$1,600","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0110001-04","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0110001-04"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0110001","Simple Silver","20069TX011",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990765",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0110001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF006","20069TX0110001-05","Simple Silver CSR 200","87% AV Level Silver Plan","87.05%",,"Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$0","$700","$0","$80","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0110001-05","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0110001-05"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0110001","Simple Silver","20069TX011",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990765",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0110001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF006","20069TX0110001-06","Simple Silver CSR 150","94% AV Level Silver Plan","93.18%",,"Yes","Yes","No","100%",,"$800","$0","$0","$200","$0","$700","$0","$80","$800","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0110001-06","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0110001-06"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0340001","Saver Bronze","20069TX034",,"TXN001","TXS001","TXF007","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990437",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0340001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF007","20069TX0340001-00","Saver Bronze","Standard Bronze Off Exchange Plan","60.63%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0340001-00","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0340001-00"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0340001","Saver Bronze","20069TX034",,"TXN001","TXS001","TXF007","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990437",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0340001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF007","20069TX0340001-01","Saver Bronze","Standard Bronze On Exchange Plan","60.63%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0340001-01","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0340001-01"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0340001","Saver Bronze","20069TX034",,"TXN001","TXS001","TXF007","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990437",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0340001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF007","20069TX0340001-02","Saver Bronze","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0340001-02","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0340001-02"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0340001","Saver Bronze","20069TX034",,"TXN001","TXS001","TXF007","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990437",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0340001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF007","20069TX0340001-03","Saver Bronze","Limited Cost Sharing Plan Variation","60.63%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0340001-03","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0340001-03"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0350001","Saver Silver","20069TX035",,"TXN001","TXS001","TXF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990773",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0350001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF008","20069TX0350001-00","Saver Silver","Standard Silver Off Exchange Plan","66.29%",,"Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$5,000","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0350001-00","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0350001-00"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0350001","Saver Silver","20069TX035",,"TXN001","TXS001","TXF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990773",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0350001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF008","20069TX0350001-01","Saver Silver","Standard Silver On Exchange Plan","66.29%",,"Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$5,000","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0350001-01","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0350001-01"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0350001","Saver Silver","20069TX035",,"TXN001","TXS001","TXF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990773",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0350001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF008","20069TX0350001-02","Saver Silver","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0350001-02","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0350001-02"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0350001","Saver Silver","20069TX035",,"TXN001","TXS001","TXF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990773",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0350001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF008","20069TX0350001-03","Saver Silver","Limited Cost Sharing Plan Variation","66.29%",,"Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$5,000","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0350001-03","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0350001-03"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0350001","Saver Silver","20069TX035",,"TXN001","TXS001","TXF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990773",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0350001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF008","20069TX0350001-04","Saver Silver - Free Calls with Doctors, Free Preventive Care","73% AV Level Silver Plan","73.01%",,"Yes","Yes","No","100%",,"$2,000","$0","$900","$200","$2,000","$0","$600","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0350001-04","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0350001-04"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0350001","Saver Silver","20069TX035",,"TXN001","TXS001","TXF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990773",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0350001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF008","20069TX0350001-05","Saver Silver - Free Calls with Doctors, Free Preventive Care","87% AV Level Silver Plan","87.60%",,"Yes","Yes","No","100%",,"$600","$0","$600","$200","$600","$0","$500","$80","$600","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0350001-05","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0350001-05"
"2018","TX","20069","HIOS","2017-09-06 02:20:26","Individual","No","47-3185443","20069TX0350001","Saver Silver","20069TX035",,"TXN001","TXS001","TXF008","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.990773",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=tx&year=2018&hios=20069TX0350001","https://www.hioscar.com/search/TX/drugs?year=2018&formulary=TXF008","20069TX0350001-06","Saver Silver - Free Calls with Doctors, Free Preventive Care","94% AV Level Silver Plan","94.35%",,"Yes","Yes","No","100%",,"$100","$0","$600","$200","$100","$0","$500","$80","$100","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=tx&year=2018&hios=20069TX0350001-06","https://www.hioscar.com/hx/brochure/?state=tn&year=2018&hios=20069TX0350001-06"
"2018","TX","23749","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","23749TX0010001","Dentegra DPO Pediatric Basic Plan","23749TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","23749TX0010001-00","Dentegra DPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tx/23749tx0010001-17"
"2018","TX","23749","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","23749TX0010004","Dentegra DPO Family Preferred Plan","23749TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","23749TX0010004-01","Dentegra DPO Family Preferred Plan","Standard High On Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","$45 per person","per group not applicable",,,,,,"$45","$45 per person","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tx/23749tx0010004-18"
"2018","TX","23749","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","23749TX0010006","Dentegra DPO Family Basic Plan","23749TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","23749TX0010006-01","Dentegra DPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tx/23749tx0010006-18"
"2018","TX","23891","HIOS","2017-08-12 02:21:25","Individual","Yes","74-2447512","23891TX0010002","DeltaCare USA Pediatric Preferred Plan","23891TX001",,"TXN001","TXS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","23891TX0010002-00","DeltaCare USA Pediatric Preferred Plan","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010002-18"
"2018","TX","23891","HIOS","2017-08-12 02:21:25","SHOP (Small Group)","Yes","74-2447512","23891TX0020002","DeltaCare USA Pediatric Preferred Plan for Small Businesses","23891TX002",,"TXN001","TXS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","23891TX0020002-00","DeltaCare USA Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0020002-17"
"2018","TX","23891","HIOS","2017-08-12 02:21:25","SHOP (Small Group)","Yes","74-2447512","23891TX0020001","DeltaCare USA Pediatric Basic Plan for Small Businesses","23891TX002",,"TXN001","TXS001",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","23891TX0020001-00","DeltaCare USA Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0020001-17"
"2018","TX","23891","HIOS","2017-08-12 02:21:25","Individual","Yes","74-2447512","23891TX0010001","DeltaCare USA Pediatric Basic Plan","23891TX001",,"TXN001","TXS001",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","23891TX0010001-00","DeltaCare USA Pediatric Basic Plan","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010001-18"
"2018","TX","23891","HIOS","2017-08-12 02:21:25","Individual","Yes","74-2447512","23891TX0010004","DeltaCare USA Preferred Plan for Families","23891TX001",,"TXN001","TXS001",,"Existing","HMO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","23891TX0010004-01","DeltaCare USA Preferred Plan for Families","Standard High On Exchange Plan","85.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010004-18"
"2018","TX","23891","HIOS","2017-08-12 02:21:25","Individual","Yes","74-2447512","23891TX0010006","DeltaCare USA Basic Plan for Families","23891TX001",,"TXN001","TXS001",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","23891TX0010006-01","DeltaCare USA Basic Plan for Families","Standard Low On Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010006-18"
"2018","TX","24349","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","Yes","94-2761537","24349TX0020001","DPO Pediatric Basic Plan for Small Businesses","24349TX002",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0020001-00","DPO Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0020001-18"
"2018","TX","24349","HIOS","2017-08-11 02:20:28","Individual","Yes","94-2761537","24349TX0010001","Delta Dental Individual DPO Pediatric Basic Plan","24349TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0010001-00","Delta Dental Individual DPO Pediatric Basic Plan","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0010001-18"
"2018","TX","24349","HIOS","2017-08-11 02:20:28","Individual","Yes","94-2761537","24349TX0010002","Delta Dental Individual DPO Pediatric Preferred Plan","24349TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0010002-00","Delta Dental Individual DPO Pediatric Preferred Plan","Standard High Off Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$40","$40 per person","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0010002-18"
"2018","TX","24349","HIOS","2017-08-11 02:20:28","SHOP (Small Group)","Yes","94-2761537","24349TX0020002","DPO Pediatric Preferred Plan for Small Businesses","24349TX002",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0020002-00","DPO Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$40","$40 per person","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0020002-18"
"2018","TX","24349","HIOS","2017-08-11 02:20:28","Individual","Yes","94-2761537","24349TX0010004","Delta Dental Individual and Family DPO Preferred Plan for Families","24349TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0010004-01","Delta Dental Individual and Family DPO Preferred Plan for Families","Standard High On Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$40","$40 per person","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0010004-18"
"2018","TX","24349","HIOS","2017-08-11 02:20:28","Individual","Yes","94-2761537","24349TX0010006","Delta Dental Individual and Family DPO Basic Plan for Families","24349TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0010006-01","Delta Dental Individual and Family DPO Basic Plan for Families","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0010006-18"
"2018","TX","26250","HIOS","2017-05-18 02:20:21","Individual","Yes","75-2698702","26250TX0070001","Managed DentalGuard TX Essentials 2","26250TX007",,"TXN002","TXS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.994","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","26250TX0070001-00","Managed DentalGuard TX Essentials 2","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/texas/","https://dentalexchange.guardianlife.com/our-plans/texas/"
"2018","TX","26250","HIOS","2017-05-18 02:20:21","SHOP (Small Group)","Yes","75-2698702","26250TX0030004","Managed DentalGuard TX 10 Family Plan","26250TX003",,"TXN001","TXS002",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.995","Estimated Rate","2018-01-01",,"No",,"No",,"No",,"","26250TX0030004-00","Managed DentalGuard TX 10 Family Plan","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TX","26250","HIOS","2017-05-18 02:20:21","SHOP (Small Group)","Yes","75-2698702","26250TX0040004","Managed DentalGuard TX 30 Family Plan","26250TX004",,"TXN001","TXS002",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.991","Estimated Rate","2018-01-01",,"No",,"No",,"No",,"","26250TX0040004-00","Managed DentalGuard TX 30 Family Plan","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TX","26250","HIOS","2017-05-18 02:20:21","Individual","Yes","75-2698702","26250TX0070001","Managed DentalGuard TX Essentials 2","26250TX007",,"TXN002","TXS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.994","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","26250TX0070001-01","Managed DentalGuard TX Essentials 2","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/texas/","https://dentalexchange.guardianlife.com/our-plans/texas/"
"2018","TX","26250","HIOS","2017-05-18 02:20:21","SHOP (Small Group)","Yes","75-2698702","26250TX0050004","Managed DentalGuard TX 40 Family Plan","26250TX005",,"TXN001","TXS002",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.992","Estimated Rate","2018-01-01",,"No",,"No",,"No",,"","26250TX0050004-00","Managed DentalGuard TX 40 Family Plan","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140001","Gold Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140001-00","Gold Coinsurance","Standard Gold Off Exchange Plan",,"0.76283449470725","Yes","Yes","No","100%",,"$1,950","$700","$1,800","$60","$1,400","$1,600","$300","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Gold_Coins_SBC.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Gold_Coins_SOC.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140001","Gold Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140001-01","Gold Coinsurance","Standard Gold On Exchange Plan",,"0.76283449470725","Yes","Yes","No","100%",,"$1,950","$700","$1,800","$60","$1,400","$1,600","$300","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Gold_Coins_SBC.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Gold_Coins_SOC.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140001","Gold Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140001-02","Gold Coinsurance","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Gold_Coins_SBC_ZERO.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Gold_Coins_SOC_ZERO.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140001","Gold Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140001-03","Gold Coinsurance","Limited Cost Sharing Plan Variation",,"0.76283449470725","Yes","Yes","No","100%",,"$1,950","$700","$1,800","$60","$1,400","$1,600","$300","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Gold_Coins_SBC_LTD.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Gold_Coins_SOC_LTD.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140003","Silver Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency Only","No","Emergency Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-00","Silver Coinsurance","Standard Silver Off Exchange Plan",,"0.717724492831284","Yes","Yes","No","100%",,"$3,800","$700","$2,700","$60","$1,200","$1,600","$500","$60","$900","$900","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_Coins_SBC.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_Coins_SOC.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140003","Silver Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency Only","No","Emergency Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-01","Silver Coinsurance","Standard Silver On Exchange Plan",,"0.717724492831284","Yes","Yes","No","100%",,"$3,800","$700","$2,700","$60","$1,200","$1,600","$500","$60","$900","$900","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_Coins_SBC.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_Coins_SOC.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140003","Silver Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency Only","No","Emergency Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-02","Silver Coinsurance","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_Coins_SBC_ZERO.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_Coins_SOC_ZERO.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140003","Silver Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency Only","No","Emergency Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-03","Silver Coinsurance","Limited Cost Sharing Plan Variation",,"0.717724492831284","Yes","Yes","No","100%",,"$3,800","$700","$2,700","$60","$1,200","$1,600","$500","$60","$900","$900","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_Coins_SBC_LTD.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_Coins_SOC_LTD.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140003","Silver Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency Only","No","Emergency Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-04","Silver Coinsurance 73% AV","73% AV Level Silver Plan",,"0.738055337473515","Yes","Yes","No","100%",,"$2,700","$400","$2,700","$60","$1,200","$1,600","$500","$60","$900","$900","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,450","$3450 per person","$6900 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_Coins_73AV_SBC.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_Coins_73AV_SOC.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140003","Silver Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency Only","No","Emergency Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-05","Silver Coinsurance 87% AV","87% AV Level Silver Plan",,"0.867489212836562","Yes","Yes","No","100%",,"$500","$100","$1,800","$60","$800","$800","$300","$60","$800","$300","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_Coins_87AV_SBC.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_Coins_87AV_SOC.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140003","Silver Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency Only","No","Emergency Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-06","Silver Coinsurance 94% AV","94% AV Level Silver Plan",,"0.936250642156242","Yes","Yes","No","100%",,"$0","$70","$900","$60","$0","$800","$200","$60","$0","$200","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_Coins_94AV_SBC.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_Coins_94AV_SOC.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140008","Silver 100% H S A","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140008-00","Silver 100% H S A","Standard Silver Off Exchange Plan",,"0.662934672262727","Yes","Yes","No","100%",,"$5,000","$0","$0","$60","$5,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_HSA_SBC.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_HSA_SOC.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140008","Silver 100% H S A","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140008-01","Silver 100% H S A","Standard Silver On Exchange Plan",,"0.662934672262727","Yes","Yes","No","100%",,"$5,000","$0","$0","$60","$5,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_HSA_SBC.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_HSA_SOC.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140008","Silver 100% H S A","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140008-02","Silver 100%","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_HSA_SBC_ZERO.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_HSA_SOC_ZERO.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140008","Silver 100% H S A","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140008-03","Silver 100% H S A","Limited Cost Sharing Plan Variation",,"0.662934672262727","Yes","Yes","No","100%",,"$5,000","$0","$0","$60","$5,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_HSA_SBC_LTD.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_HSA_SOC_LTD.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140008","Silver 100% H S A","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140008-04","Silver 100% (73% AV)","73% AV Level Silver Plan",,"0.729605713593814","Yes","Yes","No","100%",,"$3,350","$0","$0","$60","$3,350","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_HSA_73AV_SBC.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_HSA_73AV_SOC.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140008","Silver 100% H S A","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140008-05","Silver 100% (87% AV)","87% AV Level Silver Plan",,"0.862986557484674","Yes","Yes","No","100%",,"$1,250","$0","$0","$60","$1,250","$0","$0","$60","$1,250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_HSA_87AV_SBC.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_HSA_87AV_SOC.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140008","Silver 100% H S A","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency only","No","Emergency only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140008-06","Silver 100% (94% AV)","94% AV Level Silver Plan",,"0.932658386848586","Yes","Yes","No","100%",,"$550","$0","$0","$60","$550","$0","$0","$60","$550","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_HSA_94AV_SBC.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Silver_HSA_94AV_SOC.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140006","Bronze 100% H S A","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency Services Only","No","Emergency Services Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140006-00","Bronze 100% H S A","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Bronze_HSA_SBC.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Bronze_HSA_SOC.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140006","Bronze 100% H S A","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency Services Only","No","Emergency Services Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140006-01","Bronze 100% H S A","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Bronze_HSA_SBC.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Bronze_HSA_SOC.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140006","Bronze 100% H S A","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency Services Only","No","Emergency Services Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140006-02","Bronze 100%","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Bronze_HSA_SBC_ZERO.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Bronze_HSA_SOC_ZERO.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140006","Bronze 100% H S A","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency Services Only","No","Emergency Services Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140006-03","Bronze 100% H S A","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Bronze_HSA_SBC_LTD.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Bronze_HSA_SOC_LTD.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140009","Bronze Simple Choice Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency Services Only","No","Emergency Services Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140009-00","Bronze Simple Choice Coinsurance","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,900","$500","$4,000","$60","$3,400","$1,500","$2,000","$60","$1,000","$200","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Bronze_SimpleChoice_SBC.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Bronze_SimpleChoice_SOC.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140009","Bronze Simple Choice Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency Services Only","No","Emergency Services Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140009-01","Bronze Simple Choice Coinsurance","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,900","$500","$4,000","$60","$3,400","$1,500","$2,000","$60","$1,000","$200","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Bronze_SimpleChoice_SBC.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Bronze_SimpleChoice_SOC.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140009","Bronze Simple Choice Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency Services Only","No","Emergency Services Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140009-02","Bronze Simple Choice Coinsurance","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Bronze_SimpleChoice_SBC_ZERO.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Bronze_SimpleChoice_SOC_ZERO.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140009","Bronze Simple Choice Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,"2018-01-01",,"No","Emergency Services Only","No","Emergency Services Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140009-03","Bronze Simple Choice Coinsurance","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$2,900","$500","$4,000","$60","$3,400","$1,500","$2,000","$60","$1,000","$200","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Bronze_SimpleChoice_SBC_LTD.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Bronze_SimpleChoice_SOC_LTD.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140002","Gold Copay","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9965",,,"2018-01-01",,"No","Emergency Services Only","No","Emergency Services Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140002-00","Gold Copay","Standard Gold Off Exchange Plan",,"0.799793538630336","Yes","Yes","No","100%",,"$0","$2,800","$0","$60","$0","$1,600","$300","$60","$0","$900","$200","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Gold_Copay_SBC.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Gold_Copay_SOC.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140002","Gold Copay","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9965",,,"2018-01-01",,"No","Emergency Services Only","No","Emergency Services Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140002-01","Gold Copay","Standard Gold On Exchange Plan",,"0.799793538630336","Yes","Yes","No","100%",,"$0","$2,800","$0","$60","$0","$1,600","$300","$60","$0","$900","$200","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Gold_Copay_SBC.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Gold_Copay_SOC.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140002","Gold Copay","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9965",,,"2018-01-01",,"No","Emergency Services Only","No","Emergency Services Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140002-02","Gold Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Gold_Copay_SBC_ZERO.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Gold_Copay_SOC_ZERO.pdf"
"2018","TX","26539","HIOS","2017-11-01 02:20:20","Individual","No","75-2569094","26539TX0140002","Gold Copay","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9965",,,"2018-01-01",,"No","Emergency Services Only","No","Emergency Services Only","No","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx/Rx_2018_MarketPlace_Firstcare_Formulary.pdf","26539TX0140002-03","Gold Copay","Limited Cost Sharing Plan Variation",,"0.799793538630336","Yes","Yes","No","100%",,"$0","$2,800","$0","$60","$0","$1,600","$300","$60","$0","$900","$200","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Gold_Copay_SBC_LTD.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Marketplace/2018_Indv_Gold_Copay_SOC_LTD.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010001","Community Health Choice HMO Gold 001","27248TX001","7932102164","TXN001","TXS001","TXF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010001-00","Community Health Choice HMO Gold 001","Standard Gold Off Exchange Plan","81.49%","0.726953548463588","No","Yes","No","100%",,"$0","$2,200","$0","$0","$100","$2,100","$500","$0","$0","$1,000","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1559/27248tx0010001-00-gold-copay_2018.pdf","https://www.communityhealthchoice.org/media/1625/hmo-gold-copay-eoc.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010001","Community Health Choice HMO Gold 001","27248TX001","7932102164","TXN001","TXS001","TXF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010001-01","Community Health Choice HMO Gold 001","Standard Gold On Exchange Plan","81.49%","0.726953548463588","No","Yes","No","100%",,"$0","$2,200","$0","$0","$100","$2,100","$500","$0","$0","$1,000","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1560/27248tx0010001-01-gold-copay_2018.pdf","https://www.communityhealthchoice.org/media/1625/hmo-gold-copay-eoc.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010001","Community Health Choice HMO Gold 001","27248TX001","7932102164","TXN001","TXS001","TXF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010001-02","Community Health Choice HMO Gold 001","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1561/27248tx0010001-02-gold-copay-nai-zero-2018.pdf","https://www.communityhealthchoice.org/media/1625/hmo-gold-copay-eoc.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010001","Community Health Choice HMO Gold 001","27248TX001","7932102164","TXN001","TXS001","TXF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010001-03","Community Health Choice HMO Gold 001","Limited Cost Sharing Plan Variation","81.49%","0.726953548463588","No","Yes","No","100%",,"$0","$2,200","$0","$0","$100","$2,100","$500","$0","$0","$1,000","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1562/27248tx0010001-03-gold-copay-nai-limited-2018.pdf","https://www.communityhealthchoice.org/media/1625/hmo-gold-copay-eoc.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010002-00","Community Health Choice HMO Silver 002","Standard Silver Off Exchange Plan","71.89%","0.669780739056711","No","Yes","No","100%",,"$0","$3,000","$0","$0","$400","$4,200","$500","$0","$0","$2,900","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$350","$350 per person","$700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1565/27248tx0010002-00-silver-copay-2018.pdf","https://www.communityhealthchoice.org/media/1572/hmo-copay-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010002-01","Community Health Choice HMO Silver 002","Standard Silver On Exchange Plan","71.89%","0.669780739056711","No","Yes","No","100%",,"$0","$3,000","$0","$0","$400","$4,200","$500","$0","$0","$2,900","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$350","$350 per person","$700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1566/27248tx0010002-01-silver-copay-2018.pdf","https://www.communityhealthchoice.org/media/1572/hmo-copay-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010002-02","Community Health Choice HMO Silver 002","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1567/27248tx0010002-02-silver-copay-nai-zero-2018.pdf","https://www.communityhealthchoice.org/media/1572/hmo-copay-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010002-03","Community Health Choice HMO Silver 002","Limited Cost Sharing Plan Variation","71.89%","0.669780739056711","No","Yes","No","100%",,"$0","$3,000","$0","$0","$400","$4,200","$500","$0","$0","$2,900","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$350","$350 per person","$700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1568/27248tx0010002-03-silver-copay-nai-limited-2018.pdf","https://www.communityhealthchoice.org/media/1572/hmo-copay-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010002-04","Community Health Choice HMO Silver 002","73% AV Level Silver Plan","73.96%","0.698815625335831","No","Yes","No","100%",,"$0","$2,900","$0","$0","$400","$3,800","$300","$0","$0","$2,900","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$350","$350 per person","$700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1569/27248tx0010002-04-silver73copay-2018.pdf","https://www.communityhealthchoice.org/media/1572/hmo-copay-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010002-05","Community Health Choice HMO Silver 002","87% AV Level Silver Plan","87.91%","0.846231805232405","No","Yes","No","100%",,"$0","$1,500","$0","$0","$0","$1,400","$300","$0","$0","$800","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1570/27248tx0010002-05-silver87copay-2018.pdf","https://www.communityhealthchoice.org/media/1572/hmo-copay-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010002-06","Community Health Choice HMO Silver 002","94% AV Level Silver Plan","94.18%","0.928149334621254","No","Yes","No","100%",,"$0","$800","$0","$0","$0","$800","$200","$0","$0","$300","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1571/27248tx0010002-06-silver94copay-2018.pdf","https://www.communityhealthchoice.org/media/1572/hmo-copay-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010006","Community Health Choice- Gold Limited Network Plan 006","27248TX001","7932102164","TXN002","TXS002","TXF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010006-00","Community Health Choice- Gold Limited Network Plan 006","Standard Gold Off Exchange Plan","81.49%","0.726953548463588","No","Yes","No","100%",,"$0","$2,200","$0","$0","$100","$2,100","$500","$0","$0","$1,000","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1595/27248tx0010006-00-gold-copay-2018.pdf","https://www.communityhealthchoice.org/media/1625/hmo-gold-copay-eoc.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010006","Community Health Choice- Gold Limited Network Plan 006","27248TX001","7932102164","TXN002","TXS002","TXF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010006-01","Community Health Choice- Gold Limited Network Plan 006","Standard Gold On Exchange Plan","81.49%","0.726953548463588","No","Yes","No","100%",,"$0","$2,200","$0","$0","$100","$2,100","$500","$0","$0","$1,000","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1596/27248tx0010006-01-gold-copay-2018.pdf","https://www.communityhealthchoice.org/media/1625/hmo-gold-copay-eoc.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010006","Community Health Choice- Gold Limited Network Plan 006","27248TX001","7932102164","TXN002","TXS002","TXF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010006-02","Community Health Choice- Gold Limited Network Plan 006","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1597/27248tx0010006-02-gold-copay-nai-zero-2018.pdf","https://www.communityhealthchoice.org/media/1625/hmo-gold-copay-eoc.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010006","Community Health Choice- Gold Limited Network Plan 006","27248TX001","7932102164","TXN002","TXS002","TXF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010006-03","Community Health Choice- Gold Limited Network Plan 006","Limited Cost Sharing Plan Variation","81.49%","0.726953548463588","No","Yes","No","100%",,"$0","$2,200","$0","$0","$100","$2,100","$500","$0","$0","$1,000","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1598/27248tx0010006-03-gold-copay-nai-limited-2018.pdf","https://www.communityhealthchoice.org/media/1625/hmo-gold-copay-eoc.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010007","Community Health Choice- Silver Limited Network Plan 007","27248TX001","7932102164","TXN002","TXS002","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010007-00","Community Health Choice- Silver Limited Network Plan 007","Standard Silver Off Exchange Plan","71.89%","0.669780739056711","No","Yes","No","100%",,"$0","$3,000","$0","$0","$400","$4,200","$500","$0","$0","$2,900","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$350","$350 per person","$700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1600/27248tx0010007-00-silver-copay-2018.pdf","https://www.communityhealthchoice.org/media/1607/hmo-copay-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010007","Community Health Choice- Silver Limited Network Plan 007","27248TX001","7932102164","TXN002","TXS002","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010007-01","Community Health Choice- Silver Limited Network Plan 007","Standard Silver On Exchange Plan","71.89%","0.669780739056711","No","Yes","No","100%",,"$0","$3,000","$0","$0","$400","$4,200","$500","$0","$0","$2,900","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$350","$350 per person","$700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1601/27248tx0010007-01-silver-copay-2018.pdf","https://www.communityhealthchoice.org/media/1607/hmo-copay-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010007","Community Health Choice- Silver Limited Network Plan 007","27248TX001","7932102164","TXN002","TXS002","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010007-02","Community Health Choice- Silver Limited Network Plan 007","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1602/27248tx0010007-02-silver-copay-nai-zero-2018.pdf","https://www.communityhealthchoice.org/media/1607/hmo-copay-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010007","Community Health Choice- Silver Limited Network Plan 007","27248TX001","7932102164","TXN002","TXS002","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010007-03","Community Health Choice- Silver Limited Network Plan 007","Limited Cost Sharing Plan Variation","71.89%","0.669780739056711","No","Yes","No","100%",,"$0","$3,000","$0","$0","$400","$4,200","$500","$0","$0","$2,900","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$350","$350 per person","$700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1603/27248tx0010007-03-silver-copay-nai-limited-2018.pdf","https://www.communityhealthchoice.org/media/1607/hmo-copay-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010007","Community Health Choice- Silver Limited Network Plan 007","27248TX001","7932102164","TXN002","TXS002","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010007-04","Community Health Choice- Silver Limited Network Plan 007","73% AV Level Silver Plan","73.96%","0.698815625335831","No","Yes","No","100%",,"$0","$2,900","$0","$0","$400","$3,800","$300","$0","$0","$2,900","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$350","$350 per person","$700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1604/27248tx0010007-04-silver73copay-2018.pdf","https://www.communityhealthchoice.org/media/1607/hmo-copay-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010007","Community Health Choice- Silver Limited Network Plan 007","27248TX001","7932102164","TXN002","TXS002","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010007-05","Community Health Choice- Silver Limited Network Plan 007","87% AV Level Silver Plan","87.91%","0.846231805232405","No","Yes","No","100%",,"$0","$1,500","$0","$0","$0","$1,400","$300","$0","$0","$800","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1605/27248tx0010007-05-silver87copay-2018.pdf","https://www.communityhealthchoice.org/media/1607/hmo-copay-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010007","Community Health Choice- Silver Limited Network Plan 007","27248TX001","7932102164","TXN002","TXS002","TXF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except primary care",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010007-06","Community Health Choice- Silver Limited Network Plan 007","94% AV Level Silver Plan","94.18%","0.928149334621254","No","Yes","No","100%",,"$0","$800","$0","$0","$0","$800","$200","$0","$0","$300","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1606/27248tx0010007-06-silver94copay-2018.pdf","https://www.communityhealthchoice.org/media/1607/hmo-copay-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010003","Community Health Choice HMO Bronze 003","27248TX001","7932102164","TXN001","TXS001","TXF001","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010003-00","Community Health Choice HMO Bronze 003","Standard Bronze Off Exchange Plan","64.43%","0.632013078802585","No","Yes","No","100%",,"$3,000","$1,700","$2,600","$0","$2,000","$2,400","$500","$0","$1,100","$1,300","$10","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$200","$200 per person","$400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1573/27248tx0010003-00-bronze-deductible-2018.pdf","https://www.communityhealthchoice.org/media/1577/hmo-deductible-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010003","Community Health Choice HMO Bronze 003","27248TX001","7932102164","TXN001","TXS001","TXF001","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010003-01","Community Health Choice HMO Bronze 003","Standard Bronze On Exchange Plan","64.43%","0.632013078802585","No","Yes","No","100%",,"$3,000","$1,700","$2,600","$0","$2,000","$2,400","$500","$0","$1,100","$1,300","$10","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$200","$200 per person","$400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1574/27248tx0010003-01-bronze-deductible-2018.pdf","https://www.communityhealthchoice.org/media/1577/hmo-deductible-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010003","Community Health Choice HMO Bronze 003","27248TX001","7932102164","TXN001","TXS001","TXF001","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010003-02","Community Health Choice HMO Bronze 003","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1575/27248tx0010003-02-bronze-deductible-nai-zero-2018.pdf","https://www.communityhealthchoice.org/media/1577/hmo-deductible-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010003","Community Health Choice HMO Bronze 003","27248TX001","7932102164","TXN001","TXS001","TXF001","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010003-03","Community Health Choice HMO Bronze 003","Limited Cost Sharing Plan Variation","64.43%","0.632013078802585","No","Yes","No","100%",,"$3,000","$1,700","$2,600","$0","$2,000","$2,400","$500","$0","$1,100","$1,300","$10","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$200","$200 per person","$400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1576/27248tx0010003-03-bronze-deductible-nai-limited-2018.pdf","https://www.communityhealthchoice.org/media/1577/hmo-deductible-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010008","Community Health Choice HMO Bronze 008 High Deductible Health Plan- HSA Compatible","27248TX001","7932102164","TXN001","TXS001","TXF006","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010008-00","Community Health Choice HMO Bronze 008 High Deductible Health Plan- HSA Compatible","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$0","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.communityhealthchoice.org/media/1608/27248tx0010008-00-bronze-deductible-2018.pdf","https://www.communityhealthchoice.org/media/1577/hmo-deductible-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010008","Community Health Choice HMO Bronze 008 High Deductible Health Plan- HSA Compatible","27248TX001","7932102164","TXN001","TXS001","TXF006","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010008-01","Community Health Choice HMO Bronze 008 High Deductible Health Plan- HSA Compatible","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$0","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.communityhealthchoice.org/media/1609/27248tx0010008-01-bronze-deductible-2018.pdf","https://www.communityhealthchoice.org/media/1577/hmo-deductible-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010008","Community Health Choice HMO Bronze 008 High Deductible Health Plan- HSA Compatible","27248TX001","7932102164","TXN001","TXS001","TXF006","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010008-02","Community Health Choice HMO Bronze 008 High Deductible Health Plan- HSA Compatible","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.communityhealthchoice.org/media/1610/27248tx0010008-02-bronze-deductible-nai-zero-2018.pdf","https://www.communityhealthchoice.org/media/1577/hmo-deductible-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010008","Community Health Choice HMO Bronze 008 High Deductible Health Plan- HSA Compatible","27248TX001","7932102164","TXN001","TXS001","TXF006","New","HMO","Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010008-03","Community Health Choice HMO Bronze 008 High Deductible Health Plan- HSA Compatible","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$0","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.communityhealthchoice.org/media/1611/27248tx0010008-03-bronze-deductible-nai-limited-2018.pdf","https://www.communityhealthchoice.org/media/1577/hmo-deductible-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010004-00","Community Health Choice HMO Silver 004","Standard Silver Off Exchange Plan","70.52%","0.669536504043651","No","Yes","No","100%",,"$2,500","$2,000","$0","$0","$1,900","$1,100","$500","$0","$1,000","$900","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1582/27248tx0010004-00-silver-deductible-2018.pdf","https://www.communityhealthchoice.org/media/1589/hmo-deductible-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010004-01","Community Health Choice HMO Silver 004","Standard Silver On Exchange Plan","70.52%","0.669536504043651","No","Yes","No","100%",,"$2,500","$2,000","$0","$0","$1,900","$1,100","$500","$0","$1,000","$900","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1583/27248tx0010004-01-silver-deductible-2018.pdf","https://www.communityhealthchoice.org/media/1589/hmo-deductible-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010004-02","Community Health Choice HMO Silver 004","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1584/27248tx0010004-02-silver-deductible-nai-zero-2018.pdf","https://www.communityhealthchoice.org/media/1589/hmo-deductible-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010004-03","Community Health Choice HMO Silver 004","Limited Cost Sharing Plan Variation","70.52%","0.669536504043651","No","Yes","No","100%",,"$2,500","$2,000","$0","$0","$1,900","$1,100","$500","$0","$1,000","$900","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1585/27248tx0010004-03-silver-deductible-nai-limited-2018.pdf","https://www.communityhealthchoice.org/media/1589/hmo-deductible-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010004-04","Community Health Choice HMO Silver 004","73% AV Level Silver Plan","73.06%","0.702207790553492","No","Yes","No","100%",,"$2,000","$2,000","$0","$0","$2,000","$1,800","$300","$0","$1,200","$900","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1586/27248tx0010004-04-silver73deductible-2018.pdf","https://www.communityhealthchoice.org/media/1589/hmo-deductible-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010004-05","Community Health Choice HMO Silver 004","87% AV Level Silver Plan","87.91%","0.843251992223815","No","Yes","No","100%",,"$0","$1,500","$0","$0","$0","$1,400","$300","$0","$0","$800","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1587/27248tx0010004-05-silver87deductible-2018.pdf","https://www.communityhealthchoice.org/media/1589/hmo-deductible-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010004-06","Community Health Choice HMO Silver 004","94% AV Level Silver Plan","94.18%","0.918325443330924","No","Yes","No","100%",,"$0","$800","$0","$0","$0","$800","$200","$0","$0","$300","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1588/27248tx0010004-06-silver94deductible-2018.pdf","https://www.communityhealthchoice.org/media/1589/hmo-deductible-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010005","Community Health Choice HMO Gold 005","27248TX001","7932102164","TXN001","TXS001","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010005-00","Community Health Choice HMO Gold 005","Standard Gold Off Exchange Plan","80.95%","0.753011132529716","No","Yes","No","100%",,"$500","$1,700","$0","$0","$500","$1,600","$500","$0","$500","$800","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1591/27248tx0010005-00-gold-deductible-2018.pdf","https://www.communityhealthchoice.org/media/1590/hmo-deductible-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010005","Community Health Choice HMO Gold 005","27248TX001","7932102164","TXN001","TXS001","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010005-01","Community Health Choice HMO Gold 005","Standard Gold On Exchange Plan","80.95%","0.753011132529716","No","Yes","No","100%",,"$500","$1,700","$0","$0","$500","$1,600","$500","$0","$500","$800","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1592/27248tx0010005-01-gold-deductible-2018.pdf","https://www.communityhealthchoice.org/media/1590/hmo-deductible-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010005","Community Health Choice HMO Gold 005","27248TX001","7932102164","TXN001","TXS001","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010005-02","Community Health Choice HMO Gold 005","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1593/27248tx0010005-02-gold-deductible-nai-zero-2018.pdf","https://www.communityhealthchoice.org/media/1590/hmo-deductible-eoc-2018.pdf"
"2018","TX","27248","HIOS","2017-09-26 02:21:16","Individual","No","76-0495152","27248TX0010005","Community Health Choice HMO Gold 005","27248TX001","7932102164","TXN001","TXS001","TXF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"No","For emergency only","No","https://www.communityhealthchoice.org/quickpay","https://www.communityhealthchoice.org/media/1612/community-health-choice-formulary-2018.pdf","27248TX0010005-03","Community Health Choice HMO Gold 005","Limited Cost Sharing Plan Variation","80.95%","0.753011132529716","No","Yes","No","100%",,"$500","$1,700","$0","$0","$500","$1,600","$500","$0","$500","$800","$10","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communityhealthchoice.org/media/1594/27248tx0010005-03-gold-deductible-nai-limited-2018.pdf","https://www.communityhealthchoice.org/media/1590/hmo-deductible-eoc-2018.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","29418TX014",,"TXN001","TXS001","TXF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140001-00","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/29418TX0140001-00.pdf","https://api.centene.com/Brochures/2018/29418TX0140001-00.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","29418TX014",,"TXN001","TXS001","TXF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140001-01","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/29418TX0140001-01.pdf","https://api.centene.com/Brochures/2018/29418TX0140001-01.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","29418TX014",,"TXN001","TXS001","TXF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140001-02","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/29418TX0140001-02.pdf","https://api.centene.com/Brochures/2018/29418TX0140001-02.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","29418TX014",,"TXN001","TXS001","TXF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140001-03","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/29418TX0140001-03.pdf","https://api.centene.com/Brochures/2018/29418TX0140001-03.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2018)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140002-00","Ambetter Balanced Care 1 (2018)","Standard Silver Off Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140002-00.pdf","https://api.centene.com/Brochures/2018/29418TX0140002-00.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2018)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140002-01","Ambetter Balanced Care 1 (2018)","Standard Silver On Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140002-01.pdf","https://api.centene.com/Brochures/2018/29418TX0140002-01.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2018)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140002-02","Ambetter Balanced Care 1 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140002-02.pdf","https://api.centene.com/Brochures/2018/29418TX0140002-02.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2018)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140002-03","Ambetter Balanced Care 1 (2018)","Limited Cost Sharing Plan Variation",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140002-03.pdf","https://api.centene.com/Brochures/2018/29418TX0140002-03.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2018)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140002-04","Ambetter Balanced Care 1 (2018)","73% AV Level Silver Plan",,"0.739812128349422","Yes","Yes","No","100%",,"$3,000","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140002-04.pdf","https://api.centene.com/Brochures/2018/29418TX0140002-04.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2018)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140002-05","Ambetter Balanced Care 1 (2018)","87% AV Level Silver Plan",,"0.87931537568396","Yes","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$300","$400","$60","$750","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140002-05.pdf","https://api.centene.com/Brochures/2018/29418TX0140002-05.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2018)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140002-06","Ambetter Balanced Care 1 (2018)","94% AV Level Silver Plan",,"0.949528260595198","Yes","Yes","No","100%",,"$0","$0","$950","$60","$0","$300","$400","$60","$0","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140002-06.pdf","https://api.centene.com/Brochures/2018/29418TX0140002-06.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2018)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140003-00","Ambetter Balanced Care 2 (2018)","Standard Silver Off Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140003-00.pdf","https://api.centene.com/Brochures/2018/29418TX0140003-00.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2018)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140003-01","Ambetter Balanced Care 2 (2018)","Standard Silver On Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140003-01.pdf","https://api.centene.com/Brochures/2018/29418TX0140003-01.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2018)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140003-02","Ambetter Balanced Care 2 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140003-02.pdf","https://api.centene.com/Brochures/2018/29418TX0140003-02.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2018)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140003-03","Ambetter Balanced Care 2 (2018)","Limited Cost Sharing Plan Variation",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140003-03.pdf","https://api.centene.com/Brochures/2018/29418TX0140003-03.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2018)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140003-04","Ambetter Balanced Care 2 (2018)","73% AV Level Silver Plan",,"0.729896135538709","Yes","Yes","No","100%",,"$4,600","$400","$0","$60","$1,900","$1,400","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140003-04.pdf","https://api.centene.com/Brochures/2018/29418TX0140003-04.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2018)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140003-05","Ambetter Balanced Care 2 (2018)","87% AV Level Silver Plan",,"0.867181007012531","Yes","Yes","No","100%",,"$1,700","$10","$0","$60","$1,500","$250","$0","$60","$1,600","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140003-05.pdf","https://api.centene.com/Brochures/2018/29418TX0140003-05.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2018)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140003-06","Ambetter Balanced Care 2 (2018)","94% AV Level Silver Plan",,"0.942313720589882","Yes","Yes","No","100%",,"$572","$3","$0","$60","$500","$70","$0","$60","$575","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140003-06.pdf","https://api.centene.com/Brochures/2018/29418TX0140003-06.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2018)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140005-00","Ambetter Balanced Care 10 (2018)","Standard Silver Off Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140005-00.pdf","https://api.centene.com/Brochures/2018/29418TX0140005-00.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2018)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140005-01","Ambetter Balanced Care 10 (2018)","Standard Silver On Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140005-01.pdf","https://api.centene.com/Brochures/2018/29418TX0140005-01.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2018)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140005-02","Ambetter Balanced Care 10 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140005-02.pdf","https://api.centene.com/Brochures/2018/29418TX0140005-02.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2018)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140005-03","Ambetter Balanced Care 10 (2018)","Limited Cost Sharing Plan Variation",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140005-03.pdf","https://api.centene.com/Brochures/2018/29418TX0140005-03.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2018)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140005-04","Ambetter Balanced Care 10 (2018)","73% AV Level Silver Plan",,"0.73985223196154","Yes","Yes","No","100%",,"$3,700","$100","$2,000","$60","$1,500","$900","$400","$60","$1,300","$90","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140005-04.pdf","https://api.centene.com/Brochures/2018/29418TX0140005-04.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2018)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140005-05","Ambetter Balanced Care 10 (2018)","87% AV Level Silver Plan",,"0.879858510990049","Yes","Yes","No","100%",,"$800","$0","$1,400","$60","$850","$300","$400","$60","$850","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140005-05.pdf","https://api.centene.com/Brochures/2018/29418TX0140005-05.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2018)","29418TX014",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140005-06","Ambetter Balanced Care 10 (2018)","94% AV Level Silver Plan",,"0.949794807417026","Yes","Yes","No","100%",,"$250","$0","$300","$60","$250","$160","$185","$60","$250","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$595","$595 per person","$1190 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140005-06.pdf","https://api.centene.com/Brochures/2018/29418TX0140005-06.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140008","Ambetter Balanced Care 3 (2018)","29418TX014",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140008-00","Ambetter Balanced Care 3 (2018)","Standard Silver Off Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140008-00.pdf","https://api.centene.com/Brochures/2018/29418TX0140008-00.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140008","Ambetter Balanced Care 3 (2018)","29418TX014",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140008-01","Ambetter Balanced Care 3 (2018)","Standard Silver On Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140008-01.pdf","https://api.centene.com/Brochures/2018/29418TX0140008-01.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140008","Ambetter Balanced Care 3 (2018)","29418TX014",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140008-02","Ambetter Balanced Care 3 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140008-02.pdf","https://api.centene.com/Brochures/2018/29418TX0140008-02.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140008","Ambetter Balanced Care 3 (2018)","29418TX014",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140008-03","Ambetter Balanced Care 3 (2018)","Limited Cost Sharing Plan Variation",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140008-03.pdf","https://api.centene.com/Brochures/2018/29418TX0140008-03.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140008","Ambetter Balanced Care 3 (2018)","29418TX014",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140008-04","Ambetter Balanced Care 3 (2018)","73% AV Level Silver Plan",,"0.739635889295605","Yes","Yes","No","100%",,"$1,950","$1,300","$300","$60","$1,300","$1,700","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140008-04.pdf","https://api.centene.com/Brochures/2018/29418TX0140008-04.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140008","Ambetter Balanced Care 3 (2018)","29418TX014",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140008-05","Ambetter Balanced Care 3 (2018)","87% AV Level Silver Plan",,"0.879959544313859","Yes","Yes","No","100%",,"$675","$200","$300","$60","$675","$300","$600","$60","$675","$20","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140008-05.pdf","https://api.centene.com/Brochures/2018/29418TX0140008-05.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140008","Ambetter Balanced Care 3 (2018)","29418TX014",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140008-06","Ambetter Balanced Care 3 (2018)","94% AV Level Silver Plan",,"0.949879112635725","Yes","Yes","No","100%",,"$200","$90","$300","$60","$200","$200","$200","$60","$200","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140008-06.pdf","https://api.centene.com/Brochures/2018/29418TX0140008-06.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140009","Ambetter Balanced Care 4 (2018)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140009-00","Ambetter Balanced Care 4 (2018)","Standard Silver Off Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140009-00.pdf","https://api.centene.com/Brochures/2018/29418TX0140009-00.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140009","Ambetter Balanced Care 4 (2018)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140009-01","Ambetter Balanced Care 4 (2018)","Standard Silver On Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140009-01.pdf","https://api.centene.com/Brochures/2018/29418TX0140009-01.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140009","Ambetter Balanced Care 4 (2018)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140009-02","Ambetter Balanced Care 4 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140009-02.pdf","https://api.centene.com/Brochures/2018/29418TX0140009-02.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140009","Ambetter Balanced Care 4 (2018)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140009-03","Ambetter Balanced Care 4 (2018)","Limited Cost Sharing Plan Variation",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140009-03.pdf","https://api.centene.com/Brochures/2018/29418TX0140009-03.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140009","Ambetter Balanced Care 4 (2018)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140009-04","Ambetter Balanced Care 4 (2018)","73% AV Level Silver Plan",,"0.727430168333116","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$1,800","$1,300","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140009-04.pdf","https://api.centene.com/Brochures/2018/29418TX0140009-04.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140009","Ambetter Balanced Care 4 (2018)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140009-05","Ambetter Balanced Care 4 (2018)","87% AV Level Silver Plan",,"0.863154651499334","Yes","Yes","No","100%",,"$1,850","$0","$0","$60","$1,850","$0","$0","$60","$1,630","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140009-05.pdf","https://api.centene.com/Brochures/2018/29418TX0140009-05.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140009","Ambetter Balanced Care 4 (2018)","29418TX014",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140009-06","Ambetter Balanced Care 4 (2018)","94% AV Level Silver Plan",,"0.940719200046497","Yes","Yes","No","100%",,"$600","$0","$0","$60","$600","$0","$0","$60","$600","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140009-06.pdf","https://api.centene.com/Brochures/2018/29418TX0140009-06.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140010","Ambetter Balanced Care 12 (2018)","29418TX014",,"TXN001","TXS001","TXF004","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140010-00","Ambetter Balanced Care 12 (2018)","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/29418TX0140010-00.pdf","https://api.centene.com/Brochures/2018/29418TX0140010-00.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140010","Ambetter Balanced Care 12 (2018)","29418TX014",,"TXN001","TXS001","TXF004","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140010-01","Ambetter Balanced Care 12 (2018)","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/29418TX0140010-01.pdf","https://api.centene.com/Brochures/2018/29418TX0140010-01.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140010","Ambetter Balanced Care 12 (2018)","29418TX014",,"TXN001","TXS001","TXF004","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140010-02","Ambetter Balanced Care 12 (2018)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/29418TX0140010-02.pdf","https://api.centene.com/Brochures/2018/29418TX0140010-02.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140010","Ambetter Balanced Care 12 (2018)","29418TX014",,"TXN001","TXS001","TXF004","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140010-03","Ambetter Balanced Care 12 (2018)","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/29418TX0140010-03.pdf","https://api.centene.com/Brochures/2018/29418TX0140010-03.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140010","Ambetter Balanced Care 12 (2018)","29418TX014",,"TXN001","TXS001","TXF004","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140010-04","Ambetter Balanced Care 12 (2018)","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/29418TX0140010-04.pdf","https://api.centene.com/Brochures/2018/29418TX0140010-04.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140010","Ambetter Balanced Care 12 (2018)","29418TX014",,"TXN001","TXS001","TXF004","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140010-05","Ambetter Balanced Care 12 (2018)","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$100","$1,600","$60","$700","$600","$400","$60","$700","$80","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/29418TX0140010-05.pdf","https://api.centene.com/Brochures/2018/29418TX0140010-05.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140010","Ambetter Balanced Care 12 (2018)","29418TX014",,"TXN001","TXS001","TXF004","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140010-06","Ambetter Balanced Care 12 (2018)","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$100","$500","$60","$250","$200","$90","$60","$250","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/29418TX0140010-06.pdf","https://api.centene.com/Brochures/2018/29418TX0140010-06.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140006","Ambetter Essential Care 1 (2018)","29418TX014",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140006-00","Ambetter Essential Care 1 (2018)","Standard Bronze Off Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140006-00.pdf","https://api.centene.com/Brochures/2018/29418TX0140006-00.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140006","Ambetter Essential Care 1 (2018)","29418TX014",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140006-01","Ambetter Essential Care 1 (2018)","Standard Bronze On Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140006-01.pdf","https://api.centene.com/Brochures/2018/29418TX0140006-01.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140006","Ambetter Essential Care 1 (2018)","29418TX014",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140006-02","Ambetter Essential Care 1 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140006-02.pdf","https://api.centene.com/Brochures/2018/29418TX0140006-02.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140006","Ambetter Essential Care 1 (2018)","29418TX014",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140006-03","Ambetter Essential Care 1 (2018)","Limited Cost Sharing Plan Variation",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140006-03.pdf","https://api.centene.com/Brochures/2018/29418TX0140006-03.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140059","Ambetter Balanced Care 5 (2018)","29418TX014",,"TXN001","TXS001","TXF007","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140059-00","Ambetter Balanced Care 5 (2018)","Standard Silver Off Exchange Plan","66.25%","0.661631852049009","Yes","Yes","No","100%",,"$6,800","$550","$0","$60","$1,900","$1,900","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140059-00.pdf","https://api.centene.com/Brochures/2018/29418TX0140059-00.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140059","Ambetter Balanced Care 5 (2018)","29418TX014",,"TXN001","TXS001","TXF007","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140059-01","Ambetter Balanced Care 5 (2018)","Standard Silver On Exchange Plan","66.25%","0.661631852049009","Yes","Yes","No","100%",,"$6,800","$550","$0","$60","$1,900","$1,900","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140059-01.pdf","https://api.centene.com/Brochures/2018/29418TX0140059-01.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140059","Ambetter Balanced Care 5 (2018)","29418TX014",,"TXN001","TXS001","TXF007","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140059-02","Ambetter Balanced Care 5 (2018)","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140059-02.pdf","https://api.centene.com/Brochures/2018/29418TX0140059-02.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140059","Ambetter Balanced Care 5 (2018)","29418TX014",,"TXN001","TXS001","TXF007","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140059-03","Ambetter Balanced Care 5 (2018)","Limited Cost Sharing Plan Variation","66.25%","0.661631852049009","Yes","Yes","No","100%",,"$6,800","$550","$0","$60","$1,900","$1,900","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140059-03.pdf","https://api.centene.com/Brochures/2018/29418TX0140059-03.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140059","Ambetter Balanced Care 5 (2018)","29418TX014",,"TXN001","TXS001","TXF007","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140059-04","Ambetter Balanced Care 5 (2018)","73% AV Level Silver Plan","72.15%","0.718557057101132","Yes","Yes","No","100%",,"$5,000","$300","$0","$60","$1,900","$1,500","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140059-04.pdf","https://api.centene.com/Brochures/2018/29418TX0140059-04.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140059","Ambetter Balanced Care 5 (2018)","29418TX014",,"TXN001","TXS001","TXF007","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140059-05","Ambetter Balanced Care 5 (2018)","87% AV Level Silver Plan","86.18%","0.858472329117886","Yes","Yes","No","100%",,"$1,950","$0","$0","$60","$1,600","$300","$0","$60","$1,600","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140059-05.pdf","https://api.centene.com/Brochures/2018/29418TX0140059-05.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0140059","Ambetter Balanced Care 5 (2018)","29418TX014",,"TXN001","TXS001","TXF007","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0140059-06","Ambetter Balanced Care 5 (2018)","94% AV Level Silver Plan","93.63%","0.935092701963358","Yes","Yes","No","100%",,"$675","$0","$0","$60","$565","$100","$0","$60","$675","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0140059-06.pdf","https://api.centene.com/Brochures/2018/29418TX0140059-06.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150001-00","Ambetter Balanced Care 1 (2018) + Vision","Standard Silver Off Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150001-00.pdf","https://api.centene.com/Brochures/2018/29418TX0150001-00.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150001-01","Ambetter Balanced Care 1 (2018) + Vision","Standard Silver On Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150001-01.pdf","https://api.centene.com/Brochures/2018/29418TX0150001-01.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150001-02","Ambetter Balanced Care 1 (2018) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150001-02.pdf","https://api.centene.com/Brochures/2018/29418TX0150001-02.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150001-03","Ambetter Balanced Care 1 (2018) + Vision","Limited Cost Sharing Plan Variation",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150001-03.pdf","https://api.centene.com/Brochures/2018/29418TX0150001-03.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150001-04","Ambetter Balanced Care 1 (2018) + Vision","73% AV Level Silver Plan",,"0.739812128349422","Yes","Yes","No","100%",,"$3,000","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150001-04.pdf","https://api.centene.com/Brochures/2018/29418TX0150001-04.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150001-05","Ambetter Balanced Care 1 (2018) + Vision","87% AV Level Silver Plan",,"0.87931537568396","Yes","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$300","$400","$60","$750","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150001-05.pdf","https://api.centene.com/Brochures/2018/29418TX0150001-05.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150001-06","Ambetter Balanced Care 1 (2018) + Vision","94% AV Level Silver Plan",,"0.949528260595198","Yes","Yes","No","100%",,"$0","$0","$950","$60","$0","$300","$400","$60","$0","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150001-06.pdf","https://api.centene.com/Brochures/2018/29418TX0150001-06.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150002-00","Ambetter Balanced Care 2 (2018) + Vision","Standard Silver Off Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150002-00.pdf","https://api.centene.com/Brochures/2018/29418TX0150002-00.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150002-01","Ambetter Balanced Care 2 (2018) + Vision","Standard Silver On Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150002-01.pdf","https://api.centene.com/Brochures/2018/29418TX0150002-01.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150002-02","Ambetter Balanced Care 2 (2018) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150002-02.pdf","https://api.centene.com/Brochures/2018/29418TX0150002-02.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150002-03","Ambetter Balanced Care 2 (2018) + Vision","Limited Cost Sharing Plan Variation",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150002-03.pdf","https://api.centene.com/Brochures/2018/29418TX0150002-03.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150002-04","Ambetter Balanced Care 2 (2018) + Vision","73% AV Level Silver Plan",,"0.729896135538709","Yes","Yes","No","100%",,"$4,600","$400","$0","$60","$1,900","$1,400","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150002-04.pdf","https://api.centene.com/Brochures/2018/29418TX0150002-04.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150002-05","Ambetter Balanced Care 2 (2018) + Vision","87% AV Level Silver Plan",,"0.867181007012531","Yes","Yes","No","100%",,"$1,700","$10","$0","$60","$1,500","$250","$0","$60","$1,600","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150002-05.pdf","https://api.centene.com/Brochures/2018/29418TX0150002-05.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150002-06","Ambetter Balanced Care 2 (2018) + Vision","94% AV Level Silver Plan",,"0.942313720589882","Yes","Yes","No","100%",,"$572","$3","$0","$60","$500","$70","$0","$60","$575","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150002-06.pdf","https://api.centene.com/Brochures/2018/29418TX0150002-06.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150003-00","Ambetter Balanced Care 10 (2018) + Vision","Standard Silver Off Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150003-00.pdf","https://api.centene.com/Brochures/2018/29418TX0150003-00.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150003-01","Ambetter Balanced Care 10 (2018) + Vision","Standard Silver On Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150003-01.pdf","https://api.centene.com/Brochures/2018/29418TX0150003-01.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150003-02","Ambetter Balanced Care 10 (2018) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150003-02.pdf","https://api.centene.com/Brochures/2018/29418TX0150003-02.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150003-03","Ambetter Balanced Care 10 (2018) + Vision","Limited Cost Sharing Plan Variation",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150003-03.pdf","https://api.centene.com/Brochures/2018/29418TX0150003-03.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150003-04","Ambetter Balanced Care 10 (2018) + Vision","73% AV Level Silver Plan",,"0.73985223196154","Yes","Yes","No","100%",,"$3,700","$100","$2,000","$60","$1,500","$900","$400","$60","$1,300","$90","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150003-04.pdf","https://api.centene.com/Brochures/2018/29418TX0150003-04.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150003-05","Ambetter Balanced Care 10 (2018) + Vision","87% AV Level Silver Plan",,"0.879858510990049","Yes","Yes","No","100%",,"$800","$0","$1,400","$60","$850","$300","$400","$60","$850","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150003-05.pdf","https://api.centene.com/Brochures/2018/29418TX0150003-05.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF002","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150003-06","Ambetter Balanced Care 10 (2018) + Vision","94% AV Level Silver Plan",,"0.949794807417026","Yes","Yes","No","100%",,"$250","$0","$300","$60","$250","$160","$185","$60","$250","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$595","$595 per person","$1190 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150003-06.pdf","https://api.centene.com/Brochures/2018/29418TX0150003-06.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150006","Ambetter Balanced Care 3 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150006-00","Ambetter Balanced Care 3 (2018) + Vision","Standard Silver Off Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150006-00.pdf","https://api.centene.com/Brochures/2018/29418TX0150006-00.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150006","Ambetter Balanced Care 3 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150006-01","Ambetter Balanced Care 3 (2018) + Vision","Standard Silver On Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150006-01.pdf","https://api.centene.com/Brochures/2018/29418TX0150006-01.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150006","Ambetter Balanced Care 3 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150006-02","Ambetter Balanced Care 3 (2018) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150006-02.pdf","https://api.centene.com/Brochures/2018/29418TX0150006-02.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150006","Ambetter Balanced Care 3 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150006-03","Ambetter Balanced Care 3 (2018) + Vision","Limited Cost Sharing Plan Variation",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150006-03.pdf","https://api.centene.com/Brochures/2018/29418TX0150006-03.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150006","Ambetter Balanced Care 3 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150006-04","Ambetter Balanced Care 3 (2018) + Vision","73% AV Level Silver Plan",,"0.739635889295605","Yes","Yes","No","100%",,"$1,950","$1,300","$300","$60","$1,300","$1,700","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150006-04.pdf","https://api.centene.com/Brochures/2018/29418TX0150006-04.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150006","Ambetter Balanced Care 3 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150006-05","Ambetter Balanced Care 3 (2018) + Vision","87% AV Level Silver Plan",,"0.879959544313859","Yes","Yes","No","100%",,"$675","$200","$300","$60","$675","$300","$600","$60","$675","$20","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150006-05.pdf","https://api.centene.com/Brochures/2018/29418TX0150006-05.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150006","Ambetter Balanced Care 3 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150006-06","Ambetter Balanced Care 3 (2018) + Vision","94% AV Level Silver Plan",,"0.949879112635725","Yes","Yes","No","100%",,"$200","$90","$300","$60","$200","$200","$200","$60","$200","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150006-06.pdf","https://api.centene.com/Brochures/2018/29418TX0150006-06.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150004","Ambetter Essential Care 1 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150004-00","Ambetter Essential Care 1 (2018) + Vision","Standard Bronze Off Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150004-00.pdf","https://api.centene.com/Brochures/2018/29418TX0150004-00.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150004","Ambetter Essential Care 1 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150004-01","Ambetter Essential Care 1 (2018) + Vision","Standard Bronze On Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150004-01.pdf","https://api.centene.com/Brochures/2018/29418TX0150004-01.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150004","Ambetter Essential Care 1 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150004-02","Ambetter Essential Care 1 (2018) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150004-02.pdf","https://api.centene.com/Brochures/2018/29418TX0150004-02.pdf"
"2018","TX","29418","HIOS","2017-09-27 03:20:22","Individual","No","06-0641618","29418TX0150004","Ambetter Essential Care 1 (2018) + Vision","29418TX015",,"TXN001","TXS001","TXF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9868",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","https://ambetter.superiorhealthplan.com/resources/pharmacy-resources.html","29418TX0150004-03","Ambetter Essential Care 1 (2018) + Vision","Limited Cost Sharing Plan Variation",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/29418TX0150004-03.pdf","https://api.centene.com/Brochures/2018/29418TX0150004-03.pdf"
"2018","TX","29817","HIOS","2017-08-03 02:20:23","SHOP (Small Group)","Yes","57-0523959","29817TX0020001","Group EHB Dental","29817TX002",,"TXN001","TXS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","traditional with inside maximum","Yes","traditional with inside maximum","Yes",,"","29817TX0020001-00","Group EHB Dental","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460552","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS011","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460552-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","Yes","36-1236610","33602TX0500001","BlueCare Dental? 1A","33602TX050",,"TXN003","TXS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500001-00","BlueCare Dental? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbstx.com/static/tx/pdf/dental/2018/bluecare-dental-individuals-and-families-tx2018.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","Yes","36-1236610","33602TX0500001","BlueCare Dental? 1A","33602TX050",,"TXN003","TXS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500001-01","BlueCare Dental? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbstx.com/static/tx/pdf/dental/2018/bluecare-dental-individuals-and-families-tx2018.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460661","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS081","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460661-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460661","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS081","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460661-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460662","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS091","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460662-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460662","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS091","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460662-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460675","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS221","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460675-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460676","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS231","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460676-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460552","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS011","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460552-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460655","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS021","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460655-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460655","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS021","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460655-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460656","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS031","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460656-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460656","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS031","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460656-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460657","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS041","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460657-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460657","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS041","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460657-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460658","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS051","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460658-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460658","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS051","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460658-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460659","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS061","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460659-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460659","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS061","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460659-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460660","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS071","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460660-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460660","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS071","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460660-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460663","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS101","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460663-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460663","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS101","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460663-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460664","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS111","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460664-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460664","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS111","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460664-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460665","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS121","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460665-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460665","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS121","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460665-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460666","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS131","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460666-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460666","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS131","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460666-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460667","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS141","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460667-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","Yes","36-1236610","33602TX0500003","BlueCare Dental 4 Kids? 1A","33602TX050",,"TXN003","TXS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500003-00","BlueCare Dental 4 Kids? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbstx.com/static/tx/pdf/dental/2018/bluecare-dental-individuals-and-families-tx2018.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","Yes","36-1236610","33602TX0500003","BlueCare Dental 4 Kids? 1A","33602TX050",,"TXN003","TXS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500003-01","BlueCare Dental 4 Kids? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbstx.com/static/tx/pdf/dental/2018/bluecare-dental-individuals-and-families-tx2018.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460667","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS141","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460667-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460668","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS151","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460668-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460668","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS151","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460668-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460669","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS161","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460669-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460669","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS161","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460669-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460670","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS171","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460670-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460670","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS171","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460670-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460671","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS181","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460671-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460671","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS181","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460671-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460672","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS191","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460672-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460672","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS191","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460672-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460673","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS201","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460673-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460673","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS201","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460673-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460674","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS211","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460674-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460674","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS211","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460674-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460675","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS221","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460675-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460676","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS231","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460676-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460677","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS241","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460677-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460677","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS241","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460677-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460678","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS251","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460678-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460678","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS251","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460678-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460679","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS261","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460679-00","Blue Advantage Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460679","Blue Advantage Security HMO? 200","33602TX046",,"TXN001","TXS261","TXF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460679-01","Blue Advantage Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460552-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770108","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS031","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770108-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","Yes","36-1236610","33602TX0500002","BlueCare Dental? 1B","33602TX050",,"TXN003","TXS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500002-00","BlueCare Dental? 1B","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbstx.com/static/tx/pdf/dental/2018/bluecare-dental-individuals-and-families-tx2018.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770182","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS011","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770182-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770182","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS011","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770182-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","Yes","36-1236610","33602TX0500002","BlueCare Dental? 1B","33602TX050",,"TXN003","TXS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500002-01","BlueCare Dental? 1B","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbstx.com/static/tx/pdf/dental/2018/bluecare-dental-individuals-and-families-tx2018.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","Yes","36-1236610","33602TX0500005","BlueCare Dental? 2A","33602TX050",,"TXN003","TXS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500005-00","BlueCare Dental? 2A","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbstx.com/static/tx/pdf/dental/2018/bluecare-dental-individuals-and-families-tx2018.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770117","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS121","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770117-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770117","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS121","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770117-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770131","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS261","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770131-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460710","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS071","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460710-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460723","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS201","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460723-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770138","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS081","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770138-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770182","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS011","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770182-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770182","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS011","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770182-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","Yes","36-1236610","33602TX0500005","BlueCare Dental? 2A","33602TX050",,"TXN003","TXS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500005-01","BlueCare Dental? 2A","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbstx.com/static/tx/pdf/dental/2018/bluecare-dental-individuals-and-families-tx2018.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770107","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS021","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770107-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770107","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS021","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770107-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770107","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS021","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770107-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770107","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS021","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770107-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770108","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS031","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770108-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770108","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS031","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770108-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770108","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS031","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770108-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770109","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS041","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770109-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770109","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS041","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770109-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770114","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS091","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770114-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770121","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS161","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770121-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460714","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS111","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460714-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460720","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS171","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460720-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770149","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS191","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770149-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770109","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS041","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770109-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770109","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS041","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770109-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770110","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS051","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770110-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770110","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS051","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770110-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770110","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS051","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770110-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770110","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS051","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770110-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770111","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS061","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770111-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770111","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS061","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770111-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770111","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS061","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770111-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770111","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS061","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770111-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770112","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS071","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770112-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770112","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS071","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770112-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770112","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS071","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770112-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770112","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS071","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770112-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770113","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS081","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770113-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770113","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS081","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770113-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770113","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS081","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770113-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770113","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS081","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770113-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770114","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS091","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770114-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770114","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS091","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770114-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770114","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS091","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770114-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","Yes","36-1236610","33602TX0500004","BlueCare Dental 4 Kids? 1B","33602TX050",,"TXN003","TXS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500004-00","BlueCare Dental 4 Kids? 1B","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbstx.com/static/tx/pdf/dental/2018/bluecare-dental-individuals-and-families-tx2018.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770115","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS101","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770115-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770115","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS101","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770115-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","Yes","36-1236610","33602TX0500004","BlueCare Dental 4 Kids? 1B","33602TX050",,"TXN003","TXS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500004-01","BlueCare Dental 4 Kids? 1B","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbstx.com/static/tx/pdf/dental/2018/bluecare-dental-individuals-and-families-tx2018.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770115","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS101","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770115-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770115","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS101","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770115-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770116","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS111","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770116-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770116","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS111","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770116-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770116","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS111","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770116-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770116","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS111","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770116-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770117","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS121","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770117-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770117","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS121","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770117-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770118","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS131","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770118-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770118","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS131","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770118-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770118","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS131","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770118-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770118","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS131","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770118-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770119","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS141","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770119-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770119","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS141","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770119-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770119","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS141","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770119-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770119","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS141","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770119-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770120","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS151","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770120-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770120","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS151","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770120-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770120","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS151","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770120-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770120","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS151","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770120-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770121","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS161","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770121-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770121","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS161","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770121-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770121","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS161","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770121-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770122","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS171","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770122-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770122","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS171","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770122-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770122","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS171","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770122-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770122","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS171","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770122-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770123","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS181","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770123-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770123","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS181","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770123-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770123","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS181","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770123-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770123","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS181","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770123-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770124","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS191","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770124-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770124","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS191","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770124-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770124","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS191","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770124-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770124","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS191","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770124-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770125","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS201","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770125-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770125","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS201","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770125-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770125","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS201","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770125-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770125","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS201","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770125-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770126","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS211","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770126-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770126","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS211","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770126-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770126","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS211","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770126-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770126","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS211","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770126-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770127","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS221","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770127-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770127","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS221","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770127-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770127","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS221","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770127-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770127","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS221","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770127-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770128","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS231","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770128-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770128","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS231","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770128-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770128","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS231","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770128-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770128","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS231","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770128-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770129","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS241","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770129-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770129","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS241","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770129-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770129","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS241","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770129-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770129","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS241","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770129-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770130","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS251","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770130-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770130","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS251","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770130-01","Blue Advantage Plus Bronze? 201","Standard Bronze On Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770130","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS251","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770130-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770130","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS251","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770130-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770131","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS261","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770131-00","Blue Advantage Plus Bronze? 201","Standard Bronze Off Exchange Plan",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/sbc/2018/TX0770182-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770131","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS261","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770131-02","Blue Advantage Plus Bronze? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770131","Blue Advantage Plus Bronze? 201","33602TX077",,"TXN001","TXS261","TXF008","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770131-03","Blue Advantage Plus Bronze? 201","Limited Cost Sharing Plan Variation",,"0.612455749669034","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770182-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460554","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS011","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460554-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460554","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS011","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460554-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460554","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS011","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460554-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460554","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS011","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460554-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460705","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS021","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460705-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460705","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS021","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460705-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460705","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS021","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460705-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460705","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS021","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460705-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460706","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS031","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460706-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460706","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS031","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460706-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460706","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS031","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460706-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460706","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS031","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460706-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460707","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS041","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460707-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460707","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS041","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460707-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460707","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS041","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460707-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460707","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS041","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460707-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460708","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS051","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460708-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460708","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS051","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460708-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460708","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS051","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460708-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460708","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS051","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460708-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460709","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS061","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460709-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460709","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS061","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460709-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460709","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS061","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460709-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460709","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS061","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460709-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460710","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS071","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460710-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460710","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS071","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460710-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460710","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS071","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460710-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460711","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS081","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460711-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460711","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS081","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460711-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460711","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS081","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460711-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460711","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS081","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460711-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460712","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS091","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460712-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460712","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS091","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460712-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460712","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS091","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460712-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460712","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS091","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460712-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460713","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS101","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460713-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460713","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS101","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460713-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460713","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS101","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460713-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460713","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS101","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460713-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460714","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS111","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460714-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460714","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS111","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460714-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460714","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS111","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460714-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460715","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS121","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460715-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460715","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS121","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460715-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460715","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS121","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460715-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460715","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS121","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460715-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460716","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS131","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460716-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460716","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS131","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460716-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460716","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS131","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460716-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460716","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS131","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460716-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460717","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS141","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460717-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460717","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS141","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460717-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460717","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS141","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460717-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460717","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS141","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460717-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460718","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS151","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460718-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460718","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS151","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460718-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460718","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS151","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460718-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460718","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS151","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460718-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460719","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS161","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460719-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460719","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS161","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460719-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460719","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS161","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460719-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460719","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS161","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460719-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460720","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS171","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460720-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460720","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS171","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460720-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460720","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS171","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460720-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460721","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS181","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460721-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460721","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS181","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460721-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460721","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS181","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460721-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460721","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS181","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460721-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460722","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS191","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460722-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460722","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS191","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460722-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460722","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS191","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460722-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460722","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS191","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460722-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460723","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS201","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460723-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460723","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS201","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460723-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460723","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS201","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460723-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460724","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS211","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460724-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460724","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS211","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460724-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460724","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS211","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460724-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460724","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS211","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460724-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460725","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS221","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460725-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460725","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS221","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460725-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460725","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS221","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460725-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460725","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS221","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460725-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460726","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS231","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460726-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460726","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS231","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460726-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460726","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS231","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460726-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460726","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS231","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460726-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460727","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS241","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460727-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460727","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS241","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460727-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460727","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS241","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460727-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460727","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS241","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460727-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460728","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS251","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460728-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460728","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS251","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460728-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460728","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS251","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460728-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460728","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS251","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460728-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460729","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS261","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460729-00","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460729","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS261","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460729-01","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$5,600","$900","$900","$60","$5,600","$600","$60","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460729","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS261","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460729-02","Blue Advantage Bronze HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460729","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS261","TXF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460729-03","Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564657409798494","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$14700 per group","50.00%","$5,600","$5600 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460554-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770105","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS011","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770105-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770105","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS011","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770105-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770105","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS011","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770105-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770105","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS011","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770105-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770132","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS021","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770132-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770132","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS021","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770132-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770132","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS021","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770132-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770132","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS021","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770132-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770133","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS031","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770133-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770133","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS031","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770133-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770133","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS031","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770133-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770133","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS031","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770133-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770134","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS041","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770134-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770134","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS041","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770134-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770134","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS041","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770134-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770134","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS041","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770134-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770135","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS051","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770135-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770135","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS051","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770135-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770135","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS051","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770135-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770135","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS051","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770135-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770136","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS061","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770136-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770136","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS061","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770136-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770136","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS061","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770136-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770136","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS061","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770136-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770137","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS071","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770137-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770137","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS071","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770137-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770137","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS071","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770137-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770137","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS071","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770137-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770138","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS081","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770138-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770138","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS081","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770138-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770138","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS081","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770138-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770139","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS091","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770139-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770139","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS091","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770139-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770139","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS091","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770139-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770139","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS091","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770139-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770140","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS101","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770140-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770140","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS101","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770140-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770140","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS101","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770140-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770140","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS101","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770140-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770141","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS111","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770141-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770141","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS111","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770141-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770141","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS111","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770141-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770141","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS111","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770141-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770142","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS121","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770142-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770142","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS121","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770142-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770142","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS121","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770142-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770142","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS121","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770142-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770143","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS131","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770143-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770143","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS131","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770143-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770143","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS131","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770143-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770143","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS131","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770143-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770144","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS141","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770144-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770144","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS141","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770144-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770144","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS141","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770144-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770144","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS141","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770144-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770145","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS151","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770145-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770145","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS151","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770145-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770145","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS151","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770145-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770145","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS151","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770145-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770146","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS161","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770146-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770146","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS161","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770146-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770146","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS161","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770146-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770146","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS161","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770146-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770147","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS171","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770147-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770147","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS171","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770147-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770147","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS171","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770147-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770147","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS171","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770147-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770148","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS181","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770148-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770148","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS181","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770148-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770148","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS181","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770148-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770148","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS181","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770148-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770149","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS191","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770149-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770152","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS221","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770152-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770152","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS221","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770152-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770153","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS231","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770153-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770153","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS231","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770153-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770153","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS231","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770153-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770153","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS231","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770153-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770154","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS241","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770154-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770149","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS191","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770149-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770149","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS191","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770149-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770150","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS201","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770150-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770150","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS201","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770150-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770150","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS201","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770150-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770150","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS201","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770150-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770151","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS211","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770151-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770151","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS211","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770151-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770151","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS211","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770151-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770156","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS261","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770156-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770156","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS261","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770156-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460548","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS011","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460548-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460548","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS011","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460548-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460548","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS011","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460548-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460561","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS081","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460561-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460561","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS081","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460561-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770151","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS211","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770151-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770152","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS221","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770152-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770152","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS221","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770152-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770154","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS241","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770154-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460557","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS041","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460557-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460557","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS041","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460557-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460558","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS051","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460558-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460558","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS051","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460558-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460558","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS051","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460558-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460558","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS051","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460558-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460559","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS061","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460559-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770154","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS241","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770154-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770154","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS241","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770154-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770155","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS251","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770155-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770155","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS251","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770155-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770155","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS251","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770155-02","Blue Advantage Plus Gold? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770155","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS251","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770155-03","Blue Advantage Plus Gold? 203","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770156","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS261","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770156-00","Blue Advantage Plus Gold? 203","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770156","Blue Advantage Plus Gold? 203","33602TX077",,"TXN001","TXS261","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770156-01","Blue Advantage Plus Gold? 203","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770105-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460548","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS011","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460548-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460555","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS021","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460555-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460555","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS021","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460555-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460555","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS021","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460555-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460555","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS021","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460555-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460556","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS031","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460556-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460556","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS031","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460556-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460556","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS031","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460556-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460556","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS031","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460556-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460557","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS041","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460557-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460557","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS041","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460557-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460559","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS061","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460559-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460559","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS061","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460559-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460559","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS061","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460559-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460560","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS071","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460560-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460560","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS071","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460560-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460560","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS071","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460560-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460560","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS071","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460560-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460561","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS081","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460561-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460561","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS081","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460561-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460562","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS091","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460562-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460567","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS141","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460567-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460567","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS141","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460567-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460567","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS141","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460567-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460567","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS141","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460567-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460568","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS151","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460568-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460574","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS211","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460574-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460562","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS091","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460562-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460562","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS091","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460562-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460562","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS091","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460562-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460563","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS101","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460563-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460563","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS101","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460563-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460563","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS101","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460563-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460563","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS101","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460563-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460564","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS111","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460564-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460564","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS111","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460564-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460564","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS111","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460564-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460564","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS111","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460564-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460565","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS121","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460565-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460571","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS181","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460571-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460571","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS181","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460571-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460571","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS181","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460571-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460572","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS191","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460572-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460572","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS191","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460572-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460565","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS121","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460565-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460565","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS121","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460565-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460565","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS121","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460565-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460566","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS131","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460566-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460566","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS131","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460566-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460566","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS131","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460566-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460566","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS131","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460566-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460568","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS151","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460568-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460568","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS151","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460568-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460568","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS151","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460568-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460569","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS161","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460569-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460569","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS161","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460569-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460569","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS161","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460569-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460569","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS161","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460569-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460570","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS171","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460570-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460570","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS171","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460570-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460570","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS171","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460570-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460570","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS171","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460570-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460571","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS181","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460571-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460572","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS191","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460572-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460572","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS191","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460572-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460573","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS201","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460573-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460577","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS241","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460577-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460577","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS241","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460577-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460577","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS241","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460577-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460577","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS241","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460577-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460578","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS251","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460578-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460573","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS201","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460573-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460573","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS201","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460573-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460573","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS201","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460573-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460574","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS211","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460574-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460574","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS211","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460574-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460574","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS211","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460574-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460575","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS221","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460575-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460575","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS221","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460575-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460575","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS221","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460575-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770106","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS011","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770106-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770106","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS011","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770106-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770160","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS051","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770160-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770160","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS051","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770160-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770160","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS051","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770160-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460575","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS221","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460575-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460576","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS231","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460576-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460576","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS231","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460576-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460576","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS231","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460576-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460576","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS231","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460576-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460578","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS251","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460578-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460578","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS251","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460578-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460578","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS251","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460578-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770158","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS031","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770158-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770158","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS031","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770158-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770158","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS031","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770158-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770158","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS031","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770158-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770162","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS071","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770162-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460579","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS261","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460579-00","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460579","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS261","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460579-01","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460579","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS261","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460579-02","Blue Advantage Gold HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460579","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","33602TX046",,"TXN001","TXS261","TXF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460579-03","Blue Advantage Gold HMO? 206 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460548-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770106","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS011","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770106-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770106","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS011","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770106-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770106","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS011","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770106-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770106","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS011","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770106-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770106","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS011","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770106-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770157","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS021","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770157-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770157","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS021","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770157-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770157","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS021","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770157-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770157","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS021","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770157-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770157","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS021","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770157-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770157","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS021","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770157-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770157","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS021","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770157-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770158","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS031","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770158-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770158","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS031","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770158-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770158","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS031","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770158-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770159","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS041","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770159-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770159","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS041","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770159-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770159","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS041","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770159-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770159","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS041","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770159-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770159","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS041","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770159-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770159","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS041","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770159-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770159","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS041","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770159-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770160","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS051","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770160-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770160","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS051","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770160-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770160","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS051","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770160-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770160","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS051","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770160-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770161","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS061","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770161-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770161","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS061","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770161-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770164","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS091","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770164-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770164","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS091","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770164-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770168","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS131","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770168-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770168","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS131","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770168-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770161","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS061","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770161-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770161","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS061","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770161-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770161","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS061","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770161-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770161","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS061","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770161-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770161","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS061","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770161-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770162","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS071","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770162-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770162","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS071","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770162-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770162","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS071","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770162-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770162","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS071","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770162-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770162","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS071","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770162-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770162","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS071","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770162-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770163","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS081","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770163-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770163","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS081","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770163-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770166","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS111","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770166-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770166","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS111","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770166-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770166","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS111","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770166-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770163","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS081","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770163-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770163","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS081","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770163-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770163","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS081","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770163-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770163","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS081","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770163-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770163","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS081","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770163-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770164","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS091","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770164-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770164","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS091","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770164-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770164","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS091","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770164-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770164","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS091","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770164-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770164","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS091","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770164-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770165","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS101","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770165-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770165","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS101","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770165-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770165","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS101","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770165-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770165","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS101","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770165-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770165","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS101","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770165-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770165","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS101","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770165-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770165","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS101","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770165-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770166","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS111","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770166-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770166","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS111","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770166-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770166","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS111","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770166-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770166","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS111","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770166-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770167","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS121","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770167-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770167","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS121","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770167-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770167","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS121","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770167-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770169","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS141","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770169-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770169","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS141","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770169-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770169","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS141","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770169-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770167","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS121","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770167-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770167","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS121","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770167-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770167","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS121","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770167-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770167","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS121","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770167-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770168","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS131","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770168-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770168","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS131","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770168-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770171","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS161","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770171-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770175","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS201","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770175-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460680","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS021","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460680-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460683","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS051","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460683-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938306231603046","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460691","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS131","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460691-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460699","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS211","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460699-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770168","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS131","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770168-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770168","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS131","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770168-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770168","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS131","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770168-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770169","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS141","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770169-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770169","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS141","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770169-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770169","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS141","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770169-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770169","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS141","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770169-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770170","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS151","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770170-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770170","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS151","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770170-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770170","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS151","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770170-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770170","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS151","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770170-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770173","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS181","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770173-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770173","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS181","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770173-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770177","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS221","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770177-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770177","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS221","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770177-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770170","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS151","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770170-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770170","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS151","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770170-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770170","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS151","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770170-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770171","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS161","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770171-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770171","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS161","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770171-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770171","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS161","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770171-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770171","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS161","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770171-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770171","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS161","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770171-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770171","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS161","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770171-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770172","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS171","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770172-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770172","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS171","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770172-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770172","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS171","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770172-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770172","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS171","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770172-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770172","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS171","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770172-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770172","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS171","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770172-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770172","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS171","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770172-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770173","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS181","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770173-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770173","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS181","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770173-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770173","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS181","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770173-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770173","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS181","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770173-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770173","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS181","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770173-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770174","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS191","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770174-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770174","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS191","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770174-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770174","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS191","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770174-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770174","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS191","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770174-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770174","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS191","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770174-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770174","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS191","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770174-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770174","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS191","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770174-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770175","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS201","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770175-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770175","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS201","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770175-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770175","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS201","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770175-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770175","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS201","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770175-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770175","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS201","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770175-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770175","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS201","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770175-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770176","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS211","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770176-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770176","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS211","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770176-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770176","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS211","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770176-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770176","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS211","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770176-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770176","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS211","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770176-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770176","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS211","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770176-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770176","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS211","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770176-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770177","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS221","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770177-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770177","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS221","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770177-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770177","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS221","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770177-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770177","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS221","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770177-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770177","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS221","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770177-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770178","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS231","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770178-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770178","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS231","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770178-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770178","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS231","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770178-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770178","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS231","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770178-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770178","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS231","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770178-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770181","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS261","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770181-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770178","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS231","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770178-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770178","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS231","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770178-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770179","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS241","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770179-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770179","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS241","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770179-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770179","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS241","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770179-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770179","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS241","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770179-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770179","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS241","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770179-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770179","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS241","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770179-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770179","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS241","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770179-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770180","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS251","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770180-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770180","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS251","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770180-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770180","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS251","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770180-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770180","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS251","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770180-03","Blue Advantage Plus Silver? 202","Limited Cost Sharing Plan Variation",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770180","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS251","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770180-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770180","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS251","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770180-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770180","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS251","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770180-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770181","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS261","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770181-00","Blue Advantage Plus Silver? 202","Standard Silver Off Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770181","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS261","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770181-01","Blue Advantage Plus Silver? 202","Standard Silver On Exchange Plan",,"0.687388084476446","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770181","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS261","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770181-02","Blue Advantage Plus Silver? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770181","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS261","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770181-04","Blue Advantage Plus Silver? 202","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770181","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS261","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770181-05","Blue Advantage Plus Silver? 202","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0770181","Blue Advantage Plus Silver? 202","33602TX077",,"TXN001","TXS261","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0770181-06","Blue Advantage Plus Silver? 202","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0770106-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460553","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS011","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460553-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460553","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS011","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460553-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460553","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS011","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460553-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460553","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS011","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460553-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460682","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS041","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460682-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460553","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS011","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460553-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460553","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS011","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460553-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460553","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS011","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460553-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460680","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS021","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460680-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460680","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS021","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460680-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460680","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS021","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460680-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460680","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS021","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460680-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460680","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS021","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460680-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460680","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS021","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460680-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938306231603046","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460681","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS031","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460681-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460681","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS031","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460681-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460681","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS031","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460681-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460681","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS031","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460681-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460681","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS031","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460681-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460681","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS031","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460681-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460681","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS031","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460681-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938306231603046","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460682","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS041","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460682-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460682","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS041","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460682-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460682","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS041","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460682-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460682","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS041","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460682-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460682","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS041","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460682-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460682","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS041","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460682-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938306231603046","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460686","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS081","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460686-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460689","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS111","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460689-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460689","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS111","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460689-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460690","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS121","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460690-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","40540","HIOS","2017-06-16 02:20:26","Individual","Yes","47-0397286","40540TX0070001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","40540TX007",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540","","40540TX0070001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_Ped_High_2018","http://www.renaissancedental.com/TX_Ped_High_2018"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460683","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS051","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460683-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460683","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS051","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460683-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460683","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS051","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460683-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460683","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS051","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460683-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460683","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS051","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460683-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460683","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS051","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460683-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460684","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS061","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460684-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460684","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS061","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460684-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460684","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS061","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460684-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460684","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS061","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460684-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460684","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS061","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460684-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460684","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS061","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460684-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460684","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS061","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460684-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938306231603046","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460685","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS071","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460685-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460685","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS071","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460685-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460685","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS071","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460685-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460685","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS071","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460685-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460685","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS071","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460685-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460685","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS071","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460685-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460685","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS071","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460685-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460686","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS081","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460686-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460686","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS081","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460686-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460686","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS081","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460686-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460686","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS081","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460686-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460686","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS081","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460686-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460686","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS081","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460686-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460687","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS091","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460687-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460687","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS091","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460687-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460687","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS091","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460687-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460687","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS091","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460687-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460687","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS091","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460687-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460687","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS091","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460687-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460687","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS091","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460687-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460688","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS101","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460688-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460688","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS101","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460688-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460688","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS101","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460688-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460688","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS101","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460688-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460688","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS101","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460688-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460688","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS101","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460688-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460688","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS101","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460688-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460689","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS111","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460689-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460689","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS111","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460689-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460689","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS111","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460689-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460689","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS111","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460689-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460689","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS111","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460689-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460690","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS121","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460690-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460690","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS121","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460690-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460690","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS121","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460690-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460690","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS121","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460690-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460690","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS121","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460690-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460690","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS121","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460690-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460691","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS131","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460691-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460691","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS131","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460691-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460691","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS131","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460691-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460691","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS131","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460691-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460691","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS131","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460691-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460691","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS131","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460691-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460692","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS141","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460692-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460692","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS141","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460692-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460692","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS141","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460692-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460692","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS141","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460692-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460692","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS141","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460692-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460692","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS141","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460692-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460692","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS141","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460692-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460693","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS151","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460693-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460693","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS151","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460693-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460693","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS151","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460693-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460693","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS151","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460693-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460693","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS151","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460693-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460693","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS151","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460693-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460693","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS151","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460693-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460694","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS161","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460694-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460694","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS161","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460694-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460694","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS161","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460694-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460694","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS161","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460694-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460694","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS161","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460694-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460694","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS161","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460694-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460694","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS161","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460694-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460695","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS171","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460695-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460695","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS171","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460695-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460695","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS171","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460695-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460695","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS171","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460695-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460695","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS171","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460695-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460695","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS171","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460695-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460695","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS171","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460695-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460696","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS181","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460696-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460696","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS181","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460696-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460696","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS181","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460696-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460696","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS181","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460696-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460696","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS181","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460696-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460696","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS181","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460696-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460696","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS181","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460696-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460697","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS191","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460697-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460697","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS191","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460697-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460697","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS191","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460697-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460697","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS191","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460697-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460697","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS191","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460697-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460697","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS191","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460697-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460697","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS191","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460697-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460698","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS201","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460698-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460698","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS201","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460698-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460698","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS201","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460698-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460698","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS201","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460698-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460698","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS201","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460698-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460698","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS201","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460698-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460698","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS201","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460698-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460699","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS211","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460699-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460699","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS211","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460699-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460699","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS211","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460699-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460699","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS211","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460699-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460699","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS211","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460699-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460699","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS211","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460699-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460700","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS221","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460700-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460700","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS221","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460700-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460700","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS221","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460700-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460700","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS221","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460700-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460700","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS221","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460700-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460700","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS221","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460700-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460700","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","33602TX046",,"TXN001","TXS221","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460700-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460701","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS231","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460701-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460701","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS231","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460701-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460701","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS231","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460701-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460701","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS231","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460701-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460701","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS231","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460701-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460701","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS231","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460701-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460701","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS231","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460701-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460702","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS241","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460702-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460702","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS241","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460702-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460702","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS241","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460702-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460702","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS241","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460702-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460702","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS241","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460702-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460702","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS241","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460702-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460702","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS241","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460702-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460703","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS251","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460703-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460703","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS251","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460703-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460703","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS251","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460703-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460703","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS251","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460703-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460703","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS251","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460703-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460703","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS251","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460703-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460703","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS251","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460703-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460704","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS261","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460704-00","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-00.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460704","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS261","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460704-01","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$1,700","$900","$4,800","$60","$1,700","$400","$1,500","$60","$1,700","$0","$100","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-01.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460704","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS261","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460704-02","Blue Advantage Silver HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-02.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460704","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS261","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460704-03","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.666057034123619","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$5100 per group","50.00%","$1,700","$1700 per person","$5100 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-03.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460704","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS261","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460704-04","Blue Advantage Silver HMO? 205 - Two $25 PCP Visits","73% AV Level Silver Plan",,"0.729974929368243","Yes","Yes","Yes","43%","57%","$800","$900","$4,200","$60","$800","$400","$1,800","$60","$800","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","50.00%","$800","$800 per person","$2400 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-04.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460704","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS261","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460704-05","Blue Advantage Silver HMO? 205 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.867742574547682","Yes","Yes","Yes","43%","57%","$0","$300","$2,200","$60","$0","$100","$1,900","$60","$0","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-05.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","33602","HIOS","2017-09-07 07:26:32","Individual","No","36-1236610","33602TX0460704","Blue Advantage Silver HMO 205? - Two $25 PCP Visits","33602TX046",,"TXN001","TXS261","TXF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/TX_6T_EX.pdf","33602TX0460704-06","Blue Advantage Silver HMO? 205 - Two $5 PCP Visits","94% AV Level Silver Plan",,"0.938267119689012","Yes","Yes","Yes","43%","57%","$0","$10","$800","$60","$0","$20","$800","$60","$0","$0","$600","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$2400 per group","$800","$800 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/sbc/2018/TX0460553-06.pdf","http://www.bcbstx.com/brochure/2018/tx-plan-overview.pdf"
"2018","TX","40540","HIOS","2017-06-16 02:20:26","Individual","Yes","47-0397286","40540TX0020001","Renaissance Individual Dental PPO, EHB Certified","40540TX002",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","40540TX0020001-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TX","40540","HIOS","2017-06-16 02:20:26","Individual","Yes","47-0397286","40540TX0020002","Renaissance Individual Dental PPO, EHB Certified","40540TX002",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","40540TX0020002-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TX","40540","HIOS","2017-06-16 02:20:26","Individual","Yes","47-0397286","40540TX0060001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","40540TX006",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540","","40540TX0060001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_EHB_High_2018","http://www.renaissancedental.com/TX_EHB_High_2018"
"2018","TX","40540","HIOS","2017-06-16 02:20:26","Individual","Yes","47-0397286","40540TX0060002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","40540TX006",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540","","40540TX0060002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_EHB_Low_2018","http://www.renaissancedental.com/TX_EHB_Low_2018"
"2018","TX","40540","HIOS","2017-06-16 02:20:26","Individual","Yes","47-0397286","40540TX0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified","40540TX005",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","40540TX0050001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TX","40540","HIOS","2017-06-16 02:20:26","Individual","Yes","47-0397286","40540TX0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified","40540TX005",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","40540TX0050002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TX","40540","HIOS","2017-06-16 02:20:26","Individual","Yes","47-0397286","40540TX0070002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","40540TX007",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540","","40540TX0070002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_Ped_Low_2018","http://www.renaissancedental.com/TX_Ped_Low_2018"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0010001","Molina Marketplace Gold Plan","45786TX001",,"TXN001","TXS001","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0010001-00","Molina Marketplace Gold Plan","Standard Gold Off Exchange Plan",,"0.784267675929479","No","Yes","No","100%",,"$0","$433","$2,271","$60","$0","$1,875","$346","$60","$0","$394","$209","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-gold-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0010001","Molina Marketplace Gold Plan","45786TX001",,"TXN001","TXS001","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0010001-01","Molina Marketplace Gold Plan","Standard Gold On Exchange Plan",,"0.784267675929479","No","Yes","No","100%",,"$0","$433","$2,271","$60","$0","$1,875","$346","$60","$0","$394","$209","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-gold-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0010001","Molina Marketplace Gold Plan","45786TX001",,"TXN001","TXS001","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0010001-02","Molina Marketplace Gold Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-zero-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0010001","Molina Marketplace Gold Plan","45786TX001",,"TXN001","TXS001","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0010001-03","Molina Marketplace Gold Plan","Limited Cost Sharing Plan Variation",,"0.784267675929479","No","Yes","No","100%",,"$0","$433","$2,271","$60","$0","$1,875","$346","$60","$0","$394","$209","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-gold-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0010002-00","Molina Marketplace Silver Plan","Standard Silver Off Exchange Plan",,"0.708957710240302","No","Yes","No","100%",,"$0","$533","$5,677","$55","$0","$2,194","$864","$55","$0","$457","$522","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-silver-250-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0010002-01","Molina Marketplace Silver Plan","Standard Silver On Exchange Plan",,"0.708957710240302","No","Yes","No","100%",,"$0","$533","$5,677","$55","$0","$2,194","$864","$55","$0","$457","$522","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-silver-250-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0010002-02","Molina Marketplace Silver Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-zero-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0010002-03","Molina Marketplace Silver Plan","Limited Cost Sharing Plan Variation",,"0.708957710240302","No","Yes","No","100%",,"$0","$533","$5,677","$55","$0","$2,194","$864","$55","$0","$457","$522","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-silver-250-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0010002-04","Molina Marketplace Silver Plan","73% AV Level Silver Plan",,"0.736594975503135","No","Yes","No","100%",,"$0","$416","$4,910","$0","$0","$2,104","$864","$0","$0","$417","$522","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-silver-200-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0010002-05","Molina Marketplace Silver Plan","87% AV Level Silver Plan",,"0.87299977658942","No","Yes","No","100%",,"$0","$364","$1,710","$0","$0","$1,068","$432","$0","$0","$270","$261","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-silver-150-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0010002-06","Molina Marketplace Silver Plan","94% AV Level Silver Plan",,"0.936919698433715","No","Yes","No","100%",,"$0","$182","$1,135","$0","$0","$498","$173","$0","$0","$110","$104","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-silver-100-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0040001","Molina Marketplace Options Silver Plan","45786TX004",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0040001-00","Molina Marketplace Options Silver Plan","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$96","$2,480","$60","$1,489","$1,409","$372","$55","$859","$379","$215","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0040001","Molina Marketplace Options Silver Plan","45786TX004",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0040001-01","Molina Marketplace Options Silver Plan","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$96","$2,480","$60","$1,489","$1,409","$372","$55","$859","$379","$215","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0040001","Molina Marketplace Options Silver Plan","45786TX004",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0040001-02","Molina Marketplace Options Silver Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-options-zero-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0040001","Molina Marketplace Options Silver Plan","45786TX004",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0040001-03","Molina Marketplace Options Silver Plan","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$96","$2,480","$60","$1,489","$1,409","$372","$55","$859","$379","$215","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0040001","Molina Marketplace Options Silver Plan","45786TX004",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0040001-04","Molina Marketplace Options Silver Plan","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$96","$2,480","$60","$1,489","$1,409","$372","$55","$859","$379","$215","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-options-silver-200-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0040001","Molina Marketplace Options Silver Plan","45786TX004",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0040001-05","Molina Marketplace Options Silver Plan","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$700","$610","$113","$55","$700","$189","$209","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-options-silver-150-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0040001","Molina Marketplace Options Silver Plan","45786TX004",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0040001-06","Molina Marketplace Options Silver Plan","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$22","$620","$60","$250","$218","$93","$55","$250","$105","$54","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-options-silver-100-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0020001","Molina Marketplace Choice Gold Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0020001-00","Molina Marketplace Choice Gold Plan","Standard Gold Off Exchange Plan",,"0.770138560314203","No","Yes","No","100%",,"$3,800","$279","$2,271","$60","$1,382","$1,233","$346","$55","$59","$429","$166","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-standard-gold-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0020001","Molina Marketplace Choice Gold Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0020001-01","Molina Marketplace Choice Gold Plan","Standard Gold On Exchange Plan",,"0.770138560314203","No","Yes","No","100%",,"$3,800","$279","$2,271","$60","$1,382","$1,233","$346","$55","$59","$429","$166","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-gold-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0020001","Molina Marketplace Choice Gold Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0020001-02","Molina Marketplace Choice Gold Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-zero-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0020001","Molina Marketplace Choice Gold Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0020001-03","Molina Marketplace Choice Gold Plan","Limited Cost Sharing Plan Variation",,"0.770138560314203","No","Yes","No","100%",,"$3,800","$279","$2,271","$60","$1,382","$1,233","$346","$55","$59","$429","$166","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-gold-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0020002-00","Molina Marketplace Choice Silver Plan","Standard Silver Off Exchange Plan",,"0.678048193152746","No","Yes","No","100%",,"$2,054","$379","$4,541","$60","$1,037","$1,730","$4,691","$55","$44","$653","$331","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,950","$4950 per person","$9900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,950","$4950 per person","$9900 per group","$400","$400 per person","$800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-silver-250-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0020002-01","Molina Marketplace Choice Silver Plan","Standard Silver On Exchange Plan",,"0.678048193152746","No","Yes","No","100%",,"$2,054","$379","$4,541","$60","$1,037","$1,730","$4,691","$55","$44","$653","$331","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,950","$4950 per person","$9900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,950","$4950 per person","$9900 per group","$400","$400 per person","$800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-silver-250-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0020002-02","Molina Marketplace Choice Silver Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-zero-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0020002-03","Molina Marketplace Choice Silver Plan","Limited Cost Sharing Plan Variation",,"0.678048193152746","No","Yes","No","100%",,"$2,054","$379","$4,541","$60","$1,037","$1,730","$4,691","$55","$44","$653","$331","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,950","$4950 per person","$9900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,950","$4950 per person","$9900 per group","$400","$400 per person","$800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-silver-250-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0020002-04","Molina Marketplace Choice Silver Plan","73% AV Level Silver Plan",,"0.739709064127067","No","Yes","No","100%",,"$1,437","$369","$3,668","$60","$1,037","$1,493","$691","$55","$44","$565","$331","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$2,500","$2500 per person","$5000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$400","$400 per person","$800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-silver-200-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0020002-05","Molina Marketplace Choice Silver Plan","87% AV Level Silver Plan",,"0.879609893257353","No","Yes","No","100%",,"$525","$172","$1,725","$60","$525","$803","$346","$55","$59","$330","$166","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$525","$525 per person","$1050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$525","$525 per person","$1050 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-silver-150-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0020002-06","Molina Marketplace Choice Silver Plan","94% AV Level Silver Plan",,"0.949265703364465","No","Yes","No","100%",,"$0","$152","$1,070","$60","$0","$395","$173","$55","$0","$125","$83","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-silver-100-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0020003","Molina Marketplace Choice Bronze Plan","45786TX002",,"TXN001","TXS001","TXF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0020003-00","Molina Marketplace Choice Bronze Plan","Standard Bronze Off Exchange Plan",,"0.625077353580658","Yes","Yes","No","100%",,"$2,099","$384","$4,491","$60","$3,952","$1,780","$691","$55","$1,060","$447","$418","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-bronze-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0020003","Molina Marketplace Choice Bronze Plan","45786TX002",,"TXN001","TXS001","TXF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0020003-01","Molina Marketplace Choice Bronze Plan","Standard Bronze On Exchange Plan",,"0.625077353580658","Yes","Yes","No","100%",,"$2,099","$384","$4,491","$60","$3,952","$1,780","$691","$55","$1,060","$447","$418","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-bronze-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0020003","Molina Marketplace Choice Bronze Plan","45786TX002",,"TXN001","TXS001","TXF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0020003-02","Molina Marketplace Choice Bronze Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-options-zero-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","45786","HIOS","2017-08-18 07:26:23","Individual","No","20-1494502","45786TX0020003","Molina Marketplace Choice Bronze Plan","45786TX002",,"TXN001","TXS001","TXF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/formulary-2018.pdf","45786TX0020003-03","Molina Marketplace Choice Bronze Plan","Limited Cost Sharing Plan Variation",,"0.625077353580658","Yes","Yes","No","100%",,"$2,099","$384","$4,491","$60","$3,952","$1,780","$691","$55","$1,060","$447","$418","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/summary-of-benefits-choice-bronze-2018.pdf","http://www.molinahealthcare.com/members/tx/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","47665TX0020003","BESTOne Advantage Gold","47665TX002",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/current/TX_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47665TX0010007","BESTDental Premium","47665TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010007-00","BESTDental Premium","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/current/TX_BESTDental_Premium_Plan.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47665TX0010007","BESTDental Premium","47665TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010007-01","BESTDental Premium","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/current/TX_BESTDental_Premium_Plan.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","47665TX0020003","BESTOne Advantage Gold","47665TX002",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/current/TX_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","47665TX0020004","BESTOne Plus Gold","47665TX002",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/current/TX_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47665TX0010008","BESTDental Standard - H","47665TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/current/TX_BESTDental_Standard-H_Plan.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47665TX0010008","BESTDental Standard - H","47665TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/current/TX_BESTDental_Standard-H_Plan.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","47665TX0020004","BESTOne Plus Gold","47665TX002",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/current/TX_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47665TX0010010","BESTDental Choice - H","47665TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2currnet/TX_BESTDental_Choice-H_Plan.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47665TX0010010","BESTDental Choice - H","47665TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/2currnet/TX_BESTDental_Choice-H_Plan.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47665TX0010009","BESTDental Standard - L","47665TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/CURRENT/TX_BESTDental_Standard-L_Plan.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","47665TX0020005","BESTOne Plus Silver","47665TX002",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/current/TX_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","47665TX0020005","BESTOne Plus Silver","47665TX002",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/current/TX_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47665TX0010009","BESTDental Standard - L","47665TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/CURRENT/TX_BESTDental_Standard-L_Plan.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47665TX0010011","BESTDental Choice - L","47665TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/Current/TX_BESTDental_Choice-L_Plan.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","47665TX0020006","BESTOne Basic Silver","47665TX002",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/current/TX_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","47665TX0020006","BESTOne Basic Silver","47665TX002",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/current/TX_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47665TX0010011","BESTDental Choice - L","47665TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/Current/TX_BESTDental_Choice-L_Plan.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47665TX0010012","BESTDental Value","47665TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/current/TX_BESTDental_Value_Plan.pdf"
"2018","TX","47665","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47665TX0010012","BESTDental Value","47665TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/tx/current/TX_BESTDental_Value_Plan.pdf"
"2018","TX","48364","HIOS","2017-07-25 02:20:16","SHOP (Small Group)","Yes","75-2046497","48364TX0030001","Family Basic Dental Plan (Low)","48364TX003",,"TXN001","TXS001",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","48364TX0030001-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TX","53108","HIOS","2017-06-02 02:20:22","Individual","Yes","47-0098400","53108TX0010002","EHB High Passive","53108TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","53108TX0010002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","TX","53108","HIOS","2017-06-02 02:20:22","SHOP (Small Group)","Yes","47-0098400","53108TX0030002","EHB High Passive","53108TX003",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","53108TX0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","TX","53108","HIOS","2017-06-02 02:20:22","SHOP (Small Group)","Yes","47-0098400","53108TX0030001","EHB Low Passive","53108TX003",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","53108TX0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0010002","CHP TX Catastrophic","66252TX001",,"TXN001","TXS002","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0010002-01","CHP TX Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Catastrophic.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030002","CHP TX Bronze","66252TX003",,"TXN001","TXS002","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030002-00","CHP TX Bronze","Standard Bronze Off Exchange Plan",,"0.575398312791793","Yes","Yes","No","100%",,"$4,855","$2,495","$0","$60","$3,784","$2,655","$864","$55","$821","$480","$693","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Bronze.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030002","CHP TX Bronze","66252TX003",,"TXN001","TXS002","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030002-01","CHP TX Bronze","Standard Bronze On Exchange Plan",,"0.575398312791793","Yes","Yes","No","100%",,"$4,855","$2,495","$0","$60","$3,784","$2,655","$864","$55","$821","$480","$693","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Bronze.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030002","CHP TX Bronze","66252TX003",,"TXN001","TXS002","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030002-02","CHP TX Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030002","CHP TX Bronze","66252TX003",,"TXN001","TXS002","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030002-03","CHP TX Bronze","Limited Cost Sharing Plan Variation",,"0.575398312791793","Yes","Yes","No","100%",,"$4,855","$2,495","$0","$60","$3,784","$2,655","$864","$55","$821","$480","$693","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Bronze_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040002-00","CHP TX Silver HD","Standard Silver Off Exchange Plan",,"0.6652586938756","Yes","Yes","No","100%",,"$4,480","$1,520","$0","$60","$4,386","$1,278","$336","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040002-01","CHP TX Silver HD","Standard Silver On Exchange Plan",,"0.6652586938756","Yes","Yes","No","100%",,"$4,480","$1,520","$0","$60","$4,386","$1,278","$336","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040002-02","CHP TX Silver HD","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040002-03","CHP TX Silver HD","Limited Cost Sharing Plan Variation",,"0.6652586938756","Yes","Yes","No","100%",,"$4,480","$1,520","$0","$60","$4,386","$1,278","$336","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040002-04","CHP TX Silver HD","73% AV Level Silver Plan",,"0.721669471067968","Yes","Yes","No","100%",,"$2,980","$1,520","$0","$60","$3,000","$1,194","$306","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_73%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","53108","HIOS","2017-06-02 02:20:22","Individual","Yes","47-0098400","53108TX0010001","EHB Low Passive","53108TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","53108TX0010001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","TX","58609","HIOS","2017-08-10 02:20:26","Individual","Yes","20-2970185","58609TX0010001","DentaQuest PPO  Pediatric High","58609TX001","7083617218","TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58609TX0010001-00","DentaQuest PPO  Pediatric High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0010001","CHP TX Catastrophic","66252TX001",,"TXN001","TXS001","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0010001-01","CHP TX Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Catastrophic.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030001","CHP TX Bronze","66252TX003",,"TXN001","TXS001","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030001-00","CHP TX Bronze","Standard Bronze Off Exchange Plan",,"0.575398312791793","Yes","Yes","No","100%",,"$4,855","$2,495","$0","$60","$3,784","$2,655","$864","$55","$821","$480","$693","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Bronze.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030001","CHP TX Bronze","66252TX003",,"TXN001","TXS001","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030001-01","CHP TX Bronze","Standard Bronze On Exchange Plan",,"0.575398312791793","Yes","Yes","No","100%",,"$4,855","$2,495","$0","$60","$3,784","$2,655","$864","$55","$821","$480","$693","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Bronze.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030001","CHP TX Bronze","66252TX003",,"TXN001","TXS001","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030001-02","CHP TX Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030001","CHP TX Bronze","66252TX003",,"TXN001","TXS001","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030001-03","CHP TX Bronze","Limited Cost Sharing Plan Variation",,"0.575398312791793","Yes","Yes","No","100%",,"$4,855","$2,495","$0","$60","$3,784","$2,655","$864","$55","$821","$480","$693","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Bronze_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040001-00","CHP TX Silver HD","Standard Silver Off Exchange Plan",,"0.6652586938756","Yes","Yes","No","100%",,"$4,480","$1,520","$0","$60","$4,386","$1,278","$336","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040001-01","CHP TX Silver HD","Standard Silver On Exchange Plan",,"0.6652586938756","Yes","Yes","No","100%",,"$4,480","$1,520","$0","$60","$4,386","$1,278","$336","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040001-02","CHP TX Silver HD","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","58609","HIOS","2017-08-10 02:20:26","Individual","Yes","20-2970185","58609TX0010001","DentaQuest PPO  Pediatric High","58609TX001","7083617218","TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58609TX0010001-01","DentaQuest PPO  Pediatric High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/"
"2018","TX","58609","HIOS","2017-08-10 02:20:26","Individual","Yes","20-2970185","58609TX0010003","DentaQuest PPO Family High","58609TX001","7083617218","TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58609TX0010003-00","DentaQuest PPO Family High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/"
"2018","TX","58609","HIOS","2017-08-10 02:20:26","Individual","Yes","20-2970185","58609TX0010003","DentaQuest PPO Family High","58609TX001","7083617218","TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58609TX0010003-01","DentaQuest PPO Family High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/"
"2018","TX","58609","HIOS","2017-08-10 02:20:26","Individual","Yes","20-2970185","58609TX0010004","DentaQuest PPO Family Low","58609TX001","7083617218","TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58609TX0010004-00","DentaQuest PPO Family Low","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/"
"2018","TX","58609","HIOS","2017-08-10 02:20:26","Individual","Yes","20-2970185","58609TX0010004","DentaQuest PPO Family Low","58609TX001","7083617218","TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","58609TX0010004-01","DentaQuest PPO Family Low","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/"
"2018","TX","61315","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","61315TX0010001","TruAssure Basic Adult or Child Dental Plan","61315TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","61315TX0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TX","https://www.truassure.com/brochure?state=TX"
"2018","TX","61315","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","61315TX0030001","TruAssure Dental Small Group Basic Plan","61315TX003",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","61315TX0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TX","61315","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","61315TX0040001","TruAssure Dental Small Group Preferred Plan","61315TX004",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","61315TX0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TX","61315","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","61315TX0010001","TruAssure Basic Adult or Child Dental Plan","61315TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","61315TX0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TX","https://www.truassure.com/brochure?state=TX"
"2018","TX","61315","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","61315TX0020001","TruAssure Preferred Adult or Child Dental Plan","61315TX002",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","61315TX0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TX","https://www.truassure.com/brochure?state=TX"
"2018","TX","61315","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","61315TX0020001","TruAssure Preferred Adult or Child Dental Plan","61315TX002",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","61315TX0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TX","https://www.truassure.com/brochure?state=TX"
"2018","TX","63141","HIOS","2017-08-10 02:20:26","Individual","Yes","39-1263473","63141TX0760001","Humana Dental Smart Choice - Low","63141TX076",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9858","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","63141TX0760001-01","Humana Dental Smart Choice - Low","Standard Low On Exchange Plan","68.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110458"
"2018","TX","63141","HIOS","2017-08-10 02:20:26","Individual","Yes","39-1263473","63141TX0760002","Humana Dental Smart Choice - High","63141TX076",,"TXN001","TXS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9838","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","63141TX0760002-01","Humana Dental Smart Choice - High","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110445"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0010001","CHP TX Catastrophic","66252TX001",,"TXN001","TXS001","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0010001-00","CHP TX Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Catastrophic.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040001-03","CHP TX Silver HD","Limited Cost Sharing Plan Variation",,"0.6652586938756","Yes","Yes","No","100%",,"$4,480","$1,520","$0","$60","$4,386","$1,278","$336","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040001-04","CHP TX Silver HD","73% AV Level Silver Plan",,"0.721669471067968","Yes","Yes","No","100%",,"$2,980","$1,520","$0","$60","$3,000","$1,194","$306","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_73%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040001-05","CHP TX Silver HD","87% AV Level Silver Plan",,"0.868312301179787","Yes","Yes","No","100%",,"$0","$1,500","$0","$60","$550","$763","$187","$55","$550","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","20.00%",,,,,"$550","$550 per person","$1100 per group","$550","$550 per person","$1100 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_87%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040001-06","CHP TX Silver HD","94% AV Level Silver Plan",,"0.943477430850966","Yes","Yes","No","100%",,"$0","$500","$0","$60","$125","$292","$83","$55","$125","$98","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","20.00%",,,,,"$125","$125 per person","$250 per group","$125","$125 per person","$250 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_94%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050001-00","CHP TX Silver LD","Standard Silver Off Exchange Plan",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050001-01","CHP TX Silver LD","Standard Silver On Exchange Plan",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050001-02","CHP TX Silver LD","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050001-03","CHP TX Silver LD","Limited Cost Sharing Plan Variation",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050001-04","CHP TX Silver LD","73% AV Level Silver Plan",,"0.739160290286648","Yes","Yes","No","100%",,"$2,480","$1,520","$0","$60","$2,500","$1,008","$492","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_73%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050001-05","CHP TX Silver LD","87% AV Level Silver Plan",,"0.866884420915489","Yes","Yes","No","100%",,"$0","$1,500","$0","$60","$550","$640","$310","$55","$550","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","35.00%",,,,,"$550","$550 per person","$1100 per group","$550","$550 per person","$1100 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_87%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050001-06","CHP TX Silver LD","94% AV Level Silver Plan",,"0.942934961244145","Yes","Yes","No","100%",,"$0","$500","$0","$60","$125","$270","$105","$55","$125","$0","$375","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","35.00%",,,,,"$125","$125 per person","$250 per group","$125","$125 per person","$250 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_94%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070001","CHP TX Gold","66252TX007",,"TXN001","TXS001","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070001-00","CHP TX Gold","Standard Gold Off Exchange Plan",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Gold.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070001","CHP TX Gold","66252TX007",,"TXN001","TXS001","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070001-01","CHP TX Gold","Standard Gold On Exchange Plan",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Gold.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070001","CHP TX Gold","66252TX007",,"TXN001","TXS001","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070001-02","CHP TX Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070001","CHP TX Gold","66252TX007",,"TXN001","TXS001","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070001-03","CHP TX Gold","Limited Cost Sharing Plan Variation",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Gold_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0010002","CHP TX Catastrophic","66252TX001",,"TXN001","TXS002","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0010002-00","CHP TX Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Catastrophic.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040002-05","CHP TX Silver HD","87% AV Level Silver Plan",,"0.868312301179787","Yes","Yes","No","100%",,"$0","$1,500","$0","$60","$550","$763","$187","$55","$550","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","20.00%",,,,,"$550","$550 per person","$1100 per group","$550","$550 per person","$1100 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_87%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040002-06","CHP TX Silver HD","94% AV Level Silver Plan",,"0.943477430850966","Yes","Yes","No","100%",,"$0","$500","$0","$60","$125","$292","$83","$55","$125","$98","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","20.00%",,,,,"$125","$125 per person","$250 per group","$125","$125 per person","$250 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_94%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050002-00","CHP TX Silver LD","Standard Silver Off Exchange Plan",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050002-01","CHP TX Silver LD","Standard Silver On Exchange Plan",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050002-02","CHP TX Silver LD","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050002-03","CHP TX Silver LD","Limited Cost Sharing Plan Variation",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050002-04","CHP TX Silver LD","73% AV Level Silver Plan",,"0.739160290286648","Yes","Yes","No","100%",,"$2,480","$1,520","$0","$60","$2,500","$1,008","$492","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_73%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050002-05","CHP TX Silver LD","87% AV Level Silver Plan",,"0.866884420915489","Yes","Yes","No","100%",,"$0","$1,500","$0","$60","$550","$640","$310","$55","$550","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","35.00%",,,,,"$550","$550 per person","$1100 per group","$550","$550 per person","$1100 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_87%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN001","TXS002","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050002-06","CHP TX Silver LD","94% AV Level Silver Plan",,"0.942934961244145","Yes","Yes","No","100%",,"$0","$500","$0","$60","$125","$270","$105","$55","$125","$0","$375","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","35.00%",,,,,"$125","$125 per person","$250 per group","$125","$125 per person","$250 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_94%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070002","CHP TX Gold","66252TX007",,"TXN001","TXS002","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070002-00","CHP TX Gold","Standard Gold Off Exchange Plan",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Gold.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070002","CHP TX Gold","66252TX007",,"TXN001","TXS002","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070002-01","CHP TX Gold","Standard Gold On Exchange Plan",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Gold.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070002","CHP TX Gold","66252TX007",,"TXN001","TXS002","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070002-02","CHP TX Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070002","CHP TX Gold","66252TX007",,"TXN001","TXS002","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070002-03","CHP TX Gold","Limited Cost Sharing Plan Variation",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Gold_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0010003","CHP TX Catastrophic","66252TX001",,"TXN001","TXS003","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0010003-00","CHP TX Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Catastrophic.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0010003","CHP TX Catastrophic","66252TX001",,"TXN001","TXS003","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0010003-01","CHP TX Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Catastrophic.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030003","CHP TX Bronze","66252TX003",,"TXN001","TXS003","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030003-00","CHP TX Bronze","Standard Bronze Off Exchange Plan",,"0.575398312791793","Yes","Yes","No","100%",,"$4,855","$2,495","$0","$60","$3,784","$2,655","$864","$55","$821","$480","$693","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Bronze.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030003","CHP TX Bronze","66252TX003",,"TXN001","TXS003","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030003-01","CHP TX Bronze","Standard Bronze On Exchange Plan",,"0.575398312791793","Yes","Yes","No","100%",,"$4,855","$2,495","$0","$60","$3,784","$2,655","$864","$55","$821","$480","$693","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Bronze.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030003","CHP TX Bronze","66252TX003",,"TXN001","TXS003","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030003-02","CHP TX Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030003","CHP TX Bronze","66252TX003",,"TXN001","TXS003","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030003-03","CHP TX Bronze","Limited Cost Sharing Plan Variation",,"0.575398312791793","Yes","Yes","No","100%",,"$4,855","$2,495","$0","$60","$3,784","$2,655","$864","$55","$821","$480","$693","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Bronze_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040003-00","CHP TX Silver HD","Standard Silver Off Exchange Plan",,"0.6652586938756","Yes","Yes","No","100%",,"$4,480","$1,520","$0","$60","$4,386","$1,278","$336","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040003-01","CHP TX Silver HD","Standard Silver On Exchange Plan",,"0.6652586938756","Yes","Yes","No","100%",,"$4,480","$1,520","$0","$60","$4,386","$1,278","$336","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040003-02","CHP TX Silver HD","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040003-03","CHP TX Silver HD","Limited Cost Sharing Plan Variation",,"0.6652586938756","Yes","Yes","No","100%",,"$4,480","$1,520","$0","$60","$4,386","$1,278","$336","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040003-04","CHP TX Silver HD","73% AV Level Silver Plan",,"0.721669471067968","Yes","Yes","No","100%",,"$2,980","$1,520","$0","$60","$3,000","$1,194","$306","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_73%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040003-05","CHP TX Silver HD","87% AV Level Silver Plan",,"0.868312301179787","Yes","Yes","No","100%",,"$0","$1,500","$0","$60","$550","$763","$187","$55","$550","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","20.00%",,,,,"$550","$550 per person","$1100 per group","$550","$550 per person","$1100 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_87%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040003-06","CHP TX Silver HD","94% AV Level Silver Plan",,"0.943477430850966","Yes","Yes","No","100%",,"$0","$500","$0","$60","$125","$292","$83","$55","$125","$98","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","20.00%",,,,,"$125","$125 per person","$250 per group","$125","$125 per person","$250 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_94%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050003-00","CHP TX Silver LD","Standard Silver Off Exchange Plan",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050003-01","CHP TX Silver LD","Standard Silver On Exchange Plan",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050003-02","CHP TX Silver LD","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050003-03","CHP TX Silver LD","Limited Cost Sharing Plan Variation",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050003-04","CHP TX Silver LD","73% AV Level Silver Plan",,"0.739160290286648","Yes","Yes","No","100%",,"$2,480","$1,520","$0","$60","$2,500","$1,008","$492","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_73%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050003-05","CHP TX Silver LD","87% AV Level Silver Plan",,"0.866884420915489","Yes","Yes","No","100%",,"$0","$1,500","$0","$60","$550","$640","$310","$55","$550","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","35.00%",,,,,"$550","$550 per person","$1100 per group","$550","$550 per person","$1100 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_87%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN001","TXS003","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050003-06","CHP TX Silver LD","94% AV Level Silver Plan",,"0.942934961244145","Yes","Yes","No","100%",,"$0","$500","$0","$60","$125","$270","$105","$55","$125","$0","$375","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","35.00%",,,,,"$125","$125 per person","$250 per group","$125","$125 per person","$250 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_94%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070003","CHP TX Gold","66252TX007",,"TXN001","TXS003","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070003-00","CHP TX Gold","Standard Gold Off Exchange Plan",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Gold.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070003","CHP TX Gold","66252TX007",,"TXN001","TXS003","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070003-01","CHP TX Gold","Standard Gold On Exchange Plan",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Gold.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070003","CHP TX Gold","66252TX007",,"TXN001","TXS003","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070003-02","CHP TX Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070003","CHP TX Gold","66252TX007",,"TXN001","TXS003","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070003-03","CHP TX Gold","Limited Cost Sharing Plan Variation",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Gold_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0010004","CHP TX Catastrophic","66252TX001",,"TXN001","TXS004","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0010004-00","CHP TX Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Catastrophic.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0010004","CHP TX Catastrophic","66252TX001",,"TXN001","TXS004","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0010004-01","CHP TX Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Catastrophic.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030004","CHP TX Bronze","66252TX003",,"TXN001","TXS004","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030004-00","CHP TX Bronze","Standard Bronze Off Exchange Plan",,"0.575398312791793","Yes","Yes","No","100%",,"$4,855","$2,495","$0","$60","$3,784","$2,655","$864","$55","$821","$480","$693","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Bronze.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030004","CHP TX Bronze","66252TX003",,"TXN001","TXS004","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030004-01","CHP TX Bronze","Standard Bronze On Exchange Plan",,"0.575398312791793","Yes","Yes","No","100%",,"$4,855","$2,495","$0","$60","$3,784","$2,655","$864","$55","$821","$480","$693","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Bronze.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030004","CHP TX Bronze","66252TX003",,"TXN001","TXS004","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030004-02","CHP TX Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030004","CHP TX Bronze","66252TX003",,"TXN001","TXS004","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030004-03","CHP TX Bronze","Limited Cost Sharing Plan Variation",,"0.575398312791793","Yes","Yes","No","100%",,"$4,855","$2,495","$0","$60","$3,784","$2,655","$864","$55","$821","$480","$693","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Bronze_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040004-00","CHP TX Silver HD","Standard Silver Off Exchange Plan",,"0.6652586938756","Yes","Yes","No","100%",,"$4,480","$1,520","$0","$60","$4,386","$1,278","$336","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040004-01","CHP TX Silver HD","Standard Silver On Exchange Plan",,"0.6652586938756","Yes","Yes","No","100%",,"$4,480","$1,520","$0","$60","$4,386","$1,278","$336","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040004-02","CHP TX Silver HD","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040004-03","CHP TX Silver HD","Limited Cost Sharing Plan Variation",,"0.6652586938756","Yes","Yes","No","100%",,"$4,480","$1,520","$0","$60","$4,386","$1,278","$336","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040004-04","CHP TX Silver HD","73% AV Level Silver Plan",,"0.721669471067968","Yes","Yes","No","100%",,"$2,980","$1,520","$0","$60","$3,000","$1,194","$306","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_73%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040004-05","CHP TX Silver HD","87% AV Level Silver Plan",,"0.868312301179787","Yes","Yes","No","100%",,"$0","$1,500","$0","$60","$550","$763","$187","$55","$550","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","20.00%",,,,,"$550","$550 per person","$1100 per group","$550","$550 per person","$1100 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_87%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040004-06","CHP TX Silver HD","94% AV Level Silver Plan",,"0.943477430850966","Yes","Yes","No","100%",,"$0","$500","$0","$60","$125","$292","$83","$55","$125","$98","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","20.00%",,,,,"$125","$125 per person","$250 per group","$125","$125 per person","$250 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_94%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050004-00","CHP TX Silver LD","Standard Silver Off Exchange Plan",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050004-01","CHP TX Silver LD","Standard Silver On Exchange Plan",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050004-02","CHP TX Silver LD","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050004-03","CHP TX Silver LD","Limited Cost Sharing Plan Variation",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050004-04","CHP TX Silver LD","73% AV Level Silver Plan",,"0.739160290286648","Yes","Yes","No","100%",,"$2,480","$1,520","$0","$60","$2,500","$1,008","$492","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_73%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050004-05","CHP TX Silver LD","87% AV Level Silver Plan",,"0.866884420915489","Yes","Yes","No","100%",,"$0","$1,500","$0","$60","$550","$640","$310","$55","$550","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","35.00%",,,,,"$550","$550 per person","$1100 per group","$550","$550 per person","$1100 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_87%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050004-06","CHP TX Silver LD","94% AV Level Silver Plan",,"0.942934961244145","Yes","Yes","No","100%",,"$0","$500","$0","$60","$125","$270","$105","$55","$125","$0","$375","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","35.00%",,,,,"$125","$125 per person","$250 per group","$125","$125 per person","$250 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_94%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070004","CHP TX Gold","66252TX007",,"TXN001","TXS004","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070004-00","CHP TX Gold","Standard Gold Off Exchange Plan",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Gold.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070004","CHP TX Gold","66252TX007",,"TXN001","TXS004","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070004-01","CHP TX Gold","Standard Gold On Exchange Plan",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Gold.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070004","CHP TX Gold","66252TX007",,"TXN001","TXS004","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070004-02","CHP TX Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070004","CHP TX Gold","66252TX007",,"TXN001","TXS004","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070004-03","CHP TX Gold","Limited Cost Sharing Plan Variation",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Gold_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0010006","CHP TX Catastrophic","66252TX001",,"TXN001","TXS006","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0010006-00","CHP TX Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Catastrophic.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0010006","CHP TX Catastrophic","66252TX001",,"TXN001","TXS006","TXF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0010006-01","CHP TX Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Catastrophic.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030006","CHP TX Bronze","66252TX003",,"TXN001","TXS006","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030006-00","CHP TX Bronze","Standard Bronze Off Exchange Plan",,"0.575398312791793","Yes","Yes","No","100%",,"$4,855","$2,495","$0","$60","$3,784","$2,655","$864","$55","$821","$480","$693","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Bronze.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030006","CHP TX Bronze","66252TX003",,"TXN001","TXS006","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030006-01","CHP TX Bronze","Standard Bronze On Exchange Plan",,"0.575398312791793","Yes","Yes","No","100%",,"$4,855","$2,495","$0","$60","$3,784","$2,655","$864","$55","$821","$480","$693","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Bronze.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030006","CHP TX Bronze","66252TX003",,"TXN001","TXS006","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030006-02","CHP TX Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0030006","CHP TX Bronze","66252TX003",,"TXN001","TXS006","TXF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0030006-03","CHP TX Bronze","Limited Cost Sharing Plan Variation",,"0.575398312791793","Yes","Yes","No","100%",,"$4,855","$2,495","$0","$60","$3,784","$2,655","$864","$55","$821","$480","$693","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Bronze_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040006","CHP TX Silver HD","66252TX004",,"TXN001","TXS006","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040006-00","CHP TX Silver HD","Standard Silver Off Exchange Plan",,"0.6652586938756","Yes","Yes","No","100%",,"$4,480","$1,520","$0","$60","$4,386","$1,278","$336","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040006","CHP TX Silver HD","66252TX004",,"TXN001","TXS006","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040006-01","CHP TX Silver HD","Standard Silver On Exchange Plan",,"0.6652586938756","Yes","Yes","No","100%",,"$4,480","$1,520","$0","$60","$4,386","$1,278","$336","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040006","CHP TX Silver HD","66252TX004",,"TXN001","TXS006","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040006-02","CHP TX Silver HD","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040006","CHP TX Silver HD","66252TX004",,"TXN001","TXS006","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040006-03","CHP TX Silver HD","Limited Cost Sharing Plan Variation",,"0.6652586938756","Yes","Yes","No","100%",,"$4,480","$1,520","$0","$60","$4,386","$1,278","$336","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040006","CHP TX Silver HD","66252TX004",,"TXN001","TXS006","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040006-04","CHP TX Silver HD","73% AV Level Silver Plan",,"0.721669471067968","Yes","Yes","No","100%",,"$2,980","$1,520","$0","$60","$3,000","$1,194","$306","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_73%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040006","CHP TX Silver HD","66252TX004",,"TXN001","TXS006","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040006-05","CHP TX Silver HD","87% AV Level Silver Plan",,"0.868312301179787","Yes","Yes","No","100%",,"$0","$1,500","$0","$60","$550","$763","$187","$55","$550","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","20.00%",,,,,"$550","$550 per person","$1100 per group","$550","$550 per person","$1100 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_87%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0040006","CHP TX Silver HD","66252TX004",,"TXN001","TXS006","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0040006-06","CHP TX Silver HD","94% AV Level Silver Plan",,"0.943477430850966","Yes","Yes","No","100%",,"$0","$500","$0","$60","$125","$292","$83","$55","$125","$98","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","20.00%",,,,,"$125","$125 per person","$250 per group","$125","$125 per person","$250 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_HD_94%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050006","CHP TX Silver LD","66252TX005",,"TXN001","TXS006","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050006-00","CHP TX Silver LD","Standard Silver Off Exchange Plan",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050006","CHP TX Silver LD","66252TX005",,"TXN001","TXS006","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050006-01","CHP TX Silver LD","Standard Silver On Exchange Plan",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050006","CHP TX Silver LD","66252TX005",,"TXN001","TXS006","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050006-02","CHP TX Silver LD","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050006","CHP TX Silver LD","66252TX005",,"TXN001","TXS006","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050006-03","CHP TX Silver LD","Limited Cost Sharing Plan Variation",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050006","CHP TX Silver LD","66252TX005",,"TXN001","TXS006","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050006-04","CHP TX Silver LD","73% AV Level Silver Plan",,"0.739160290286648","Yes","Yes","No","100%",,"$2,480","$1,520","$0","$60","$2,500","$1,008","$492","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_73%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050006","CHP TX Silver LD","66252TX005",,"TXN001","TXS006","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050006-05","CHP TX Silver LD","87% AV Level Silver Plan",,"0.866884420915489","Yes","Yes","No","100%",,"$0","$1,500","$0","$60","$550","$640","$310","$55","$550","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","35.00%",,,,,"$550","$550 per person","$1100 per group","$550","$550 per person","$1100 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_87%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0050006","CHP TX Silver LD","66252TX005",,"TXN001","TXS006","TXF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0050006-06","CHP TX Silver LD","94% AV Level Silver Plan",,"0.942934961244145","Yes","Yes","No","100%",,"$0","$500","$0","$60","$125","$270","$105","$55","$125","$0","$375","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","35.00%",,,,,"$125","$125 per person","$250 per group","$125","$125 per person","$250 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Silver_LD_94%.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070006","CHP TX Gold","66252TX007",,"TXN001","TXS006","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070006-00","CHP TX Gold","Standard Gold Off Exchange Plan",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Gold.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070006","CHP TX Gold","66252TX007",,"TXN001","TXS006","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070006-01","CHP TX Gold","Standard Gold On Exchange Plan",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Gold.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070006","CHP TX Gold","66252TX007",,"TXN001","TXS006","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070006-02","CHP TX Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","66252","HIOS","2017-11-01 02:20:20","Individual","No","45-2106295","66252TX0070006","CHP TX Gold","66252TX007",,"TXN001","TXS006","TXF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/tx2018healthexchangeformulary","66252TX0070006-03","CHP TX Gold","Limited Cost Sharing Plan Variation",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/66252_Gold_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","TX","71837","HIOS","2017-09-24 02:46:58","Individual","No","27-5219887","71837TX0010003","IdealCare Essential by Sendero Health Plans","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.9919",,,"2018-01-01",,"No",,"No",,"No","https://senderohealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010003-00","IdealCare Essential by Sendero Health Plans","Standard Bronze Off Exchange Plan",,"0.600350637178113","Yes","Yes","No","100%",,"$6,500","$1,715","$0","$60","$3,235","$1,615","$0","$1,783","$374","$1,440","$35","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","70%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"http://senderohealth.com/files/2018/71837TX001000301_Essential_Std.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010007","Together Silver Select","14630WI001",,"WIN001","WIS001","WIF015","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010007-06","Together Silver Select 100","94% AV Level Silver Plan",,"0.949120219282171","Yes","Yes","No","100%",,"$100","$15","$991","$60","$100","$225","$176","$55","$100","$45","$153","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/Silver-Select-200-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010008","Together Catastrophic","14630WI001",,"WIN001","WIS001","WIF012","New","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010008-00","Together Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/Together-Catastrophic-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010008","Together Catastrophic","14630WI001",,"WIN001","WIS001","WIF012","New","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010008-01","Together Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/Together-Catastrophic-2018","http://togetherCCHP.org/benefits"
"2018","WI","16837","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","16837WI0010001","Dentegra Dental PPO Pediatric Basic Plan","16837WI001",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","16837WI0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","$65 per person","per group not applicable",,,,,,"$65","$65 per person","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wi/16837wi0010001-18"
"2018","WI","16837","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","16837WI0010008","Dentegra Dental PPO Family Preferred Plan","16837WI001",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","16837WI0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","$65 per person","per group not applicable",,,,,,"$65","$65 per person","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wi/16837wi0010008-18"
"2018","TX","69758","HIOS","2017-06-02 02:20:22","SHOP (Small Group)","Yes","36-0883760","69758TX0030002","EHB High Passive","69758TX003",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","69758TX0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2018","TX","71837","HIOS","2017-09-24 02:46:58","Individual","No","27-5219887","71837TX0010001","IdealCare Complete by Sendero Health Plans","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.9929",,,"2018-01-01",,"No",,"No",,"No","https://senderohealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010001-03","IdealCare Complete by Sendero Health Plans","Limited Cost Sharing Plan Variation",,"0.688130356622766","Yes","Yes","No","100%",,"$3,850","$1,290","$0","$60","$3,062","$1,590","$0","$1,783","$446","$920","$17","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,850","$3850 per person","$7700 per group","No",,,"http://senderohealth.com/files/2018/71837TX001000103_Complete_Ltd_CS.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2018","TX","69758","HIOS","2017-06-02 02:20:22","SHOP (Small Group)","Yes","36-0883760","69758TX0030001","EHB Low Passive","69758TX003",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","69758TX0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2018","TX","71837","HIOS","2017-09-24 02:46:58","Individual","No","27-5219887","71837TX0010001","IdealCare Complete by Sendero Health Plans","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.9929",,,"2018-01-01",,"No",,"No",,"No","https://senderohealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010001-00","IdealCare Complete by Sendero Health Plans","Standard Silver Off Exchange Plan",,"0.688130356622766","Yes","Yes","No","100%",,"$3,850","$1,290","$0","$60","$3,062","$1,590","$0","$1,783","$446","$920","$17","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,850","$3850 per person","$7700 per group","No",,,"http://senderohealth.com/files/2018/71837TX001000101_Complete_Std.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2018","TX","71837","HIOS","2017-09-24 02:46:58","Individual","No","27-5219887","71837TX0010001","IdealCare Complete by Sendero Health Plans","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.9929",,,"2018-01-01",,"No",,"No",,"No","https://senderohealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010001-01","IdealCare Complete by Sendero Health Plans","Standard Silver On Exchange Plan",,"0.688130356622766","Yes","Yes","No","100%",,"$3,850","$1,290","$0","$60","$3,062","$1,590","$0","$1,783","$446","$920","$17","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,850","$3850 per person","$7700 per group","No",,,"http://senderohealth.com/files/2018/71837TX001000101_Complete_Std.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2018","TX","71837","HIOS","2017-09-24 02:46:58","Individual","No","27-5219887","71837TX0010001","IdealCare Complete by Sendero Health Plans","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.9929",,,"2018-01-01",,"No",,"No",,"No","https://senderohealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010001-02","IdealCare Complete by Sendero Health Plans","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://senderohealth.com/files/2018/71837TX001000102_Complete_Zero.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2018","TX","71837","HIOS","2017-09-24 02:46:58","Individual","No","27-5219887","71837TX0010001","IdealCare Complete by Sendero Health Plans","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.9929",,,"2018-01-01",,"No",,"No",,"No","https://senderohealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010001-04","IdealCare Complete by Sendero Health Plans","73% AV Level Silver Plan",,"0.722862651773722","Yes","Yes","No","100%",,"$3,000","$1,130","$0","$60","$3,000","$1,530","$0","$1,783","$446","$890","$17","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://senderohealth.com/files/2018/71837TX001000104_Complete_73_AV.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2018","TX","71837","HIOS","2017-09-24 02:46:58","Individual","No","27-5219887","71837TX0010001","IdealCare Complete by Sendero Health Plans","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.9929",,,"2018-01-01",,"No",,"No",,"No","https://senderohealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010001-05","IdealCare Complete by Sendero Health Plans","87% AV Level Silver Plan",,"0.863605581935855","Yes","Yes","No","100%",,"$500","$1,062","$0","$60","$500","$1,108","$0","$1,783","$449","$800","$13","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No",,,"http://senderohealth.com/files/2018/71837TX001000105_Complete_87_AV.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2018","TX","71837","HIOS","2017-09-24 02:46:58","Individual","No","27-5219887","71837TX0010001","IdealCare Complete by Sendero Health Plans","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.9929",,,"2018-01-01",,"No",,"No",,"No","https://senderohealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010001-06","IdealCare Complete by Sendero Health Plans","94% AV Level Silver Plan",,"0.931771482313698","Yes","Yes","No","100%",,"$0","$955","$0","$60","$0","$799","$0","$1,783","$0","$620","$7","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://senderohealth.com/files/2018/71837TX001000106_Complete_94_AV.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2018","TX","71837","HIOS","2017-09-24 02:46:58","Individual","No","27-5219887","71837TX0010003","IdealCare Essential by Sendero Health Plans","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.9919",,,"2018-01-01",,"No",,"No",,"No","https://senderohealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010003-01","IdealCare Essential by Sendero Health Plans","Standard Bronze On Exchange Plan",,"0.600350637178113","Yes","Yes","No","100%",,"$6,500","$1,715","$0","$60","$3,235","$1,615","$0","$1,783","$374","$1,440","$35","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","70%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"http://senderohealth.com/files/2018/71837TX001000301_Essential_Std.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2018","TX","71837","HIOS","2017-09-24 02:46:58","Individual","No","27-5219887","71837TX0010003","IdealCare Essential by Sendero Health Plans","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.9919",,,"2018-01-01",,"No",,"No",,"No","https://senderohealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010003-02","IdealCare Essential by Sendero Health Plans","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://senderohealth.com/files/2018/71837TX001000302_Essential_Zero_CS.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2018","TX","71837","HIOS","2017-09-24 02:46:58","Individual","No","27-5219887","71837TX0010003","IdealCare Essential by Sendero Health Plans","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.9919",,,"2018-01-01",,"No",,"No",,"No","https://senderohealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010003-03","IdealCare Essential by Sendero Health Plans","Limited Cost Sharing Plan Variation",,"0.600350637178113","Yes","Yes","No","100%",,"$6,500","$1,715","$0","$60","$3,235","$1,615","$0","$1,783","$374","$1,440","$35","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","70%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"http://senderohealth.com/files/2018/71837TX001000303_Essential_Ltd_CS.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2018","TX","71837","HIOS","2017-09-24 02:46:58","Individual","No","27-5219887","71837TX0010004","IdealCare HSA by Sendero Health Plans","71837TX001","7386647516","TXN001","TXS001","TXF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://senderohealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010004-00","IdealCare HSA by Sendero Health Plans","Standard Bronze Off Exchange Plan",,"0.615153525400954","Yes","Yes","No","100%",,"$5,000","$1,715","$0","$60","$4,347","$1,615","$0","$1,783","$374","$1,440","$35","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes",,,"http://senderohealth.com/files/2018/71837TX001000401_Essential_Std.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2018","TX","71837","HIOS","2017-09-24 02:46:58","Individual","No","27-5219887","71837TX0010004","IdealCare HSA by Sendero Health Plans","71837TX001","7386647516","TXN001","TXS001","TXF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://senderohealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010004-01","IdealCare HSA by Sendero Health Plans","Standard Bronze On Exchange Plan",,"0.615153525400954","Yes","Yes","No","100%",,"$5,000","$1,715","$0","$60","$4,347","$1,615","$0","$1,783","$374","$1,440","$35","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes",,,"http://senderohealth.com/files/2018/71837TX001000401_Essential_Std.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2018","TX","71837","HIOS","2017-09-24 02:46:58","Individual","No","27-5219887","71837TX0010004","IdealCare HSA by Sendero Health Plans","71837TX001","7386647516","TXN001","TXS001","TXF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://senderohealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010004-02","IdealCare HSA by Sendero Health Plans","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://senderohealth.com/files/2018/71837TX001000402_Essential_Zero_CS.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2018","TX","71837","HIOS","2017-09-24 02:46:58","Individual","No","27-5219887","71837TX0010004","IdealCare HSA by Sendero Health Plans","71837TX001","7386647516","TXN001","TXS001","TXF001","New","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.9914",,,"2018-01-01",,"No",,"No",,"No","https://senderohealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010004-03","IdealCare HSA by Sendero Health Plans","Limited Cost Sharing Plan Variation",,"0.615153525400954","Yes","Yes","No","100%",,"$5,000","$1,715","$0","$60","$4,347","$1,615","$0","$1,783","$374","$1,440","$35","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes",,,"http://senderohealth.com/files/2018/71837TX001000403_Essential_Ltd_CS.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2018","TX","71837","HIOS","2017-09-24 02:46:58","Individual","No","27-5219887","71837TX0010002","IdealCare Total by Sendero Health Plans","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.9923",,,"2018-01-01",,"No",,"No",,"No","https://senderohealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010002-00","IdealCare Total by Sendero Health Plans","Standard Gold Off Exchange Plan",,"0.774676311794153","Yes","Yes","No","100%",,"$0","$590","$1,792","$60","$1,000","$1,245","$0","$1,783","$0","$1,750","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"http://senderohealth.com/files/2018/71837TX001000201_Total_Std.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2018","TX","71837","HIOS","2017-09-24 02:46:58","Individual","No","27-5219887","71837TX0010002","IdealCare Total by Sendero Health Plans","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.9923",,,"2018-01-01",,"No",,"No",,"No","https://senderohealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010002-01","IdealCare Total by Sendero Health Plans","Standard Gold On Exchange Plan",,"0.774676311794153","Yes","Yes","No","100%",,"$0","$590","$1,792","$60","$1,000","$1,245","$0","$1,783","$0","$1,750","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"http://senderohealth.com/files/2018/71837TX001000201_Total_Std.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2018","TX","71837","HIOS","2017-09-24 02:46:58","Individual","No","27-5219887","71837TX0010002","IdealCare Total by Sendero Health Plans","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.9923",,,"2018-01-01",,"No",,"No",,"No","https://senderohealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010002-02","IdealCare Total by Sendero Health Plans","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://senderohealth.com/files/2018/71837TX001000202_Total_Zero.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2018","TX","71837","HIOS","2017-09-24 02:46:58","Individual","No","27-5219887","71837TX0010002","IdealCare Total by Sendero Health Plans","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.9923",,,"2018-01-01",,"No",,"No",,"No","https://senderohealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://senderohealth.com/idealcareeng/formulary.html","71837TX0010002-03","IdealCare Total by Sendero Health Plans","Limited Cost Sharing Plan Variation",,"0.774676311794153","Yes","Yes","No","100%",,"$0","$590","$1,792","$60","$1,000","$1,245","$0","$1,783","$0","$1,750","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"http://senderohealth.com/files/2018/71837TX001000203_Total_Ltd_CS.pdf","http://www.senderohealth.com/idealcareeng/planbrochure.html"
"2018","TX","90453","HIOS","2017-08-03 02:20:23","SHOP (Small Group)","Yes","42-0127290","90453TX0050001","Principal Plan Dental 70","90453TX005",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"0.76","Estimated Rate","2018-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","90453TX0050001-00","Principal Plan Dental 70","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TX","91476","HIOS","2017-06-09 02:20:26","Individual","Yes","20-4023720","91476TX0010001","EMI Health Choice (High)","91476TX001",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9651","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","91476TX0010001-01","EMI Health Choice (High)","Standard High On Exchange Plan","86.44%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$15","$15 per person","$45 per group",,"$15","$15 per person","$45 per group",,"$15","$15 per person","$45 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/tx-federal-marketplace-dental.aspx"
"2018","TX","91476","HIOS","2017-06-09 02:20:26","Individual","Yes","20-4023720","91476TX0010002","EMI Health Choice (Low)","91476TX001",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9574","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","91476TX0010002-01","EMI Health Choice (Low)","Standard Low On Exchange Plan","70.37%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,"$75","$75 per person","$225 per group",,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/tx-federal-marketplace-dental.aspx"
"2018","TX","91476","HIOS","2017-06-09 02:20:26","Individual","Yes","20-4023720","91476TX0010003","EMI Health Advantage Co-Pay","91476TX001",,"TXN002","TXS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9572","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","91476TX0010003-01","EMI Health Advantage Co-Pay","Standard Low On Exchange Plan","70.84%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/tx-federal-marketplace-dental.aspx"
"2018","TX","92388","HIOS","2017-06-03 02:07:36","SHOP (Small Group)","Yes","13-5581829","92388TX0190001","Family Basic Dental Plan (Low)","92388TX019",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"0.9","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","92388TX0190001-00","Family Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","TX","98899","HIOS","2017-06-02 02:20:22","SHOP (Small Group)","Yes","93-0242990","98899TX0030002","EHB High Passive","98899TX003",,"TXN001","TXS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","98899TX0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2018","TX","98899","HIOS","2017-06-02 02:20:22","SHOP (Small Group)","Yes","93-0242990","98899TX0030001","EHB Low Passive","98899TX003",,"TXN001","TXS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","98899TX0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010001","Together Bronze","14630WI001",,"WIN001","WIS001","WIF001","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010001-00","Together Bronze","Standard Bronze Off Exchange Plan",,"0.61652579728721","Yes","Yes","No","100%",,"$6,250","$0","$1,100","$60","$5,717","$906","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/bronze-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010001","Together Bronze","14630WI001",,"WIN001","WIS001","WIF001","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010001-01","Together Bronze","Standard Bronze On Exchange Plan",,"0.61652579728721","Yes","Yes","No","100%",,"$6,250","$0","$1,100","$60","$5,717","$906","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/bronze-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010001","Together Bronze","14630WI001",,"WIN001","WIS001","WIF001","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010001-02","Together Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/bronze-zero-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010001","Together Bronze","14630WI001",,"WIN001","WIS001","WIF001","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010001-03","Together Bronze Limited","Limited Cost Sharing Plan Variation",,"0.61652579728721","Yes","Yes","No","100%",,"$6,250","$0","$1,100","$60","$5,717","$906","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/bronze-limited-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010002","Together Standard Silver","14630WI001",,"WIN001","WIS001","WIF002","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010002-00","Together Standard Silver","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$161","$1,301","$60","$1,862","$1,409","$0","$55","$1,632","$195","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://TogetherCCHP.org/standard-silver-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010002","Together Standard Silver","14630WI001",,"WIN001","WIS001","WIF002","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010002-01","Together Standard Silver","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$161","$1,301","$60","$1,862","$1,409","$0","$55","$1,632","$195","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://TogetherCCHP.org/standard-silver-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010002","Together Standard Silver","14630WI001",,"WIN001","WIS001","WIF002","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010002-02","Together Standard Silver Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://TogetherCCHP.org/standard-silver-zero-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010002","Together Standard Silver","14630WI001",,"WIN001","WIS001","WIF002","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010002-03","Together Standard Silver Limited","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$161","$1,301","$60","$1,862","$1,409","$0","$55","$1,632","$195","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://TogetherCCHP.org/standard-silver-limited-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010002","Together Standard Silver","14630WI001",,"WIN001","WIS001","WIF002","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010002-04","Together Standard Silver 200","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$161","$1,401","$60","$1,862","$1,409","$0","$55","$1,632","$195","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://TogetherCCHP.org/standard-silver-100-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010002","Together Standard Silver","14630WI001",,"WIN001","WIS001","WIF002","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010002-05","Together Standard Silver 150","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$25","$1,725","$60","$700","$610","$232","$55","$700","$75","$186","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://TogetherCCHP.org/standard-silver-150-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010002","Together Standard Silver","14630WI001",,"WIN001","WIS001","WIF002","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010002-06","Together Standard Silver 100","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$32","$488","$60","$250","$218","$81","$55","$250","$30","$69","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://TogetherCCHP.org/standard-silver-200-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010003","Together Silver","14630WI001",,"WIN001","WIS001","WIF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010003-00","Together Silver","Standard Silver Off Exchange Plan",,"0.660859495235763","Yes","Yes","No","100%",,"$4,250","$233","$2,302","$60","$4,250","$899","$477","$55","$1,632","$273","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/silver-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010003","Together Silver","14630WI001",,"WIN001","WIS001","WIF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010003-01","Together Silver","Standard Silver On Exchange Plan",,"0.660859495235763","Yes","Yes","No","100%",,"$4,250","$233","$2,302","$60","$4,250","$899","$477","$55","$1,632","$273","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/silver-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010003","Together Silver","14630WI001",,"WIN001","WIS001","WIF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010003-02","Together Silver Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/silver-zero-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010003","Together Silver","14630WI001",,"WIN001","WIS001","WIF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010003-03","Together Silver Limited","Limited Cost Sharing Plan Variation",,"0.660859495235763","Yes","Yes","No","100%",,"$4,250","$233","$2,302","$60","$4,250","$899","$477","$55","$1,632","$273","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/silver-limited-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010003","Together Silver","14630WI001",,"WIN001","WIS001","WIF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010003-04","Together Silver 200","73% AV Level Silver Plan",,"0.739950300616979","Yes","Yes","No","100%",,"$2,000","$180","$2,402","$60","$2,000","$635","$1,033","$55","$1,632","$233","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/silver-100-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010003","Together Silver","14630WI001",,"WIN001","WIS001","WIF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010003-05","Together Silver 150","87% AV Level Silver Plan",,"0.879470245807898","Yes","Yes","No","100%",,"$500","$20","$1,780","$60","$500","$275","$989","$55","$500","$60","$226","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/silver-150-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010003","Together Silver","14630WI001",,"WIN001","WIS001","WIF006","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010003-06","Together Silver 100","94% AV Level Silver Plan",,"0.949177331940429","Yes","Yes","No","100%",,"$100","$10","$790","$60","$100","$215","$534","$55","$100","$30","$153","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/silver-200-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010004","Together Gold","14630WI001",,"WIN001","WIS001","WIF010","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010004-00","Together Gold","Standard Gold Off Exchange Plan",,"0.818898609547577","Yes","Yes","No","100%",,"$1,000","$75","$1,801","$60","$1,000","$1,020","$172","$55","$1,000","$105","$126","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/gold-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010004","Together Gold","14630WI001",,"WIN001","WIS001","WIF010","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010004-01","Together Gold","Standard Gold On Exchange Plan",,"0.818898609547577","Yes","Yes","No","100%",,"$1,000","$75","$1,801","$60","$1,000","$1,020","$172","$55","$1,000","$105","$126","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/gold-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010004","Together Gold","14630WI001",,"WIN001","WIS001","WIF010","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010004-02","Together Gold Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/gold-zero-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010004","Together Gold","14630WI001",,"WIN001","WIS001","WIF010","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010004-03","Together Gold Limited","Limited Cost Sharing Plan Variation",,"0.818898609547577","Yes","Yes","No","100%",,"$1,000","$75","$1,801","$60","$1,000","$1,020","$172","$55","$1,000","$105","$126","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/gold-limited-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010005","Together Bronze HDHP","14630WI001",,"WIN001","WIS001","WIF012","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010005-00","Together Bronze HDHP","Standard Bronze Off Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://TogetherCCHP.org/Bronze-HDHP-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010005","Together Bronze HDHP","14630WI001",,"WIN001","WIS001","WIF012","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010005-01","Together Bronze HDHP","Standard Bronze On Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://TogetherCCHP.org/Bronze-HDHP-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010005","Together Bronze HDHP","14630WI001",,"WIN001","WIS001","WIF012","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010005-02","Together Bronze HDHP Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/Bronze-HDHP-Zero-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010005","Together Bronze HDHP","14630WI001",,"WIN001","WIS001","WIF012","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010005-03","Together Bronze HDHP Limited","Limited Cost Sharing Plan Variation",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://TogetherCCHP.org/Bronze-HDHP-Limited-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010006","Together Silver HDHP","14630WI001",,"WIN001","WIS001","WIF013","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010006-00","Together Silver HDHP","Standard Silver Off Exchange Plan",,"0.660171210822999","Yes","Yes","No","100%",,"$4,000","$0","$1,700","$60","$4,000","$0","$637","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://TogetherCCHP.org/Silver-HDHP-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010006","Together Silver HDHP","14630WI001",,"WIN001","WIS001","WIF013","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010006-01","Together Silver HDHP","Standard Silver On Exchange Plan",,"0.660171210822999","Yes","Yes","No","100%",,"$4,000","$0","$1,700","$60","$4,000","$0","$637","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://TogetherCCHP.org/Silver-HDHP-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010006","Together Silver HDHP","14630WI001",,"WIN001","WIS001","WIF013","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010006-02","Together Silver HDHP Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/Silver-HDHP-Zero-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010006","Together Silver HDHP","14630WI001",,"WIN001","WIS001","WIF013","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010006-03","Together Silver HDHP Limited","Limited Cost Sharing Plan Variation",,"0.660171210822999","Yes","Yes","No","100%",,"$4,000","$0","$1,700","$60","$4,000","$0","$637","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://TogetherCCHP.org/Silver-HDHP-Limited-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010006","Together Silver HDHP","14630WI001",,"WIN001","WIS001","WIF013","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010006-04","Together Silver HDHP 200","73% AV Level Silver Plan",,"0.739466580696938","Yes","Yes","No","100%",,"$1,750","$0","$2,177","$60","$1,750","$0","$1,087","$55","$1,750","$0","$35","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/Silver-HDHP-100-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010006","Together Silver HDHP","14630WI001",,"WIN001","WIS001","WIF013","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010006-05","Together Silver HDHP 150","87% AV Level Silver Plan",,"0.879017271109053","Yes","Yes","No","100%",,"$500","$0","$950","$60","$500","$0","$950","$55","$500","$0","$285","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/Silver-HDHP-150-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010006","Together Silver HDHP","14630WI001",,"WIN001","WIS001","WIF013","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010006-06","Together Silver HDHP 100","94% AV Level Silver Plan",,"0.948806255758045","Yes","Yes","No","100%",,"$50","$0","$950","$60","$50","$0","$713","$55","$50","$0","$188","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/Silver-HDHP-200-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010007","Together Silver Select","14630WI001",,"WIN001","WIS001","WIF015","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010007-00","Together Silver Select","Standard Silver Off Exchange Plan",,"0.719264668208657","Yes","Yes","No","100%",,"$2,500","$186","$3,002","$60","$1,862","$1,479","$0","$55","$1,632","$233","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/Silver-Select-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010007","Together Silver Select","14630WI001",,"WIN001","WIS001","WIF015","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010007-01","Together Silver Select","Standard Silver On Exchange Plan",,"0.719264668208657","Yes","Yes","No","100%",,"$2,500","$186","$3,002","$60","$1,862","$1,479","$0","$55","$1,632","$233","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/Silver-Select-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010007","Together Silver Select","14630WI001",,"WIN001","WIS001","WIF015","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010007-02","Together Silver Select Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/Silver-Select-Limited-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010007","Together Silver Select","14630WI001",,"WIN001","WIS001","WIF015","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010007-03","Together Silver Select Limited","Limited Cost Sharing Plan Variation",,"0.719264668208657","Yes","Yes","No","100%",,"$2,500","$186","$3,002","$60","$1,862","$1,479","$0","$55","$1,632","$233","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/Silver-Select-Zero-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010007","Together Silver Select","14630WI001",,"WIN001","WIS001","WIF015","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010007-04","Together Silver Select 200","73% AV Level Silver Plan",,"0.739750546070916","Yes","Yes","No","100%",,"$2,500","$186","$3,002","$60","$1,862","$1,479","$0","$55","$1,632","$233","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/Silver-Select-100-2018","http://togetherCCHP.org/benefits"
"2018","WI","14630","HIOS","2017-08-15 02:20:31","Individual","No","27-1494977","14630WI0010007","Together Silver Select","14630WI001",,"WIN001","WIS001","WIF015","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Depression, Pregnancy","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","http://togethercchp.org/pay-bill","http://togetherCCHP.org/formulary","14630WI0010007-05","Together Silver Select 150","87% AV Level Silver Plan",,"0.879679204550011","Yes","Yes","No","100%",,"$850","$40","$860","$60","$850","$655","$202","$55","$850","$120","$156","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://TogetherCCHP.org/Silver-Select-150-2018","http://togetherCCHP.org/benefits"
"2018","WI","16837","HIOS","2017-08-11 02:20:28","Individual","Yes","75-1233841","16837WI0010007","Dentegra Dental PPO Family Basic Plan","16837WI001",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","16837WI0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","$65 per person","per group not applicable",,,,,,"$65","$65 per person","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wi/16837wi0010007-18"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130021","Atlas Individual $2300 Plus Silver","20173WI013",,"WIN001","WIS001","WIF002","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130021-01","Atlas Individual $2300 Plus Silver","Standard Silver On Exchange Plan","71.95%","0.703070280029039","Yes","Yes","No","100%",,"$2,300","$40","$2,200","$60","$2,300","$400","$900","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","25.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192643.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130021","Atlas Individual $2300 Plus Silver","20173WI013",,"WIN001","WIS001","WIF002","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130021-02","Atlas Individual Silver Zero Cost Chare Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192646.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130021","Atlas Individual $2300 Plus Silver","20173WI013",,"WIN001","WIS001","WIF002","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130021-03","Atlas Individual $2300 Plus Silver Limited Cost Share Plan","Limited Cost Sharing Plan Variation","71.95%","0.703070280029039","Yes","Yes","No","100%",,"$2,300","$40","$2,200","$60","$2,300","$400","$900","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","25.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192647.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130021","Atlas Individual $2300 Plus Silver","20173WI013",,"WIN001","WIS001","WIF002","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130021-04","Atlas Individual $2100 Plus Silver Cost Share Reduction Plan","73% AV Level Silver Plan","74.00%","0.725670593783961","Yes","Yes","No","100%",,"$2,100","$40","$2,200","$60","$2,100","$400","$1,000","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","25.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192650.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130021","Atlas Individual $2300 Plus Silver","20173WI013",,"WIN001","WIS001","WIF002","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130021-05","Atlas Individual $800 Plus Silver Cost Share Reduction Plan","87% AV Level Silver Plan","86.11%","0.853322443627517","Yes","Yes","No","100%",,"$800","$40","$1,000","$60","$800","$500","$500","$60","$800","$90","$70","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192649.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130021","Atlas Individual $2300 Plus Silver","20173WI013",,"WIN001","WIS001","WIF002","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130021-06","Atlas Individual $100 Plus Silver Cost Share Reduction Plan","94% AV Level Silver Plan","93.29%","0.929575861634382","Yes","Yes","No","100%",,"$100","$40","$500","$60","$100","$600","$300","$60","$100","$300","$60","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192648.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130023","Atlas Individual $6000 Plus Bronze","20173WI013",,"WIN001","WIS001","WIF001","Existing","PPO","Expanded Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130023-01","Atlas Individual $6000 Plus Bronze","Standard Bronze On Exchange Plan","63.65%","0.610841644320084","Yes","Yes","No","100%",,"$6,000","$20","$1,000","$60","$6,000","$200","$70","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192658.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130023","Atlas Individual $6000 Plus Bronze","20173WI013",,"WIN001","WIS001","WIF001","Existing","PPO","Expanded Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130023-02","Atlas Individual Bronze Zero Cost Share Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192657.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130023","Atlas Individual $6000 Plus Bronze","20173WI013",,"WIN001","WIS001","WIF001","Existing","PPO","Expanded Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130023-03","Atlas Individual $6000 Plus Bronze Limited Cost Share Plan","Limited Cost Sharing Plan Variation","63.65%","0.610841644320084","Yes","Yes","No","100%",,"$6,000","$20","$1,000","$60","$6,000","$200","$70","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192659.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130025","Atlas Individual $7350 Catastrophic","20173WI013",,"WIN001","WIS001","WIF004","Existing","PPO","Catastrophic","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130025-01","Atlas Individual $7350 Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192660.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130026","Atlas Individual $3000 HSA Silver","20173WI013",,"WIN001","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130026-01","Atlas Individual $3000 HSA Silver","Standard Silver On Exchange Plan","68.67%","0.683168357982993","Yes","Yes","No","100%",,"$3,000","$0","$1,200","$60","$3,000","$0","$600","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192661.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130026","Atlas Individual $3000 HSA Silver","20173WI013",,"WIN001","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130026-02","Atlas Individual Silver Zero Cost Share Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192662.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130026","Atlas Individual $3000 HSA Silver","20173WI013",,"WIN001","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130026-03","Atlas Individual $3000 Silver Limited Cost Share Plan","Limited Cost Sharing Plan Variation","68.67%","0.683168357982993","Yes","Yes","No","100%",,"$3,000","$0","$1,200","$60","$3,000","$0","$600","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192663.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130026","Atlas Individual $3000 HSA Silver","20173WI013",,"WIN001","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130026-04","Atlas Individual $2200 Silver Cost Share Reduction Plan","73% AV Level Silver Plan","72.50%","0.720899204274544","Yes","Yes","No","100%",,"$2,200","$0","$1,300","$60","$2,200","$0","$700","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","15.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192666.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130026","Atlas Individual $3000 HSA Silver","20173WI013",,"WIN001","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130026-05","Atlas Individual $800 Silver Cost Share Reduction Plan","87% AV Level Silver Plan","87.28%","0.86588218818375","Yes","Yes","No","100%",,"$800","$0","$500","$60","$800","$0","$300","$60","$800","$0","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","5.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192665.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130026","Atlas Individual $3000 HSA Silver","20173WI013",,"WIN001","WIS001","WIF005","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130026-06","Atlas Individual $200 Silver Cost Share Reduction Plan","94% AV Level Silver Plan","93.69%","0.929495603630034","Yes","Yes","No","100%",,"$200","$0","$500","$60","$200","$0","$300","$60","$200","$0","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","5.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192664.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130027","Atlas Individual $6600 HSA Bronze","20173WI013",,"WIN001","WIS001","WIF004","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130027-01","Atlas Individual $6600 HSA Bronze","Standard Bronze On Exchange Plan","60.36%","0.603585155542397","Yes","Yes","No","100%",,"$6,600","$0","$0","$60","$6,600","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192667.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130027","Atlas Individual $6600 HSA Bronze","20173WI013",,"WIN001","WIS001","WIF004","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130027-02","Atlas Individual Bronze Zero Cost Share Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192668.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130027","Atlas Individual $6600 HSA Bronze","20173WI013",,"WIN001","WIS001","WIF004","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130027-03","Atlas Individual $6600 Bronze Limited Cost Share Plan","Limited Cost Sharing Plan Variation","60.36%","0.603585155542397","Yes","Yes","No","100%",,"$6,600","$0","$0","$60","$6,600","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192669.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130020","Atlas Individual $1000 w/Copay Gold","20173WI013",,"WIN001","WIS001","WIF001","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130020-01","Atlas Individual $1000 w/Copay Gold","Standard Gold On Exchange Plan","79.40%","0.788057001469089","Yes","Yes","No","100%",,"$1,000","$20","$2,000","$60","$1,000","$300","$900","$60","$1,000","$30","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192641.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130020","Atlas Individual $1000 w/Copay Gold","20173WI013",,"WIN001","WIS001","WIF001","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130020-02","Atlas Individual Gold Zero Cost Share Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192644.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130020","Atlas Individual $1000 w/Copay Gold","20173WI013",,"WIN001","WIS001","WIF001","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130020-03","Atlas Individual $1000 w/Copay Gold Limited Cost Share Plan","Limited Cost Sharing Plan Variation","79.40%","0.788057001469089","Yes","Yes","No","100%",,"$1,000","$20","$2,000","$60","$1,000","$300","$900","$60","$1,000","$30","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192642.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130028","Atlas Individual $3500 Plus Silver","20173WI013",,"WIN001","WIS001","WIF003","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130028-01","Atlas Individual $3500 Plus Silver","Standard Silver On Exchange Plan","70.24%","0.682786507728434","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$3,500","$400","$400","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","15.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192651.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","31248","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","31248WI0020001","TruAssure Preferred Adult or Child Dental Plan","31248WI002",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","31248WI0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WI","https://www.truassure.com/brochure?state=WI"
"2018","WI","31248","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","31248WI0020001","TruAssure Preferred Adult or Child Dental Plan","31248WI002",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","31248WI0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WI","https://www.truassure.com/brochure?state=WI"
"2018","WI","34210","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","34210WI0020003","Renaissance Individual Dental PPO, EHB Certified","34210WI002",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34210WI0020003-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","WI","34210","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","34210WI0020004","Renaissance Individual Dental PPO, EHB Certified","34210WI002",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34210WI0020004-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","WI","34210","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","34210WI0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","34210WI004",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34210","","34210WI0040001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WI_EHB_High_2018","http://www.renaissancedental.com/WI_EHB_High_2018"
"2018","WI","34210","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","34210WI0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","34210WI004",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34210","","34210WI0040002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WI_EHB_Low_2018","http://www.renaissancedental.com/WI_EHB_Low_2018"
"2018","WI","34210","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","34210WI0060001","Renaissance Individual Dental Pediatric-Only, EHB Certified","34210WI006",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34210WI0060001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","WI","34210","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","34210WI0060002","Renaissance Individual Dental Pediatric-Only, EHB Certified","34210WI006",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34210WI0060002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130028","Atlas Individual $3500 Plus Silver","20173WI013",,"WIN001","WIS001","WIF003","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130028-02","Atlas Individual Silver Zero Cost Chare Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192652.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130028","Atlas Individual $3500 Plus Silver","20173WI013",,"WIN001","WIS001","WIF003","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130028-03","Atlas Individual $3500 Plus Silver Limited Cost Share Plan","Limited Cost Sharing Plan Variation","70.24%","0.682786507728434","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$3,500","$400","$400","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","15.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192653.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130028","Atlas Individual $3500 Plus Silver","20173WI013",,"WIN001","WIS001","WIF003","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130028-04","Atlas Individual $3000 Plus Silver Cost Share Reduction Plan","73% AV Level Silver Plan","72.66%","0.709312626722036","Yes","Yes","No","100%",,"$3,000","$40","$1,200","$60","$3,000","$400","$500","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192656.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130028","Atlas Individual $3500 Plus Silver","20173WI013",,"WIN001","WIS001","WIF003","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130028-05","Atlas Individual $800 Plus Silver Cost Share Reduction Plan","87% AV Level Silver Plan","86.11%","0.853322443627517","Yes","Yes","No","100%",,"$800","$40","$1,000","$60","$800","$500","$500","$60","$800","$90","$70","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192655.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","20173","HIOS","2017-11-01 02:20:20","Individual","No","41-1683523","20173WI0130028","Atlas Individual $3500 Plus Silver","20173WI013",,"WIN001","WIS001","WIF003","New","PPO","Silver","Not Applicable","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","No",,"https://www.healthpartners.com/genericsadvantagerx","20173WI0130028-06","Atlas Individual $125 Plus Silver Cost Share Reduction Plan","94% AV Level Silver Plan","93.07%","0.92715382446772","Yes","Yes","No","100%",,"$100","$40","$500","$60","$100","$600","$300","$60","$100","$300","$60","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","5.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_192654.pdf","https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_193818.pdf"
"2018","WI","31248","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","31248WI0010001","TruAssure Basic Adult or Child Dental Plan","31248WI001",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","31248WI0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","68.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$145","$145 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WI","https://www.truassure.com/brochure?state=WI"
"2018","WI","31248","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","31248WI0030001","TruAssure Dental Small Group Basic Plan","31248WI003",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","31248WI0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$80","$80 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","WI","31248","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","36-3757528","31248WI0040001","TruAssure Dental Small Group Preferred Plan","31248WI004",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","31248WI0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$80","$80 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","WI","31248","HIOS","2017-08-15 02:20:31","Individual","Yes","36-3757528","31248WI0010001","TruAssure Basic Adult or Child Dental Plan","31248WI001",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","31248WI0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","68.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$145","$145 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WI","https://www.truassure.com/brochure?state=WI"
"2018","WI","34210","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","34210WI0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","34210WI005",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34210","","34210WI0050001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WI_Ped_High_2018","http://www.renaissancedental.com/WI_Ped_High_2018"
"2018","WI","34210","HIOS","2017-07-30 02:12:13","Individual","Yes","47-0397286","34210WI0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","34210WI005",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34210","","34210WI0050002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WY_Ped_Low_2018","http://www.renaissancedental.com/WY_Ped_Low_2018"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510003","Prime Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510003-00","Prime Gold Healthy You - PCP Copay $30","Standard Gold Off Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG510300","https://unityhealth.com/2018/Prime/Brochure/Gold/PG510301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510087","Beloit One Bronze Deductible $6500","37833WI051","7114920342","WIN003","WIS003","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510087-02","Beloit One Bronze Deductible $6500","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB518702","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB518701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510053","ProHealth Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS004","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510053-01","ProHealth Silver 7100 Value - PCP Copay $75","Standard Silver On Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS515301","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS515301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510054","Pioneer One Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN004","WIS005","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510054-05","Pioneer One Silver Value - PCP Copay $25","87% AV Level Silver Plan",,"0.87981447908029","No","Yes","No","100%",,"$250","$400","$1,800","$10","$100","$1,300","$0","$0","$250","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$500 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS515405","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS515401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510009","Prime Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510009-06","Prime Silver Value - PCP Copay $15","94% AV Level Silver Plan",,"0.949621786946921","No","Yes","No","100%",,"$0","$300","$0","$10","$0","$900","$0","$0","$0","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$2450 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS510906","https://unityhealth.com/2018/Prime/Brochure/Silver/PS510901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510022","Beloit One Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510022-01","Beloit One Gold Healthy You - PCP Copay $30","Standard Gold On Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG512201","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG512201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510009","Prime Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510009-03","Prime Silver 7100 Value - PCP Copay $75","Limited Cost Sharing Plan Variation",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS510903","https://unityhealth.com/2018/Prime/Brochure/Silver/PS510901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510009","Prime Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510009-04","Prime Silver 4750 Value - PCP Copay $30","73% AV Level Silver Plan",,"0.738588705820109","No","Yes","No","100%",,"$4,750","$500","$600","$10","$100","$1,900","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$5850 per person","$9500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS510904","https://unityhealth.com/2018/Prime/Brochure/Silver/PS510901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510003","Prime Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510003-01","Prime Gold Healthy You - PCP Copay $30","Standard Gold On Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG510301","https://unityhealth.com/2018/Prime/Brochure/Gold/PG510301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510003","Prime Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510003-02","Prime Gold Healthy You - PCP Copay $30","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG510302","https://unityhealth.com/2018/Prime/Brochure/Gold/PG510301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510003","Prime Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510003-03","Prime Gold Healthy You - PCP Copay $30","Limited Cost Sharing Plan Variation",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG510303","https://unityhealth.com/2018/Prime/Brochure/Gold/PG510301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510008","Prime Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510008-00","Prime Silver 5000 Value - PCP Copay $35","Standard Silver Off Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS510800","https://unityhealth.com/2018/Prime/Brochure/Silver/PS510801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510008","Prime Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510008-01","Prime Silver 5000 Value - PCP Copay $35","Standard Silver On Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS510801","https://unityhealth.com/2018/Prime/Brochure/Silver/PS510801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510008","Prime Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510008-02","Prime Silver 5000 Value - PCP Copay $35","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS510802","https://unityhealth.com/2018/Prime/Brochure/Silver/PS510801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510008","Prime Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510008-03","Prime Silver 5000 Value - PCP Copay $35","Limited Cost Sharing Plan Variation",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS510803","https://unityhealth.com/2018/Prime/Brochure/Silver/PS510801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510008","Prime Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510008-04","Prime Silver 5000 Value - PCP Copay $35","73% AV Level Silver Plan",,"0.73969515180156","No","Yes","No","100%",,"$5,000","$600","$300","$10","$100","$1,900","$0","$0","$1,100","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5850 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS510804","https://unityhealth.com/2018/Prime/Brochure/Silver/PS510801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510008","Prime Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510008-05","Prime Silver Value - PCP Copay $15","87% AV Level Silver Plan",,"0.879665455688055","No","Yes","No","100%",,"$400","$200","$1,800","$10","$100","$900","$0","$0","$400","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$800 per person","$800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS510805","https://unityhealth.com/2018/Prime/Brochure/Silver/PS510801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510008","Prime Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510008-06","Prime Silver Value - PCP Copay $5","94% AV Level Silver Plan",,"0.9495901272702","No","Yes","No","100%",,"$100","$100","$500","$10","$100","$600","$10","$0","$100","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS510806","https://unityhealth.com/2018/Prime/Brochure/Silver/PS510801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510009","Prime Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510009-00","Prime Silver 7100 Value - PCP Copay $75","Standard Silver Off Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS510900","https://unityhealth.com/2018/Prime/Brochure/Silver/PS510901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510009","Prime Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510009-01","Prime Silver 7100 Value - PCP Copay $75","Standard Silver On Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS510901","https://unityhealth.com/2018/Prime/Brochure/Silver/PS510901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510009","Prime Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510009-02","Prime Silver 7100 Value - PCP Copay $75","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS510902","https://unityhealth.com/2018/Prime/Brochure/Silver/PS510901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510009","Prime Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510009-05","Prime Silver Value - PCP Copay $25","87% AV Level Silver Plan",,"0.87981447908029","No","Yes","No","100%",,"$250","$400","$1,800","$10","$100","$1,300","$0","$0","$250","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$500 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS510905","https://unityhealth.com/2018/Prime/Brochure/Silver/PS510901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510019","Elite Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510019-02","Elite Silver 7100 Value - PCP Copay $75","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES511902","https://unityhealth.com/2018/Elite/Brochure/Silver/ES511901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510019","Elite Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510019-03","Elite Silver 7100 Value - PCP Copay $75","Limited Cost Sharing Plan Variation",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES511903","https://unityhealth.com/2018/Elite/Brochure/Silver/ES511901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510019","Elite Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510019-04","Elite Silver 4750 Value - PCP Copay $30","73% AV Level Silver Plan",,"0.738588705820109","No","Yes","No","100%",,"$4,750","$500","$600","$10","$100","$1,900","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$5850 per person","$9500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES511904","https://unityhealth.com/2018/Elite/Brochure/Silver/ES511901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510019","Elite Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510019-05","Elite Silver Value - PCP Copay $25","87% AV Level Silver Plan",,"0.87981447908029","No","Yes","No","100%",,"$250","$400","$1,800","$10","$100","$1,300","$0","$0","$250","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$500 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES511905","https://unityhealth.com/2018/Elite/Brochure/Silver/ES511901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510085","Prime Bronze Deductible $6500","37833WI051","7114920342","WIN001","WIS001","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510085-00","Prime Bronze Deductible $6500","Standard Bronze Off Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB518500","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB518501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510085","Prime Bronze Deductible $6500","37833WI051","7114920342","WIN001","WIS001","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510085-01","Prime Bronze Deductible $6500","Standard Bronze On Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB518501","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB518501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510085","Prime Bronze Deductible $6500","37833WI051","7114920342","WIN001","WIS001","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510085-02","Prime Bronze Deductible $6500","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB518502","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB518501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510085","Prime Bronze Deductible $6500","37833WI051","7114920342","WIN001","WIS001","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510085-03","Prime Bronze Deductible $6500","Limited Cost Sharing Plan Variation",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB518503","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB518501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540004","Prime Catastrophic","37833WI054","7114920342","WIN001","WIS001","WIF009","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540004-00","Prime Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$6,800","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Prime/SBC/Catastrophic/PC540400","https://unityhealth.com/2018/Prime/Brochure/Catastrophic/PC540401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540004","Prime Catastrophic","37833WI054","7114920342","WIN001","WIS001","WIF009","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540004-01","Prime Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$6,800","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Prime/SBC/Catastrophic/PC540401","https://unityhealth.com/2018/Prime/Brochure/Catastrophic/PC540401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510013","Elite Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510013-00","Elite Gold Healthy You - PCP Copay $30","Standard Gold Off Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG511300","https://unityhealth.com/2018/Elite/Brochure/Gold/EG511301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510013","Elite Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510013-01","Elite Gold Healthy You - PCP Copay $30","Standard Gold On Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG511301","https://unityhealth.com/2018/Elite/Brochure/Gold/EG511301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510013","Elite Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510013-02","Elite Gold Healthy You - PCP Copay $30","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG511302","https://unityhealth.com/2018/Elite/Brochure/Gold/EG511301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510013","Elite Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510013-03","Elite Gold Healthy You - PCP Copay $30","Limited Cost Sharing Plan Variation",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG511303","https://unityhealth.com/2018/Elite/Brochure/Gold/EG511301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510018","Elite Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510018-00","Elite Silver 5000 Value - PCP Copay $35","Standard Silver Off Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES511800","https://unityhealth.com/2018/Elite/Brochure/Silver/ES511801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510018","Elite Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510018-01","Elite Silver 5000 Value - PCP Copay $35","Standard Silver On Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES511801","https://unityhealth.com/2018/Elite/Brochure/Silver/ES511801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510018","Elite Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510018-02","Elite Silver 5000 Value - PCP Copay $35","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES511802","https://unityhealth.com/2018/Elite/Brochure/Silver/ES511801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510018","Elite Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510018-03","Elite Silver 5000 Value - PCP Copay $35","Limited Cost Sharing Plan Variation",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES511803","https://unityhealth.com/2018/Elite/Brochure/Silver/ES511801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510018","Elite Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510018-04","Elite Silver 5000 Value - PCP Copay $35","73% AV Level Silver Plan",,"0.73969515180156","No","Yes","No","100%",,"$5,000","$600","$300","$10","$100","$1,900","$0","$0","$1,100","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5850 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES511804","https://unityhealth.com/2018/Elite/Brochure/Silver/ES511801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510018","Elite Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510018-05","Elite Silver Value - PCP Copay $15","87% AV Level Silver Plan",,"0.879665455688055","No","Yes","No","100%",,"$400","$200","$1,800","$10","$100","$900","$0","$0","$400","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$800 per person","$800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES511805","https://unityhealth.com/2018/Elite/Brochure/Silver/ES511801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510018","Elite Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510018-06","Elite Silver Value - PCP Copay $5","94% AV Level Silver Plan",,"0.9495901272702","No","Yes","No","100%",,"$100","$100","$500","$10","$100","$600","$10","$0","$100","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES511806","https://unityhealth.com/2018/Elite/Brochure/Silver/ES511801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510019","Elite Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510019-00","Elite Silver 7100 Value - PCP Copay $75","Standard Silver Off Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES511900","https://unityhealth.com/2018/Elite/Brochure/Silver/ES511901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510019","Elite Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510019-01","Elite Silver 7100 Value - PCP Copay $75","Standard Silver On Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES511901","https://unityhealth.com/2018/Elite/Brochure/Silver/ES511901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510019","Elite Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510019-06","Elite Silver Value - PCP Copay $15","94% AV Level Silver Plan",,"0.949621786946921","No","Yes","No","100%",,"$0","$300","$0","$10","$0","$900","$0","$0","$0","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$2450 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES511906","https://unityhealth.com/2018/Elite/Brochure/Silver/ES511901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510086","Elite Bronze Deductible $6500","37833WI051","7114920342","WIN002","WIS002","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510086-00","Elite Bronze Deductible $6500","Standard Bronze Off Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB518600","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB518601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510086","Elite Bronze Deductible $6500","37833WI051","7114920342","WIN002","WIS002","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510086-01","Elite Bronze Deductible $6500","Standard Bronze On Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB518601","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB518601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510086","Elite Bronze Deductible $6500","37833WI051","7114920342","WIN002","WIS002","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510086-02","Elite Bronze Deductible $6500","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB518602","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB518601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510086","Elite Bronze Deductible $6500","37833WI051","7114920342","WIN002","WIS002","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510086-03","Elite Bronze Deductible $6500","Limited Cost Sharing Plan Variation",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB518603","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB518601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540008","Elite Catastrophic","37833WI054","7114920342","WIN002","WIS002","WIF009","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540008-00","Elite Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$6,800","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Elite/SBC/Catastrophic/EC540800","https://unityhealth.com/2018/Elite/Brochure/Catastrophic/EC540801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540008","Elite Catastrophic","37833WI054","7114920342","WIN002","WIS002","WIF009","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540008-01","Elite Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$6,800","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Elite/SBC/Catastrophic/EC540801","https://unityhealth.com/2018/Elite/Brochure/Catastrophic/EC540801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510022","Beloit One Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510022-00","Beloit One Gold Healthy You - PCP Copay $30","Standard Gold Off Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG512200","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG512201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510022","Beloit One Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510022-02","Beloit One Gold Healthy You - PCP Copay $30","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG512202","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG512201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510022","Beloit One Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510022-03","Beloit One Gold Healthy You - PCP Copay $30","Limited Cost Sharing Plan Variation",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG512203","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG512201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510044","Beloit One Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510044-00","Beloit One Silver 5000 Value - PCP Copay $35","Standard Silver Off Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS514400","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS514401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510044","Beloit One Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510044-01","Beloit One Silver 5000 Value - PCP Copay $35","Standard Silver On Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS514401","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS514401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510091","Prime Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN001","WIS001","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510091-03","Prime Gold Maintenance - PCP Copay $20","Limited Cost Sharing Plan Variation",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG519103","https://unityhealth.com/2018/Prime/Brochure/Gold/PG519101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510092","Elite Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN002","WIS002","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510092-00","Elite Gold Maintenance - PCP Copay $20","Standard Gold Off Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG519200","https://unityhealth.com/2018/Elite/Brochure/Gold/EG519201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510092","Elite Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN002","WIS002","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510092-01","Elite Gold Maintenance - PCP Copay $20","Standard Gold On Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG519201","https://unityhealth.com/2018/Elite/Brochure/Gold/EG519201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510092","Elite Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN002","WIS002","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510092-02","Elite Gold Maintenance - PCP Copay $20","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG519202","https://unityhealth.com/2018/Elite/Brochure/Gold/EG519201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510044","Beloit One Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510044-02","Beloit One Silver 5000 Value - PCP Copay $35","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS514402","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS514401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510044","Beloit One Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510044-03","Beloit One Silver 5000 Value - PCP Copay $35","Limited Cost Sharing Plan Variation",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS514403","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS514401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510044","Beloit One Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510044-04","Beloit One Silver 5000 Value - PCP Copay $35","73% AV Level Silver Plan",,"0.73969515180156","No","Yes","No","100%",,"$5,000","$600","$300","$10","$100","$1,900","$0","$0","$1,100","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5850 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS514404","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS514401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510044","Beloit One Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510044-05","Beloit One Silver Value - PCP Copay $15","87% AV Level Silver Plan",,"0.879665455688055","No","Yes","No","100%",,"$400","$200","$1,800","$10","$100","$900","$0","$0","$400","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$800 per person","$800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS514405","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS514401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510044","Beloit One Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510044-06","Beloit One Silver Value - PCP Copay $5","94% AV Level Silver Plan",,"0.9495901272702","No","Yes","No","100%",,"$100","$100","$500","$10","$100","$600","$10","$0","$100","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS514406","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS514401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510024","Beloit One Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510024-00","Beloit One Silver 7100 Value - PCP Copay $75","Standard Silver Off Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS512400","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS512401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510024","Beloit One Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510024-01","Beloit One Silver 7100 Value - PCP Copay $75","Standard Silver On Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS512401","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS512401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510024","Beloit One Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510024-02","Beloit One Silver 7100 Value - PCP Copay $75","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS512402","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS512401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510024","Beloit One Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510024-03","Beloit One Silver 7100 Value - PCP Copay $75","Limited Cost Sharing Plan Variation",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS512403","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS512401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510024","Beloit One Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510024-04","Beloit One Silver 4750 Value - PCP Copay $30","73% AV Level Silver Plan",,"0.738588705820109","No","Yes","No","100%",,"$4,750","$500","$600","$10","$100","$1,900","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$5850 per person","$9500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS512404","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS512401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510024","Beloit One Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510024-05","Beloit One Silver Value - PCP Copay $25","87% AV Level Silver Plan",,"0.87981447908029","No","Yes","No","100%",,"$250","$400","$1,800","$10","$100","$1,300","$0","$0","$250","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$500 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS512405","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS512401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510024","Beloit One Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510024-06","Beloit One Silver Value - PCP Copay $15","94% AV Level Silver Plan",,"0.949621786946921","No","Yes","No","100%",,"$0","$300","$0","$10","$0","$900","$0","$0","$0","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$2450 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS512406","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS512401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510087","Beloit One Bronze Deductible $6500","37833WI051","7114920342","WIN003","WIS003","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510087-00","Beloit One Bronze Deductible $6500","Standard Bronze Off Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB518700","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB518701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510087","Beloit One Bronze Deductible $6500","37833WI051","7114920342","WIN003","WIS003","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510087-01","Beloit One Bronze Deductible $6500","Standard Bronze On Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB518701","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB518701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510087","Beloit One Bronze Deductible $6500","37833WI051","7114920342","WIN003","WIS003","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510087-03","Beloit One Bronze Deductible $6500","Limited Cost Sharing Plan Variation",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB518703","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB518701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540011","Beloit One Catastrophic","37833WI054","7114920342","WIN003","WIS003","WIF009","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540011-00","Beloit One Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$6,800","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Catastrophic/BOC541100","https://unityhealth.com/2018/BeloitOne/Brochure/Catastrophic/BOC541101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540011","Beloit One Catastrophic","37833WI054","7114920342","WIN003","WIS003","WIF009","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540011-01","Beloit One Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$6,800","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Catastrophic/BOC541101","https://unityhealth.com/2018/BeloitOne/Brochure/Catastrophic/BOC541101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510091","Prime Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN001","WIS001","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510091-00","Prime Gold Maintenance - PCP Copay $20","Standard Gold Off Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG519100","https://unityhealth.com/2018/Prime/Brochure/Gold/PG519101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510091","Prime Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN001","WIS001","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510091-01","Prime Gold Maintenance - PCP Copay $20","Standard Gold On Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG519101","https://unityhealth.com/2018/Prime/Brochure/Gold/PG519101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510091","Prime Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN001","WIS001","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510091-02","Prime Gold Maintenance - PCP Copay $20","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG519102","https://unityhealth.com/2018/Prime/Brochure/Gold/PG519101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510092","Elite Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN002","WIS002","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510092-03","Elite Gold Maintenance - PCP Copay $20","Limited Cost Sharing Plan Variation",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG519203","https://unityhealth.com/2018/Elite/Brochure/Gold/EG519201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510093","Beloit One Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN003","WIS003","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510093-00","Beloit One Gold Maintenance - PCP Copay $20","Standard Gold Off Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG519300","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG519301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510093","Beloit One Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN003","WIS003","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510093-01","Beloit One Gold Maintenance - PCP Copay $20","Standard Gold On Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG519301","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG519301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510093","Beloit One Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN003","WIS003","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510093-02","Beloit One Gold Maintenance - PCP Copay $20","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG519302","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG519301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510093","Beloit One Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN003","WIS003","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510093-03","Beloit One Gold Maintenance - PCP Copay $20","Limited Cost Sharing Plan Variation",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG519303","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG519301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510045","ProHealth Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN002","WIS004","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510045-00","ProHealth Gold Healthy You - PCP Copay $30","Standard Gold Off Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG514500","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG514501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510045","ProHealth Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN002","WIS004","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510045-01","ProHealth Gold Healthy You - PCP Copay $30","Standard Gold On Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG514501","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG514501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510045","ProHealth Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN002","WIS004","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510045-02","ProHealth Gold Healthy You - PCP Copay $30","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG514502","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG514501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510045","ProHealth Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN002","WIS004","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510045-03","ProHealth Gold Healthy You - PCP Copay $30","Limited Cost Sharing Plan Variation",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG514503","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG514501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510051","ProHealth Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510051-00","ProHealth Silver 5000 Value - PCP Copay $35","Standard Silver Off Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS515100","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS515101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510051","ProHealth Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510051-01","ProHealth Silver 5000 Value - PCP Copay $35","Standard Silver On Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS515101","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS515101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510051","ProHealth Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510051-02","ProHealth Silver 5000 Value - PCP Copay $35","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS515102","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS515101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510051","ProHealth Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510051-03","ProHealth Silver 5000 Value - PCP Copay $35","Limited Cost Sharing Plan Variation",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS515103","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS515101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510051","ProHealth Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510051-04","ProHealth Silver 5000 Value - PCP Copay $35","73% AV Level Silver Plan",,"0.73969515180156","No","Yes","No","100%",,"$5,000","$600","$300","$10","$100","$1,900","$0","$0","$1,100","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5850 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS515104","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS515101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510051","ProHealth Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510051-05","ProHealth Silver Value - PCP Copay $15","87% AV Level Silver Plan",,"0.879665455688055","No","Yes","No","100%",,"$400","$200","$1,800","$10","$100","$900","$0","$0","$400","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$800 per person","$800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS515105","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS515101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510051","ProHealth Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510051-06","ProHealth Silver Value - PCP Copay $5","94% AV Level Silver Plan",,"0.9495901272702","No","Yes","No","100%",,"$100","$100","$500","$10","$100","$600","$10","$0","$100","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS515106","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS515101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510053","ProHealth Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS004","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510053-00","ProHealth Silver 7100 Value - PCP Copay $75","Standard Silver Off Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS515300","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS515301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510053","ProHealth Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS004","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510053-02","ProHealth Silver 7100 Value - PCP Copay $75","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS515302","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS515301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510053","ProHealth Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS004","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510053-03","ProHealth Silver 7100 Value - PCP Copay $75","Limited Cost Sharing Plan Variation",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS515303","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS515301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510053","ProHealth Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS004","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510053-04","ProHealth Silver 4750 Value - PCP Copay $30","73% AV Level Silver Plan",,"0.738588705820109","No","Yes","No","100%",,"$4,750","$500","$600","$10","$100","$1,900","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$5850 per person","$9500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS515304","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS515301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510053","ProHealth Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS004","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510053-05","ProHealth Silver Value - PCP Copay $25","87% AV Level Silver Plan",,"0.87981447908029","No","Yes","No","100%",,"$250","$400","$1,800","$10","$100","$1,300","$0","$0","$250","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$500 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS515305","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS515301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510053","ProHealth Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS004","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510053-06","ProHealth Silver Value - PCP Copay $15","94% AV Level Silver Plan",,"0.949621786946921","No","Yes","No","100%",,"$0","$300","$0","$10","$0","$900","$0","$0","$0","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$2450 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS515306","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS515301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510088","ProHealth Bronze Deductible $6500","37833WI051","7114920342","WIN002","WIS004","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510088-00","ProHealth Bronze Deductible $6500","Standard Bronze Off Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB518800","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB518801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510088","ProHealth Bronze Deductible $6500","37833WI051","7114920342","WIN002","WIS004","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510088-01","ProHealth Bronze Deductible $6500","Standard Bronze On Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB518801","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB518801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510088","ProHealth Bronze Deductible $6500","37833WI051","7114920342","WIN002","WIS004","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510088-02","ProHealth Bronze Deductible $6500","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB518802","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB518801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510088","ProHealth Bronze Deductible $6500","37833WI051","7114920342","WIN002","WIS004","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510088-03","ProHealth Bronze Deductible $6500","Limited Cost Sharing Plan Variation",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB518803","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB518801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540021","ProHealth Catastrophic","37833WI054","7114920342","WIN002","WIS004","WIF009","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540021-00","ProHealth Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$6,800","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/ProHealth/SBC/Catastrophic/PHC542100","https://unityhealth.com/2018/ProHealth/Brochure/Catastrophic/PHC542101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540021","ProHealth Catastrophic","37833WI054","7114920342","WIN002","WIS004","WIF009","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540021-01","ProHealth Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$6,800","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/ProHealth/SBC/Catastrophic/PHC542101","https://unityhealth.com/2018/ProHealth/Brochure/Catastrophic/PHC542101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510046","Pioneer One Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN004","WIS005","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510046-00","Pioneer One Gold Healthy You - PCP Copay $30","Standard Gold Off Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG514600","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG514601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510046","Pioneer One Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN004","WIS005","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510046-01","Pioneer One Gold Healthy You - PCP Copay $30","Standard Gold On Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG514601","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG514601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510046","Pioneer One Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN004","WIS005","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510046-02","Pioneer One Gold Healthy You - PCP Copay $30","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG514602","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG514601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510046","Pioneer One Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN004","WIS005","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510046-03","Pioneer One Gold Healthy You - PCP Copay $30","Limited Cost Sharing Plan Variation",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG514603","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG514601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510089","Pioneer One Bronze Deductible $6500","37833WI051","7114920342","WIN004","WIS005","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510089-03","Pioneer One Bronze Deductible $6500","Limited Cost Sharing Plan Variation",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB518903","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB518901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540022","Pioneer One Catastrophic","37833WI054","7114920342","WIN004","WIS005","WIF009","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540022-00","Pioneer One Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$6,800","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Catastrophic/POC542200","https://unityhealth.com/2018/PioneerOne/Brochure/Catastrophic/POC542201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510052","Pioneer One Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN004","WIS005","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510052-00","Pioneer One Silver 5000 Value - PCP Copay $35","Standard Silver Off Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS515200","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS515201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510052","Pioneer One Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN004","WIS005","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510052-01","Pioneer One Silver 5000 Value - PCP Copay $35","Standard Silver On Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS515201","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS515201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510052","Pioneer One Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN004","WIS005","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510052-02","Pioneer One Silver 5000 Value - PCP Copay $35","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS515202","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS515201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510052","Pioneer One Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN004","WIS005","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510052-03","Pioneer One Silver 5000 Value - PCP Copay $35","Limited Cost Sharing Plan Variation",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS515203","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS515201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510052","Pioneer One Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN004","WIS005","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510052-04","Pioneer One Silver 5000 Value - PCP Copay $35","73% AV Level Silver Plan",,"0.73969515180156","No","Yes","No","100%",,"$5,000","$600","$300","$10","$100","$1,900","$0","$0","$1,100","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5850 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS515204","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS515201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510052","Pioneer One Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN004","WIS005","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510052-05","Pioneer One Silver Value - PCP Copay $15","87% AV Level Silver Plan",,"0.879665455688055","No","Yes","No","100%",,"$400","$200","$1,800","$10","$100","$900","$0","$0","$400","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$800 per person","$800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS515205","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS515201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510052","Pioneer One Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN004","WIS005","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510052-06","Pioneer One Silver Value - PCP Copay $5","94% AV Level Silver Plan",,"0.9495901272702","No","Yes","No","100%",,"$100","$100","$500","$10","$100","$600","$10","$0","$100","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS515206","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS515201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510054","Pioneer One Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN004","WIS005","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510054-00","Pioneer One Silver 7100 Value - PCP Copay $75","Standard Silver Off Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS515400","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS515401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510054","Pioneer One Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN004","WIS005","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510054-01","Pioneer One Silver 7100 Value - PCP Copay $75","Standard Silver On Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS515401","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS515401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510054","Pioneer One Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN004","WIS005","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510054-02","Pioneer One Silver 7100 Value - PCP Copay $75","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS515402","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS515401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510054","Pioneer One Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN004","WIS005","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510054-03","Pioneer One Silver 7100 Value - PCP Copay $75","Limited Cost Sharing Plan Variation",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS515403","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS515401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510054","Pioneer One Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN004","WIS005","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510054-04","Pioneer One Silver 4750 Value - PCP Copay $30","73% AV Level Silver Plan",,"0.738588705820109","No","Yes","No","100%",,"$4,750","$500","$600","$10","$100","$1,900","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$5850 per person","$9500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS515404","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS515401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510054","Pioneer One Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN004","WIS005","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510054-06","Pioneer One Silver Value - PCP Copay $15","94% AV Level Silver Plan",,"0.949621786946921","No","Yes","No","100%",,"$0","$300","$0","$10","$0","$900","$0","$0","$0","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$2450 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS515406","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS515401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510089","Pioneer One Bronze Deductible $6500","37833WI051","7114920342","WIN004","WIS005","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510089-00","Pioneer One Bronze Deductible $6500","Standard Bronze Off Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB518900","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB518901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510089","Pioneer One Bronze Deductible $6500","37833WI051","7114920342","WIN004","WIS005","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510089-01","Pioneer One Bronze Deductible $6500","Standard Bronze On Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB518901","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB518901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510089","Pioneer One Bronze Deductible $6500","37833WI051","7114920342","WIN004","WIS005","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510089-02","Pioneer One Bronze Deductible $6500","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB518902","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB518901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510079","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS006","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510079-02","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS517902","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS517901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510079","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS006","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510079-03","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75","Limited Cost Sharing Plan Variation",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS517903","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS517901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510079","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS006","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510079-04","Gundersen Health System (R) Silver 4750 Value - PCP Copay $30","73% AV Level Silver Plan",,"0.738588705820109","No","Yes","No","100%",,"$4,750","$500","$600","$10","$100","$1,900","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$5850 per person","$9500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS517904","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS517901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510079","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS006","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510079-05","Gundersen Health System (R) Silver Value - PCP Copay $25","87% AV Level Silver Plan",,"0.87981447908029","No","Yes","No","100%",,"$250","$400","$1,800","$10","$100","$1,300","$0","$0","$250","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$500 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS517905","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS517901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540022","Pioneer One Catastrophic","37833WI054","7114920342","WIN004","WIS005","WIF009","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540022-01","Pioneer One Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$6,800","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Catastrophic/POC542201","https://unityhealth.com/2018/PioneerOne/Brochure/Catastrophic/POC542201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510077","Gundersen Health System (R) Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN002","WIS006","WIF001","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510077-00","Gundersen Health System (R) Gold Healthy You - PCP Copay $30","Standard Gold Off Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG517700","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG517701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510090","Gundersen Health System (R) Bronze Deductible $6500","37833WI051","7114920342","WIN002","WIS006","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510090-03","Gundersen Health System (R) Bronze Deductible $6500","Limited Cost Sharing Plan Variation",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB519003","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB519001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540044","Gundersen Health System (R) Catastrophic","37833WI054","7114920342","WIN002","WIS006","WIF009","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540044-00","Gundersen Health System (R) Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$6,800","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/GHS/SBC/Catastrophic/GHSC544400","https://unityhealth.com/2018/GHS/Brochure/Catastrophic/GHSC544401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540044","Gundersen Health System (R) Catastrophic","37833WI054","7114920342","WIN002","WIS006","WIF009","New","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540044-01","Gundersen Health System (R) Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$6,800","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/GHS/SBC/Catastrophic/GHSC544401","https://unityhealth.com/2018/GHS/Brochure/Catastrophic/GHSC544401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510094","ProHealth Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510094-00","ProHealth Gold Maintenance - PCP Copay $20","Standard Gold Off Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG519400","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG519401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380084","Prime Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380084-00","Prime Bronze Deductible $6500 with Dental","Standard Bronze Off Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB388400","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB388401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380084","Prime Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380084-01","Prime Bronze Deductible $6500 with Dental","Standard Bronze On Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB388401","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB388401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510077","Gundersen Health System (R) Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN002","WIS006","WIF001","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510077-01","Gundersen Health System (R) Gold Healthy You - PCP Copay $30","Standard Gold On Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG517701","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG517701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510077","Gundersen Health System (R) Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN002","WIS006","WIF001","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510077-02","Gundersen Health System (R) Gold Healthy You - PCP Copay $30","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG517702","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG517701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510077","Gundersen Health System (R) Gold Healthy You - PCP Copay $30","37833WI051","7114920342","WIN002","WIS006","WIF001","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510077-03","Gundersen Health System (R) Gold Healthy You - PCP Copay $30","Limited Cost Sharing Plan Variation",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG517703","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG517701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510080","Gundersen Health System (R) Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN002","WIS006","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510080-00","Gundersen Health System (R) Gold Maintenance - PCP Copay $20","Standard Gold Off Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG518000","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG518001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510080","Gundersen Health System (R) Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN002","WIS006","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510080-01","Gundersen Health System (R) Gold Maintenance - PCP Copay $20","Standard Gold On Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG518001","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG518001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510080","Gundersen Health System (R) Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN002","WIS006","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510080-02","Gundersen Health System (R) Gold Maintenance - PCP Copay $20","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG518002","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG518001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510080","Gundersen Health System (R) Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN002","WIS006","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510080-03","Gundersen Health System (R) Gold Maintenance - PCP Copay $20","Limited Cost Sharing Plan Variation",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG518003","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG518001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510078","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS006","WIF004","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510078-00","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35","Standard Silver Off Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS517800","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS517801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510078","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS006","WIF004","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510078-01","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35","Standard Silver On Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS517801","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS517801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510078","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS006","WIF004","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510078-02","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS517802","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS517801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510078","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS006","WIF004","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510078-03","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35","Limited Cost Sharing Plan Variation",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS517803","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS517801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510078","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS006","WIF004","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510078-04","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35","73% AV Level Silver Plan",,"0.73969515180156","No","Yes","No","100%",,"$5,000","$600","$300","$10","$100","$1,900","$0","$0","$1,100","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5850 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS517804","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS517801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510078","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS006","WIF004","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510078-05","Gundersen Health System (R) Silver Value - PCP Copay $15","87% AV Level Silver Plan",,"0.879665455688055","No","Yes","No","100%",,"$400","$200","$1,800","$10","$100","$900","$0","$0","$400","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$800 per person","$800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS517805","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS517801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510078","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35","37833WI051","7114920342","WIN002","WIS006","WIF004","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510078-06","Gundersen Health System (R) Silver Value - PCP Copay $5","94% AV Level Silver Plan",,"0.9495901272702","No","Yes","No","100%",,"$100","$100","$500","$10","$100","$600","$10","$0","$100","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS517806","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS517801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510079","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS006","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510079-00","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75","Standard Silver Off Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS517900","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS517901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510079","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS006","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510079-01","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75","Standard Silver On Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS517901","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS517901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510079","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75","37833WI051","7114920342","WIN002","WIS006","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510079-06","Gundersen Health System (R) Silver Value - PCP Copay $15","94% AV Level Silver Plan",,"0.949621786946921","No","Yes","No","100%",,"$0","$300","$0","$10","$0","$900","$0","$0","$0","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$2450 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS517906","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS517901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510090","Gundersen Health System (R) Bronze Deductible $6500","37833WI051","7114920342","WIN002","WIS006","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510090-00","Gundersen Health System (R) Bronze Deductible $6500","Standard Bronze Off Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB519000","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB519001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510090","Gundersen Health System (R) Bronze Deductible $6500","37833WI051","7114920342","WIN002","WIS006","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510090-01","Gundersen Health System (R) Bronze Deductible $6500","Standard Bronze On Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB519001","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB519001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510090","Gundersen Health System (R) Bronze Deductible $6500","37833WI051","7114920342","WIN002","WIS006","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510090-02","Gundersen Health System (R) Bronze Deductible $6500","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB519002","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB519001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510094","ProHealth Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510094-01","ProHealth Gold Maintenance - PCP Copay $20","Standard Gold On Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG519401","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG519401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510094","ProHealth Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510094-02","ProHealth Gold Maintenance - PCP Copay $20","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG519402","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG519401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510094","ProHealth Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN002","WIS004","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510094-03","ProHealth Gold Maintenance - PCP Copay $20","Limited Cost Sharing Plan Variation",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG519403","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG519401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510095","Pioneer One Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510095-00","Pioneer One Gold Maintenance - PCP Copay $20","Standard Gold Off Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG519500","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG519501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510095","Pioneer One Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510095-01","Pioneer One Gold Maintenance - PCP Copay $20","Standard Gold On Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG519501","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG519501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510095","Pioneer One Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510095-02","Pioneer One Gold Maintenance - PCP Copay $20","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG519502","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG519501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510095","Pioneer One Gold Maintenance - PCP Copay $20","37833WI051","7114920342","WIN004","WIS005","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510095-03","Pioneer One Gold Maintenance - PCP Copay $20","Limited Cost Sharing Plan Variation",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG519503","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG519501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380009","Prime Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380009-00","Prime Gold Healthy You - PCP Copay $30 with Dental","Standard Gold Off Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG380900","https://unityhealth.com/2018/Prime/Brochure/Gold/PG380901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380009","Prime Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380009-01","Prime Gold Healthy You - PCP Copay $30 with Dental","Standard Gold On Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG380901","https://unityhealth.com/2018/Prime/Brochure/Gold/PG380901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380009","Prime Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380009-02","Prime Gold Healthy You - PCP Copay $30 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG380902","https://unityhealth.com/2018/Prime/Brochure/Gold/PG380901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380009","Prime Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380009-03","Prime Gold Healthy You - PCP Copay $30 with Dental","Limited Cost Sharing Plan Variation",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG380903","https://unityhealth.com/2018/Prime/Brochure/Gold/PG380901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380018","Prime Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380018-00","Prime Silver 5000 Value - PCP Copay $35 with Dental","Standard Silver Off Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS381800","https://unityhealth.com/2018/Prime/Brochure/Silver/PS381801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380018","Prime Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380018-01","Prime Silver 5000 Value - PCP Copay $35 with Dental","Standard Silver On Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS381801","https://unityhealth.com/2018/Prime/Brochure/Silver/PS381801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380018","Prime Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380018-02","Prime Silver 5000 Value - PCP Copay $35 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS381802","https://unityhealth.com/2018/Prime/Brochure/Silver/PS381801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380018","Prime Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380018-03","Prime Silver 5000 Value - PCP Copay $35 with Dental","Limited Cost Sharing Plan Variation",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS381803","https://unityhealth.com/2018/Prime/Brochure/Silver/PS381801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380018","Prime Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380018-04","Prime Silver 5000 Value - PCP Copay $35 with Dental","73% AV Level Silver Plan",,"0.73969515180156","No","Yes","No","100%",,"$5,000","$600","$300","$10","$100","$1,900","$0","$0","$1,100","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5850 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS381804","https://unityhealth.com/2018/Prime/Brochure/Silver/PS381801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380018","Prime Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380018-05","Prime Silver Value - PCP Copay $15 with Dental","87% AV Level Silver Plan",,"0.879665455688055","No","Yes","No","100%",,"$400","$200","$1,800","$10","$100","$900","$0","$0","$400","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$800 per person","$800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS381805","https://unityhealth.com/2018/Prime/Brochure/Silver/PS381801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380018","Prime Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380018-06","Prime Silver Value - PCP Copay $5 with Dental","94% AV Level Silver Plan",,"0.9495901272702","No","Yes","No","100%",,"$100","$100","$500","$10","$100","$600","$10","$0","$100","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS381806","https://unityhealth.com/2018/Prime/Brochure/Silver/PS381801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380019","Prime Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380019-00","Prime Silver 7100 Value - PCP Copay $75 with Dental","Standard Silver Off Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS381900","https://unityhealth.com/2018/Prime/Brochure/Silver/PS381901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380019","Prime Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380019-01","Prime Silver 7100 Value - PCP Copay $75 with Dental","Standard Silver On Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS381901","https://unityhealth.com/2018/Prime/Brochure/Silver/PS381901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380019","Prime Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380019-02","Prime Silver 7100 Value - PCP Copay $75 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS381902","https://unityhealth.com/2018/Prime/Brochure/Silver/PS381901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380019","Prime Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380019-03","Prime Silver 7100 Value - PCP Copay $75 with Dental","Limited Cost Sharing Plan Variation",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS381903","https://unityhealth.com/2018/Prime/Brochure/Silver/PS381901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380019","Prime Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380019-04","Prime Silver 4750 Value - PCP Copay $30 with Dental","73% AV Level Silver Plan",,"0.738588705820109","No","Yes","No","100%",,"$4,750","$500","$600","$10","$100","$1,900","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$5850 per person","$9500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS381904","https://unityhealth.com/2018/Prime/Brochure/Silver/PS381901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380019","Prime Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380019-05","Prime Silver Value - PCP Copay $25 with Dental","87% AV Level Silver Plan",,"0.87981447908029","No","Yes","No","100%",,"$250","$400","$1,800","$10","$100","$1,300","$0","$0","$250","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$500 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS381905","https://unityhealth.com/2018/Prime/Brochure/Silver/PS381901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380029","Elite Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380029-04","Elite Silver 4750 Value - PCP Copay $30 with Dental","73% AV Level Silver Plan",,"0.738588705820109","No","Yes","No","100%",,"$4,750","$500","$600","$10","$100","$1,900","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$5850 per person","$9500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES382904","https://unityhealth.com/2018/Elite/Brochure/Silver/ES382901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380029","Elite Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380029-05","Elite Silver Value - PCP Copay $25 with Dental","87% AV Level Silver Plan",,"0.87981447908029","No","Yes","No","100%",,"$250","$400","$1,800","$10","$100","$1,300","$0","$0","$250","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$500 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES382905","https://unityhealth.com/2018/Elite/Brochure/Silver/ES382901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380019","Prime Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380019-06","Prime Silver Value - PCP Copay $15 with Dental","94% AV Level Silver Plan",,"0.949621786946921","No","Yes","No","100%",,"$0","$300","$0","$10","$0","$900","$0","$0","$0","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$2450 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS381906","https://unityhealth.com/2018/Prime/Brochure/Silver/PS381901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380084","Prime Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380084-02","Prime Bronze Deductible $6500 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB388402","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB388401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380084","Prime Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380084-03","Prime Bronze Deductible $6500 with Dental","Limited Cost Sharing Plan Variation",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB388403","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB388401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380023","Elite Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380023-00","Elite Gold Healthy You - PCP Copay $30 with Dental","Standard Gold Off Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG382300","https://unityhealth.com/2018/Elite/Brochure/Gold/EG382301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380074","Pioneer One Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380074-00","Pioneer One Silver 5000 Value - PCP Copay $35 with Dental","Standard Silver Off Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS387400","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS387401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380074","Pioneer One Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380074-01","Pioneer One Silver 5000 Value - PCP Copay $35 with Dental","Standard Silver On Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS387401","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS387401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380085","Elite Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380085-01","Elite Bronze Deductible $6500 with Dental","Standard Bronze On Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB388501","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB388501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380085","Elite Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380085-02","Elite Bronze Deductible $6500 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB388502","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB388501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380073","ProHealth Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380073-03","ProHealth Silver 5000 Value - PCP Copay $35 with Dental","Limited Cost Sharing Plan Variation",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS387303","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS387301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380023","Elite Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380023-01","Elite Gold Healthy You - PCP Copay $30 with Dental","Standard Gold On Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG382301","https://unityhealth.com/2018/Elite/Brochure/Gold/EG382301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380023","Elite Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380023-02","Elite Gold Healthy You - PCP Copay $30 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG382302","https://unityhealth.com/2018/Elite/Brochure/Gold/EG382301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380023","Elite Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380023-03","Elite Gold Healthy You - PCP Copay $30 with Dental","Limited Cost Sharing Plan Variation",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG382303","https://unityhealth.com/2018/Elite/Brochure/Gold/EG382301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380028","Elite Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380028-00","Elite Silver 5000 Value - PCP Copay $35 with Dental","Standard Silver Off Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES382800","https://unityhealth.com/2018/Elite/Brochure/Silver/ES382801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380028","Elite Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380028-01","Elite Silver 5000 Value - PCP Copay $35 with Dental","Standard Silver On Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES382801","https://unityhealth.com/2018/Elite/Brochure/Silver/ES382801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380028","Elite Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380028-02","Elite Silver 5000 Value - PCP Copay $35 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES382802","https://unityhealth.com/2018/Elite/Brochure/Silver/ES382801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380028","Elite Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380028-03","Elite Silver 5000 Value - PCP Copay $35 with Dental","Limited Cost Sharing Plan Variation",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES382803","https://unityhealth.com/2018/Elite/Brochure/Silver/ES382801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380028","Elite Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380028-04","Elite Silver 5000 Value - PCP Copay $35 with Dental","73% AV Level Silver Plan",,"0.73969515180156","No","Yes","No","100%",,"$5,000","$600","$300","$10","$100","$1,900","$0","$0","$1,100","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5850 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES382804","https://unityhealth.com/2018/Elite/Brochure/Silver/ES382801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380028","Elite Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380028-05","Elite Silver Value - PCP Copay $15 with Dental","87% AV Level Silver Plan",,"0.879665455688055","No","Yes","No","100%",,"$400","$200","$1,800","$10","$100","$900","$0","$0","$400","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$800 per person","$800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES382805","https://unityhealth.com/2018/Elite/Brochure/Silver/ES382801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380028","Elite Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380028-06","Elite Silver Value - PCP Copay $5 with Dental","94% AV Level Silver Plan",,"0.9495901272702","No","Yes","No","100%",,"$100","$100","$500","$10","$100","$600","$10","$0","$100","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES382806","https://unityhealth.com/2018/Elite/Brochure/Silver/ES382801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380029","Elite Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380029-00","Elite Silver 7100 Value - PCP Copay $75 with Dental","Standard Silver Off Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES382900","https://unityhealth.com/2018/Elite/Brochure/Silver/ES382901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380029","Elite Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380029-01","Elite Silver 7100 Value - PCP Copay $75 with Dental","Standard Silver On Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES382901","https://unityhealth.com/2018/Elite/Brochure/Silver/ES382901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380029","Elite Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380029-02","Elite Silver 7100 Value - PCP Copay $75 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES382902","https://unityhealth.com/2018/Elite/Brochure/Silver/ES382901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380029","Elite Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380029-03","Elite Silver 7100 Value - PCP Copay $75 with Dental","Limited Cost Sharing Plan Variation",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES382903","https://unityhealth.com/2018/Elite/Brochure/Silver/ES382901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380029","Elite Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380029-06","Elite Silver Value - PCP Copay $15 with Dental","94% AV Level Silver Plan",,"0.949621786946921","No","Yes","No","100%",,"$0","$300","$0","$10","$0","$900","$0","$0","$0","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$2450 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES382906","https://unityhealth.com/2018/Elite/Brochure/Silver/ES382901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380085","Elite Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380085-00","Elite Bronze Deductible $6500 with Dental","Standard Bronze Off Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB388500","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB388501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380035","Beloit One Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380035-06","Beloit One Silver Value - PCP Copay $15 with Dental","94% AV Level Silver Plan",,"0.949621786946921","No","Yes","No","100%",,"$0","$300","$0","$10","$0","$900","$0","$0","$0","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$2450 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS383506","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS383501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380086","Beloit One Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380086-00","Beloit One Bronze Deductible $6500 with Dental","Standard Bronze Off Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB388600","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB388601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380086","Beloit One Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380086-01","Beloit One Bronze Deductible $6500 with Dental","Standard Bronze On Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB388601","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB388601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380086","Beloit One Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380086-02","Beloit One Bronze Deductible $6500 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB388602","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB388601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380085","Elite Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380085-03","Elite Bronze Deductible $6500 with Dental","Limited Cost Sharing Plan Variation",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB388503","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB388501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380032","Beloit One Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380032-00","Beloit One Gold Healthy You - PCP Copay $30 with Dental","Standard Gold Off Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG383200","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG383201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380032","Beloit One Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380032-01","Beloit One Gold Healthy You - PCP Copay $30 with Dental","Standard Gold On Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG383201","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG383201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380032","Beloit One Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380032-02","Beloit One Gold Healthy You - PCP Copay $30 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG383202","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG383201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380032","Beloit One Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380032-03","Beloit One Gold Healthy You - PCP Copay $30 with Dental","Limited Cost Sharing Plan Variation",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG383203","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG383201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380061","Beloit One Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380061-00","Beloit One Silver 5000 Value - PCP Copay $35 with Dental","Standard Silver Off Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS386100","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS386101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380061","Beloit One Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380061-01","Beloit One Silver 5000 Value - PCP Copay $35 with Dental","Standard Silver On Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS386101","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS386101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380061","Beloit One Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380061-02","Beloit One Silver 5000 Value - PCP Copay $35 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS386102","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS386101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380061","Beloit One Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380061-03","Beloit One Silver 5000 Value - PCP Copay $35 with Dental","Limited Cost Sharing Plan Variation",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS386103","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS386101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380061","Beloit One Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380061-04","Beloit One Silver 5000 Value - PCP Copay $35 with Dental","73% AV Level Silver Plan",,"0.73969515180156","No","Yes","No","100%",,"$5,000","$600","$300","$10","$100","$1,900","$0","$0","$1,100","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5850 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS386104","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS386101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380061","Beloit One Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380061-05","Beloit One Silver Value - PCP Copay $15 with Dental","87% AV Level Silver Plan",,"0.879665455688055","No","Yes","No","100%",,"$400","$200","$1,800","$10","$100","$900","$0","$0","$400","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$800 per person","$800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS386105","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS386101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380061","Beloit One Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380061-06","Beloit One Silver Value - PCP Copay $5 with Dental","94% AV Level Silver Plan",,"0.9495901272702","No","Yes","No","100%",,"$100","$100","$500","$10","$100","$600","$10","$0","$100","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS386106","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS386101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380035","Beloit One Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380035-00","Beloit One Silver 7100 Value - PCP Copay $75 with Dental","Standard Silver Off Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS383500","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS383501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380035","Beloit One Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380035-01","Beloit One Silver 7100 Value - PCP Copay $75 with Dental","Standard Silver On Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS383501","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS383501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380035","Beloit One Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380035-02","Beloit One Silver 7100 Value - PCP Copay $75 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS383502","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS383501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380035","Beloit One Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380035-03","Beloit One Silver 7100 Value - PCP Copay $75 with Dental","Limited Cost Sharing Plan Variation",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS383503","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS383501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380035","Beloit One Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380035-04","Beloit One Silver 4750 Value - PCP Copay $30 with Dental","73% AV Level Silver Plan",,"0.738588705820109","No","Yes","No","100%",,"$4,750","$500","$600","$10","$100","$1,900","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$5850 per person","$9500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS383504","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS383501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380035","Beloit One Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380035-05","Beloit One Silver Value - PCP Copay $25 with Dental","87% AV Level Silver Plan",,"0.87981447908029","No","Yes","No","100%",,"$250","$400","$1,800","$10","$100","$1,300","$0","$0","$250","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$500 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS383505","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS383501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380086","Beloit One Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380086-03","Beloit One Bronze Deductible $6500 with Dental","Limited Cost Sharing Plan Variation",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB388603","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB388601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380062","ProHealth Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380062-00","ProHealth Gold Healthy You - PCP Copay $30 with Dental","Standard Gold Off Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG386200","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG386201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380062","ProHealth Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380062-01","ProHealth Gold Healthy You - PCP Copay $30 with Dental","Standard Gold On Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG386201","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG386201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380062","ProHealth Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380062-02","ProHealth Gold Healthy You - PCP Copay $30 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG386202","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG386201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380062","ProHealth Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380062-03","ProHealth Gold Healthy You - PCP Copay $30 with Dental","Limited Cost Sharing Plan Variation",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG386203","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG386201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380073","ProHealth Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380073-00","ProHealth Silver 5000 Value - PCP Copay $35 with Dental","Standard Silver Off Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS387300","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS387301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380073","ProHealth Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380073-01","ProHealth Silver 5000 Value - PCP Copay $35 with Dental","Standard Silver On Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS387301","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS387301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380073","ProHealth Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380073-02","ProHealth Silver 5000 Value - PCP Copay $35 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS387302","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS387301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380073","ProHealth Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380073-04","ProHealth Silver 5000 Value - PCP Copay $35 with Dental","73% AV Level Silver Plan",,"0.73969515180156","No","Yes","No","100%",,"$5,000","$600","$300","$10","$100","$1,900","$0","$0","$1,100","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5850 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS387304","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS387301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380073","ProHealth Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380073-05","ProHealth Silver Value - PCP Copay $15 with Dental","87% AV Level Silver Plan",,"0.879665455688055","No","Yes","No","100%",,"$400","$200","$1,800","$10","$100","$900","$0","$0","$400","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$800 per person","$800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS387305","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS387301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380073","ProHealth Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380073-06","ProHealth Silver Value - PCP Copay $5 with Dental","94% AV Level Silver Plan",,"0.9495901272702","No","Yes","No","100%",,"$100","$100","$500","$10","$100","$600","$10","$0","$100","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS387306","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS387301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380075","ProHealth Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380075-00","ProHealth Silver 7100 Value - PCP Copay $75 with Dental","Standard Silver Off Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS387500","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS387501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380075","ProHealth Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380075-01","ProHealth Silver 7100 Value - PCP Copay $75 with Dental","Standard Silver On Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS387501","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS387501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380092","Beloit One Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380092-03","Beloit One Gold Maintenance - PCP Copay $20 with Dental","Limited Cost Sharing Plan Variation",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG389203","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG389201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380074","Pioneer One Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380074-05","Pioneer One Silver Value - PCP Copay $15 with Dental","87% AV Level Silver Plan",,"0.879665455688055","No","Yes","No","100%",,"$400","$200","$1,800","$10","$100","$900","$0","$0","$400","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$800 per person","$800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS387405","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS387401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380074","Pioneer One Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380074-06","Pioneer One Silver Value - PCP Copay $5 with Dental","94% AV Level Silver Plan",,"0.9495901272702","No","Yes","No","100%",,"$100","$100","$500","$10","$100","$600","$10","$0","$100","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS387406","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS387401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380075","ProHealth Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380075-02","ProHealth Silver 7100 Value - PCP Copay $75 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS387502","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS387501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380075","ProHealth Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380075-03","ProHealth Silver 7100 Value - PCP Copay $75 with Dental","Limited Cost Sharing Plan Variation",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS387503","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS387501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380075","ProHealth Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380075-04","ProHealth Silver 4750 Value - PCP Copay $30 with Dental","73% AV Level Silver Plan",,"0.738588705820109","No","Yes","No","100%",,"$4,750","$500","$600","$10","$100","$1,900","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$5850 per person","$9500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS387504","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS387501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380075","ProHealth Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380075-05","ProHealth Silver Value - PCP Copay $25 with Dental","87% AV Level Silver Plan",,"0.87981447908029","No","Yes","No","100%",,"$250","$400","$1,800","$10","$100","$1,300","$0","$0","$250","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$500 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS387505","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS387501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380075","ProHealth Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380075-06","ProHealth Silver Value - PCP Copay $15 with Dental","94% AV Level Silver Plan",,"0.949621786946921","No","Yes","No","100%",,"$0","$300","$0","$10","$0","$900","$0","$0","$0","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$2450 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS387506","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS387501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380087","ProHealth Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380087-00","ProHealth Bronze Deductible $6500 with Dental","Standard Bronze Off Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB388700","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB388701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380087","ProHealth Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380087-01","ProHealth Bronze Deductible $6500 with Dental","Standard Bronze On Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB388701","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB388701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380087","ProHealth Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380087-02","ProHealth Bronze Deductible $6500 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB388702","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB388701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380087","ProHealth Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380087-03","ProHealth Bronze Deductible $6500 with Dental","Limited Cost Sharing Plan Variation",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB388703","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB388701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380063","Pioneer One Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380063-00","Pioneer One Gold Healthy You - PCP Copay $30 with Dental","Standard Gold Off Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG386300","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG386301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380063","Pioneer One Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380063-01","Pioneer One Gold Healthy You - PCP Copay $30 with Dental","Standard Gold On Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG386301","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG386301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380063","Pioneer One Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380063-02","Pioneer One Gold Healthy You - PCP Copay $30 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG386302","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG386301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380063","Pioneer One Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380063-03","Pioneer One Gold Healthy You - PCP Copay $30 with Dental","Limited Cost Sharing Plan Variation",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG386303","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG386301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380074","Pioneer One Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380074-02","Pioneer One Silver 5000 Value - PCP Copay $35 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS387402","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS387401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380074","Pioneer One Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380074-03","Pioneer One Silver 5000 Value - PCP Copay $35 with Dental","Limited Cost Sharing Plan Variation",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS387403","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS387401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380074","Pioneer One Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380074-04","Pioneer One Silver 5000 Value - PCP Copay $35 with Dental","73% AV Level Silver Plan",,"0.73969515180156","No","Yes","No","100%",,"$5,000","$600","$300","$10","$100","$1,900","$0","$0","$1,100","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5850 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS387404","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS387401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380081","Gundersen Health System (R) Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380081-03","Gundersen Health System (R) Gold Maintenance - PCP Copay $20 with Dental","Limited Cost Sharing Plan Variation",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG388103","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG388101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380082","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF004","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380082-00","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35 with Dental","Standard Silver Off Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS388200","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS388201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380082","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF004","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380082-01","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35 with Dental","Standard Silver On Exchange Plan",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS388201","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS388201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380082","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF004","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380082-02","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS388202","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS388201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380076","Pioneer One Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380076-00","Pioneer One Silver 7100 Value - PCP Copay $75 with Dental","Standard Silver Off Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS387600","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS387601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380082","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF004","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380082-06","Gundersen Health System (R) Silver Value - PCP Copay $5 with Dental","94% AV Level Silver Plan",,"0.9495901272702","No","Yes","No","100%",,"$100","$100","$500","$10","$100","$600","$10","$0","$100","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS388206","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS388201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380083","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380083-00","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75 with Dental","Standard Silver Off Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS388300","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS388301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380083","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380083-01","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75 with Dental","Standard Silver On Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS388301","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS388301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380083","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380083-02","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS388302","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS388301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380094","Pioneer One Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380094-01","Pioneer One Gold Maintenance - PCP Copay $20 with Dental","Standard Gold On Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG389401","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG389401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380094","Pioneer One Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380094-02","Pioneer One Gold Maintenance - PCP Copay $20 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG389402","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG389401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380094","Pioneer One Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380094-03","Pioneer One Gold Maintenance - PCP Copay $20 with Dental","Limited Cost Sharing Plan Variation",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG389403","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG389401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380076","Pioneer One Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380076-01","Pioneer One Silver 7100 Value - PCP Copay $75 with Dental","Standard Silver On Exchange Plan",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS387601","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS387601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380076","Pioneer One Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380076-02","Pioneer One Silver 7100 Value - PCP Copay $75 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS387602","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS387601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380076","Pioneer One Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380076-03","Pioneer One Silver 7100 Value - PCP Copay $75 with Dental","Limited Cost Sharing Plan Variation",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS387603","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS387601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380076","Pioneer One Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380076-04","Pioneer One Silver 4750 Value - PCP Copay $30 with Dental","73% AV Level Silver Plan",,"0.738588705820109","No","Yes","No","100%",,"$4,750","$500","$600","$10","$100","$1,900","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$5850 per person","$9500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS387604","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS387601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380076","Pioneer One Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380076-05","Pioneer One Silver Value - PCP Copay $25 with Dental","87% AV Level Silver Plan",,"0.87981447908029","No","Yes","No","100%",,"$250","$400","$1,800","$10","$100","$1,300","$0","$0","$250","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$500 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS387605","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS387601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380076","Pioneer One Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380076-06","Pioneer One Silver Value - PCP Copay $15 with Dental","94% AV Level Silver Plan",,"0.949621786946921","No","Yes","No","100%",,"$0","$300","$0","$10","$0","$900","$0","$0","$0","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$2450 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS387606","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS387601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380088","Pioneer One Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380088-00","Pioneer One Bronze Deductible $6500 with Dental","Standard Bronze Off Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB388800","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB388801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380088","Pioneer One Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380088-01","Pioneer One Bronze Deductible $6500 with Dental","Standard Bronze On Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB388801","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB388801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380088","Pioneer One Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380088-02","Pioneer One Bronze Deductible $6500 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB388802","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB388801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380088","Pioneer One Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380088-03","Pioneer One Bronze Deductible $6500 with Dental","Limited Cost Sharing Plan Variation",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB388803","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB388801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380079","Gundersen Health System (R) Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF001","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380079-00","Gundersen Health System (R) Gold Healthy You - PCP Copay $30 with Dental","Standard Gold Off Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG387900","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG387901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380079","Gundersen Health System (R) Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF001","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380079-01","Gundersen Health System (R) Gold Healthy You - PCP Copay $30 with Dental","Standard Gold On Exchange Plan",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG387901","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG387901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380079","Gundersen Health System (R) Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF001","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380079-02","Gundersen Health System (R) Gold Healthy You - PCP Copay $30 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG387902","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG387901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380079","Gundersen Health System (R) Gold Healthy You - PCP Copay $30 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF001","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380079-03","Gundersen Health System (R) Gold Healthy You - PCP Copay $30 with Dental","Limited Cost Sharing Plan Variation",,"0.761802124339666","No","Yes","No","100%",,"$2,900","$500","$1,400","$10","$100","$1,500","$0","$0","$1,100","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG387903","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG387901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380081","Gundersen Health System (R) Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380081-00","Gundersen Health System (R) Gold Maintenance - PCP Copay $20 with Dental","Standard Gold Off Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG388100","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG388101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380081","Gundersen Health System (R) Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380081-01","Gundersen Health System (R) Gold Maintenance - PCP Copay $20 with Dental","Standard Gold On Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG388101","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG388101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380081","Gundersen Health System (R) Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380081-02","Gundersen Health System (R) Gold Maintenance - PCP Copay $20 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG388102","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG388101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380082","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF004","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380082-03","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35 with Dental","Limited Cost Sharing Plan Variation",,"0.71848303755261","No","Yes","No","100%",,"$5,000","$600","$1,500","$10","$100","$1,900","$0","$0","$1,100","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$7350 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS388203","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS388201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380082","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF004","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380082-04","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35 with Dental","73% AV Level Silver Plan",,"0.73969515180156","No","Yes","No","100%",,"$5,000","$600","$300","$10","$100","$1,900","$0","$0","$1,100","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5850 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS388204","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS388201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380082","Gundersen Health System (R) Silver 5000 Value - PCP Copay $35 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF004","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380082-05","Gundersen Health System (R) Silver Value - PCP Copay $15 with Dental","87% AV Level Silver Plan",,"0.879665455688055","No","Yes","No","100%",,"$400","$200","$1,800","$10","$100","$900","$0","$0","$400","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$800 per person","$800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS388205","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS388201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380083","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380083-03","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75 with Dental","Limited Cost Sharing Plan Variation",,"0.660728074073253","No","Yes","No","100%",,"$6,200","$1,200","$0","$10","$100","$2,200","$0","$0","$1,100","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,100","$7350 per person","$14200 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS388303","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS388301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380083","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380083-04","Gundersen Health System (R) Silver 4750 Value - PCP Copay $30 with Dental","73% AV Level Silver Plan",,"0.738588705820109","No","Yes","No","100%",,"$4,750","$500","$600","$10","$100","$1,900","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$5850 per person","$9500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS388304","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS388301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380083","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380083-05","Gundersen Health System (R) Silver Value - PCP Copay $25 with Dental","87% AV Level Silver Plan",,"0.87981447908029","No","Yes","No","100%",,"$250","$400","$1,800","$10","$100","$1,300","$0","$0","$250","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$500 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS388305","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS388301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380083","Gundersen Health System (R) Silver 7100 Value - PCP Copay $75 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380083-06","Gundersen Health System (R) Silver Value - PCP Copay $15 with Dental","94% AV Level Silver Plan",,"0.949621786946921","No","Yes","No","100%",,"$0","$300","$0","$10","$0","$900","$0","$0","$0","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$2450 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS388306","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS388301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380089","Gundersen Health System (R) Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380089-00","Gundersen Health System (R) Bronze Deductible $6500 with Dental","Standard Bronze Off Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB388900","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB388901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380089","Gundersen Health System (R) Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380089-01","Gundersen Health System (R) Bronze Deductible $6500 with Dental","Standard Bronze On Exchange Plan",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB388901","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB388901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380089","Gundersen Health System (R) Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380089-02","Gundersen Health System (R) Bronze Deductible $6500 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB388902","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB388901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380089","Gundersen Health System (R) Bronze Deductible $6500 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF007","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380089-03","Gundersen Health System (R) Bronze Deductible $6500 with Dental","Limited Cost Sharing Plan Variation",,"0.61583287644318","No","Yes","No","100%",,"$6,500","$50","$800","$10","$1,200","$2,900","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB388903","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB388901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380090","Prime Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380090-00","Prime Gold Maintenance - PCP Copay $20 with Dental","Standard Gold Off Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG389000","https://unityhealth.com/2018/Prime/Brochure/Gold/PG389001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380090","Prime Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380090-01","Prime Gold Maintenance - PCP Copay $20 with Dental","Standard Gold On Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG389001","https://unityhealth.com/2018/Prime/Brochure/Gold/PG389001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380090","Prime Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380090-02","Prime Gold Maintenance - PCP Copay $20 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG389002","https://unityhealth.com/2018/Prime/Brochure/Gold/PG389001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380090","Prime Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380090-03","Prime Gold Maintenance - PCP Copay $20 with Dental","Limited Cost Sharing Plan Variation",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG389003","https://unityhealth.com/2018/Prime/Brochure/Gold/PG389001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380091","Elite Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380091-00","Elite Gold Maintenance - PCP Copay $20 with Dental","Standard Gold Off Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG389100","https://unityhealth.com/2018/Elite/Brochure/Gold/EG389101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380091","Elite Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380091-01","Elite Gold Maintenance - PCP Copay $20 with Dental","Standard Gold On Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG389101","https://unityhealth.com/2018/Elite/Brochure/Gold/EG389101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380091","Elite Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380091-02","Elite Gold Maintenance - PCP Copay $20 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG389102","https://unityhealth.com/2018/Elite/Brochure/Gold/EG389101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380091","Elite Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380091-03","Elite Gold Maintenance - PCP Copay $20 with Dental","Limited Cost Sharing Plan Variation",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG389103","https://unityhealth.com/2018/Elite/Brochure/Gold/EG389101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380092","Beloit One Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380092-00","Beloit One Gold Maintenance - PCP Copay $20 with Dental","Standard Gold Off Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG389200","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG389201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380092","Beloit One Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380092-01","Beloit One Gold Maintenance - PCP Copay $20 with Dental","Standard Gold On Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG389201","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG389201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380092","Beloit One Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380092-02","Beloit One Gold Maintenance - PCP Copay $20 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG389202","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG389201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380093","ProHealth Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380093-00","ProHealth Gold Maintenance - PCP Copay $20 with Dental","Standard Gold Off Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG389300","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG389301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380093","ProHealth Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380093-01","ProHealth Gold Maintenance - PCP Copay $20 with Dental","Standard Gold On Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG389301","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG389301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380093","ProHealth Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380093-02","ProHealth Gold Maintenance - PCP Copay $20 with Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG389302","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG389301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380093","ProHealth Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380093-03","ProHealth Gold Maintenance - PCP Copay $20 with Dental","Limited Cost Sharing Plan Variation",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG389303","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG389301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380094","Pioneer One Gold Maintenance - PCP Copay $20 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380094-00","Pioneer One Gold Maintenance - PCP Copay $20 with Dental","Standard Gold Off Exchange Plan",,"0.771785730624744","No","Yes","No","100%",,"$900","$2,800","$0","$10","$100","$1,600","$0","$0","$1,100","$600","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG389400","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG389401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510068","Elite Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS002","WIF006","Existing","HMO","Silver","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510068-02","Elite Silver Standard - PCP Copay $30","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES516802","https://unityhealth.com/2018/Elite/Brochure/Silver/ES516801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510068","Elite Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS002","WIF006","Existing","HMO","Silver","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510068-03","Elite Silver Standard - PCP Copay $30","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$500","$1,300","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES516803","https://unityhealth.com/2018/Elite/Brochure/Silver/ES516801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510068","Elite Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS002","WIF006","Existing","HMO","Silver","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510068-04","Elite Silver Standard - PCP Copay $30","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$500","$1,400","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES516804","https://unityhealth.com/2018/Elite/Brochure/Silver/ES516801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510062","Prime Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Gold","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510062-00","Prime Gold Standard - PCP Copay $20","Standard Gold Off Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$400","$1,700","$10","$100","$1,400","$0","$0","$1,400","$70","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG516200","https://unityhealth.com/2018/Prime/Brochure/Gold/PG516201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510062","Prime Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Gold","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510062-01","Prime Gold Standard - PCP Copay $20","Standard Gold On Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$400","$1,700","$10","$100","$1,400","$0","$0","$1,400","$70","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG516201","https://unityhealth.com/2018/Prime/Brochure/Gold/PG516201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510062","Prime Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Gold","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510062-02","Prime Gold Standard - PCP Copay $20","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG516202","https://unityhealth.com/2018/Prime/Brochure/Gold/PG516201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510062","Prime Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Gold","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510062-03","Prime Gold Standard - PCP Copay $20","Limited Cost Sharing Plan Variation",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$400","$1,700","$10","$100","$1,400","$0","$0","$1,400","$70","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG516203","https://unityhealth.com/2018/Prime/Brochure/Gold/PG516201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510067","Prime Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN001","WIS001","WIF006","Existing","HMO","Silver","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510067-00","Prime Silver Standard - PCP Copay $30","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$500","$1,300","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS516700","https://unityhealth.com/2018/Prime/Brochure/Silver/PS516701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510067","Prime Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN001","WIS001","WIF006","Existing","HMO","Silver","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510067-01","Prime Silver Standard - PCP Copay $30","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$500","$1,300","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS516701","https://unityhealth.com/2018/Prime/Brochure/Silver/PS516701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510067","Prime Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN001","WIS001","WIF006","Existing","HMO","Silver","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510067-02","Prime Silver Standard - PCP Copay $30","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS516702","https://unityhealth.com/2018/Prime/Brochure/Silver/PS516701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510067","Prime Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN001","WIS001","WIF006","Existing","HMO","Silver","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510067-03","Prime Silver Standard - PCP Copay $30","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$500","$1,300","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS516703","https://unityhealth.com/2018/Prime/Brochure/Silver/PS516701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510067","Prime Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN001","WIS001","WIF006","Existing","HMO","Silver","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510067-04","Prime Silver Standard - PCP Copay $30","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$500","$1,400","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS516704","https://unityhealth.com/2018/Prime/Brochure/Silver/PS516701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510067","Prime Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN001","WIS001","WIF006","Existing","HMO","Silver","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510067-05","Prime Silver Standard - PCP Copay $10","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$200","$1,600","$10","$100","$800","$0","$0","$700","$40","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS516705","https://unityhealth.com/2018/Prime/Brochure/Silver/PS516701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510067","Prime Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN001","WIS001","WIF006","Existing","HMO","Silver","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510067-06","Prime Silver Standard - PCP Copay $5","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$100","$500","$10","$100","$400","$0","$0","$250","$20","$70","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS516706","https://unityhealth.com/2018/Prime/Brochure/Silver/PS516701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510063","Elite Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Gold","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510063-00","Elite Gold Standard - PCP Copay $20","Standard Gold Off Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$400","$1,700","$10","$100","$1,400","$0","$0","$1,400","$70","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG516300","https://unityhealth.com/2018/Elite/Brochure/Gold/EG516301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510063","Elite Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Gold","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510063-01","Elite Gold Standard - PCP Copay $20","Standard Gold On Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$400","$1,700","$10","$100","$1,400","$0","$0","$1,400","$70","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG516301","https://unityhealth.com/2018/Elite/Brochure/Gold/EG516301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510063","Elite Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Gold","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510063-02","Elite Gold Standard - PCP Copay $20","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG516302","https://unityhealth.com/2018/Elite/Brochure/Gold/EG516301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510063","Elite Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Gold","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510063-03","Elite Gold Standard - PCP Copay $20","Limited Cost Sharing Plan Variation",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$400","$1,700","$10","$100","$1,400","$0","$0","$1,400","$70","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG516303","https://unityhealth.com/2018/Elite/Brochure/Gold/EG516301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510068","Elite Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS002","WIF006","Existing","HMO","Silver","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510068-00","Elite Silver Standard - PCP Copay $30","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$500","$1,300","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES516800","https://unityhealth.com/2018/Elite/Brochure/Silver/ES516801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510068","Elite Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS002","WIF006","Existing","HMO","Silver","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510068-01","Elite Silver Standard - PCP Copay $30","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$500","$1,300","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES516801","https://unityhealth.com/2018/Elite/Brochure/Silver/ES516801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510068","Elite Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS002","WIF006","Existing","HMO","Silver","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510068-05","Elite Silver Standard - PCP Copay $10","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$200","$1,600","$10","$100","$800","$0","$0","$700","$40","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES516805","https://unityhealth.com/2018/Elite/Brochure/Silver/ES516801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510070","ProHealth Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS004","WIF006","Existing","HMO","Silver","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510070-04","ProHealth Silver Standard - PCP Copay $30","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$500","$1,400","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS517004","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS517001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510070","ProHealth Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS004","WIF006","Existing","HMO","Silver","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510070-05","ProHealth Silver Standard - PCP Copay $10","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$200","$1,600","$10","$100","$800","$0","$0","$700","$40","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS517005","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS517001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510070","ProHealth Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS004","WIF006","Existing","HMO","Silver","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510070-06","ProHealth Silver Standard - PCP Copay $5","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$100","$500","$10","$100","$400","$0","$0","$250","$20","$70","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS517006","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS517001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510066","Pioneer One Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN004","WIS005","WIF003","Existing","HMO","Gold","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510066-00","Pioneer One Gold Standard - PCP Copay $20","Standard Gold Off Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$400","$1,700","$10","$100","$1,400","$0","$0","$1,400","$70","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG516600","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG516601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540026","Elite Bronze Standard HSA $6000","37833WI054","7114920342","WIN002","WIS002","WIF009","New","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540026-02","Elite Bronze Standard HSA $6000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB542602","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB542601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540026","Elite Bronze Standard HSA $6000","37833WI054","7114920342","WIN002","WIS002","WIF009","New","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540026-03","Elite Bronze Standard HSA $6000","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB542603","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB542601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540028","Beloit One Bronze Standard HSA $6000","37833WI054","7114920342","WIN003","WIS003","WIF009","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540028-00","Beloit One Bronze Standard HSA $6000","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB542800","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB542801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510068","Elite Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS002","WIF006","Existing","HMO","Silver","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510068-06","Elite Silver Standard - PCP Copay $5","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$100","$500","$10","$100","$400","$0","$0","$250","$20","$70","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES516806","https://unityhealth.com/2018/Elite/Brochure/Silver/ES516801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510064","Beloit One Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Gold","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510064-00","Beloit One Gold Standard - PCP Copay $20","Standard Gold Off Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$400","$1,700","$10","$100","$1,400","$0","$0","$1,400","$70","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG516400","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG516401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510064","Beloit One Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Gold","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510064-01","Beloit One Gold Standard - PCP Copay $20","Standard Gold On Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$400","$1,700","$10","$100","$1,400","$0","$0","$1,400","$70","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG516401","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG516401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510064","Beloit One Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Gold","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510064-02","Beloit One Gold Standard - PCP Copay $20","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG516402","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG516401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510064","Beloit One Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Gold","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510064-03","Beloit One Gold Standard - PCP Copay $20","Limited Cost Sharing Plan Variation",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$400","$1,700","$10","$100","$1,400","$0","$0","$1,400","$70","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG516403","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG516401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510069","Beloit One Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN003","WIS003","WIF006","Existing","HMO","Silver","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510069-00","Beloit One Silver Standard - PCP Copay $30","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$500","$1,300","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS516900","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS516901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510069","Beloit One Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN003","WIS003","WIF006","Existing","HMO","Silver","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510069-01","Beloit One Silver Standard - PCP Copay $30","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$500","$1,300","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS516901","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS516901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510069","Beloit One Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN003","WIS003","WIF006","Existing","HMO","Silver","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510069-02","Beloit One Silver Standard - PCP Copay $30","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS516902","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS516901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510069","Beloit One Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN003","WIS003","WIF006","Existing","HMO","Silver","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510069-03","Beloit One Silver Standard - PCP Copay $30","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$500","$1,300","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS516903","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS516901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510069","Beloit One Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN003","WIS003","WIF006","Existing","HMO","Silver","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510069-04","Beloit One Silver Standard - PCP Copay $30","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$500","$1,400","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS516904","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS516901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510069","Beloit One Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN003","WIS003","WIF006","Existing","HMO","Silver","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510069-05","Beloit One Silver Standard - PCP Copay $10","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$200","$1,600","$10","$100","$800","$0","$0","$700","$40","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS516905","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS516901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510069","Beloit One Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN003","WIS003","WIF006","Existing","HMO","Silver","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510069-06","Beloit One Silver Standard - PCP Copay $5","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$100","$500","$10","$100","$400","$0","$0","$250","$20","$70","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS516906","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS516901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510065","ProHealth Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN002","WIS004","WIF003","Existing","HMO","Gold","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510065-00","ProHealth Gold Standard - PCP Copay $20","Standard Gold Off Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$400","$1,700","$10","$100","$1,400","$0","$0","$1,400","$70","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG516500","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG516501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510065","ProHealth Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN002","WIS004","WIF003","Existing","HMO","Gold","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510065-01","ProHealth Gold Standard - PCP Copay $20","Standard Gold On Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$400","$1,700","$10","$100","$1,400","$0","$0","$1,400","$70","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG516501","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG516501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510065","ProHealth Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN002","WIS004","WIF003","Existing","HMO","Gold","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510065-02","ProHealth Gold Standard - PCP Copay $20","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG516502","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG516501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510065","ProHealth Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN002","WIS004","WIF003","Existing","HMO","Gold","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510065-03","ProHealth Gold Standard - PCP Copay $20","Limited Cost Sharing Plan Variation",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$400","$1,700","$10","$100","$1,400","$0","$0","$1,400","$70","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG516503","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG516501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510070","ProHealth Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS004","WIF006","Existing","HMO","Silver","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510070-00","ProHealth Silver Standard - PCP Copay $30","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$500","$1,300","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS517000","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS517001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510070","ProHealth Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS004","WIF006","Existing","HMO","Silver","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510070-01","ProHealth Silver Standard - PCP Copay $30","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$500","$1,300","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS517001","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS517001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510070","ProHealth Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS004","WIF006","Existing","HMO","Silver","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510070-02","ProHealth Silver Standard - PCP Copay $30","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS517002","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS517001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510070","ProHealth Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS004","WIF006","Existing","HMO","Silver","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510070-03","ProHealth Silver Standard - PCP Copay $30","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$500","$1,300","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS517003","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS517001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510066","Pioneer One Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN004","WIS005","WIF003","Existing","HMO","Gold","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510066-01","Pioneer One Gold Standard - PCP Copay $20","Standard Gold On Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$400","$1,700","$10","$100","$1,400","$0","$0","$1,400","$70","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG516601","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG516601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510066","Pioneer One Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN004","WIS005","WIF003","Existing","HMO","Gold","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510066-02","Pioneer One Gold Standard - PCP Copay $20","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG516602","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG516601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510066","Pioneer One Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN004","WIS005","WIF003","Existing","HMO","Gold","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510066-03","Pioneer One Gold Standard - PCP Copay $20","Limited Cost Sharing Plan Variation",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$400","$1,700","$10","$100","$1,400","$0","$0","$1,400","$70","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG516603","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG516601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510071","Pioneer One Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN004","WIS005","WIF006","Existing","HMO","Silver","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510071-00","Pioneer One Silver Standard - PCP Copay $30","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$500","$1,300","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS517100","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS517101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510071","Pioneer One Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN004","WIS005","WIF006","Existing","HMO","Silver","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510071-01","Pioneer One Silver Standard - PCP Copay $30","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$500","$1,300","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS517101","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS517101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510071","Pioneer One Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN004","WIS005","WIF006","Existing","HMO","Silver","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510071-02","Pioneer One Silver Standard - PCP Copay $30","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS517102","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS517101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510071","Pioneer One Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN004","WIS005","WIF006","Existing","HMO","Silver","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510071-03","Pioneer One Silver Standard - PCP Copay $30","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$500","$1,300","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS517103","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS517101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510071","Pioneer One Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN004","WIS005","WIF006","Existing","HMO","Silver","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510071-04","Pioneer One Silver Standard - PCP Copay $30","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$500","$1,400","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS517104","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS517101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510071","Pioneer One Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN004","WIS005","WIF006","Existing","HMO","Silver","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510071-05","Pioneer One Silver Standard - PCP Copay $10","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$200","$1,600","$10","$100","$800","$0","$0","$700","$40","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS517105","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS517101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510071","Pioneer One Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN004","WIS005","WIF006","Existing","HMO","Silver","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510071-06","Pioneer One Silver Standard - PCP Copay $5","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$100","$500","$10","$100","$400","$0","$0","$250","$20","$70","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS517106","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS517101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510082","Gundersen Health System (R) Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN002","WIS006","WIF003","New","HMO","Gold","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510082-00","Gundersen Health System (R) Gold Standard - PCP Copay $20","Standard Gold Off Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$400","$1,700","$10","$100","$1,400","$0","$0","$1,400","$70","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG518200","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG518201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510082","Gundersen Health System (R) Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN002","WIS006","WIF003","New","HMO","Gold","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510082-01","Gundersen Health System (R) Gold Standard - PCP Copay $20","Standard Gold On Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$400","$1,700","$10","$100","$1,400","$0","$0","$1,400","$70","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG518201","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG518201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510082","Gundersen Health System (R) Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN002","WIS006","WIF003","New","HMO","Gold","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510082-02","Gundersen Health System (R) Gold Standard - PCP Copay $20","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG518202","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG518201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540030","ProHealth Bronze Standard HSA $6000","37833WI054","7114920342","WIN002","WIS004","WIF009","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540030-03","ProHealth Bronze Standard HSA $6000","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB543003","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB543001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540032","Pioneer One Bronze Standard HSA $6000","37833WI054","7114920342","WIN004","WIS005","WIF009","New","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540032-00","Pioneer One Bronze Standard HSA $6000","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB543200","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB543201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540032","Pioneer One Bronze Standard HSA $6000","37833WI054","7114920342","WIN004","WIS005","WIF009","New","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540032-01","Pioneer One Bronze Standard HSA $6000","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB543201","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB543201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540032","Pioneer One Bronze Standard HSA $6000","37833WI054","7114920342","WIN004","WIS005","WIF009","New","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540032-02","Pioneer One Bronze Standard HSA $6000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB543202","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB543201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510082","Gundersen Health System (R) Gold Standard - PCP Copay $20","37833WI051","7114920342","WIN002","WIS006","WIF003","New","HMO","Gold","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510082-03","Gundersen Health System (R) Gold Standard - PCP Copay $20","Limited Cost Sharing Plan Variation",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$400","$1,700","$10","$100","$1,400","$0","$0","$1,400","$70","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG518203","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG518201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510083","Gundersen Health System (R) Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS006","WIF006","New","HMO","Silver","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510083-00","Gundersen Health System (R) Silver Standard - PCP Copay $30","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$500","$1,300","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS518300","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS518301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510083","Gundersen Health System (R) Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS006","WIF006","New","HMO","Silver","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510083-01","Gundersen Health System (R) Silver Standard - PCP Copay $30","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$500","$1,300","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS518301","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS518301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510083","Gundersen Health System (R) Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS006","WIF006","New","HMO","Silver","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510083-02","Gundersen Health System (R) Silver Standard - PCP Copay $30","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS518302","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS518301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510083","Gundersen Health System (R) Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS006","WIF006","New","HMO","Silver","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510083-03","Gundersen Health System (R) Silver Standard - PCP Copay $30","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$500","$1,300","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS518303","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS518301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510083","Gundersen Health System (R) Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS006","WIF006","New","HMO","Silver","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510083-04","Gundersen Health System (R) Silver Standard - PCP Copay $30","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$500","$1,400","$10","$100","$1,800","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS518304","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS518301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510083","Gundersen Health System (R) Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS006","WIF006","New","HMO","Silver","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510083-05","Gundersen Health System (R) Silver Standard - PCP Copay $10","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$200","$1,600","$10","$100","$800","$0","$0","$700","$40","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS518305","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS518301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510083","Gundersen Health System (R) Silver Standard - PCP Copay $30","37833WI051","7114920342","WIN002","WIS006","WIF006","New","HMO","Silver","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510083-06","Gundersen Health System (R) Silver Standard - PCP Copay $5","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$100","$500","$10","$100","$400","$0","$0","$250","$20","$70","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS518306","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS518301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540024","Prime Bronze Standard HSA $6000","37833WI054","7114920342","WIN001","WIS001","WIF009","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540024-00","Prime Bronze Standard HSA $6000","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB542400","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB542401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540024","Prime Bronze Standard HSA $6000","37833WI054","7114920342","WIN001","WIS001","WIF009","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540024-01","Prime Bronze Standard HSA $6000","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB542401","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB542401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540024","Prime Bronze Standard HSA $6000","37833WI054","7114920342","WIN001","WIS001","WIF009","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540024-02","Prime Bronze Standard HSA $6000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB542402","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB542401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540024","Prime Bronze Standard HSA $6000","37833WI054","7114920342","WIN001","WIS001","WIF009","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540024-03","Prime Bronze Standard HSA $6000","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB542403","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB542401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540026","Elite Bronze Standard HSA $6000","37833WI054","7114920342","WIN002","WIS002","WIF009","New","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540026-00","Elite Bronze Standard HSA $6000","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB542600","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB542601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540026","Elite Bronze Standard HSA $6000","37833WI054","7114920342","WIN002","WIS002","WIF009","New","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540026-01","Elite Bronze Standard HSA $6000","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB542601","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB542601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540028","Beloit One Bronze Standard HSA $6000","37833WI054","7114920342","WIN003","WIS003","WIF009","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540028-01","Beloit One Bronze Standard HSA $6000","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB542801","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB542801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540028","Beloit One Bronze Standard HSA $6000","37833WI054","7114920342","WIN003","WIS003","WIF009","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540028-02","Beloit One Bronze Standard HSA $6000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB542802","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB542801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540028","Beloit One Bronze Standard HSA $6000","37833WI054","7114920342","WIN003","WIS003","WIF009","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540028-03","Beloit One Bronze Standard HSA $6000","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB542803","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB542801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540030","ProHealth Bronze Standard HSA $6000","37833WI054","7114920342","WIN002","WIS004","WIF009","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540030-00","ProHealth Bronze Standard HSA $6000","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB543000","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB543001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540030","ProHealth Bronze Standard HSA $6000","37833WI054","7114920342","WIN002","WIS004","WIF009","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540030-01","ProHealth Bronze Standard HSA $6000","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB543001","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB543001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540030","ProHealth Bronze Standard HSA $6000","37833WI054","7114920342","WIN002","WIS004","WIF009","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540030-02","ProHealth Bronze Standard HSA $6000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB543002","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB543001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540032","Pioneer One Bronze Standard HSA $6000","37833WI054","7114920342","WIN004","WIS005","WIF009","New","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540032-03","Pioneer One Bronze Standard HSA $6000","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB543203","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB543201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540034","Gundersen Health System (R) Bronze Standard HSA $6000","37833WI054","7114920342","WIN002","WIS006","WIF009","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540034-00","Gundersen Health System (R) Bronze Standard HSA $6000","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB543400","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB543401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540034","Gundersen Health System (R) Bronze Standard HSA $6000","37833WI054","7114920342","WIN002","WIS006","WIF009","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540034-01","Gundersen Health System (R) Bronze Standard HSA $6000","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB543401","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB543401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540034","Gundersen Health System (R) Bronze Standard HSA $6000","37833WI054","7114920342","WIN002","WIS006","WIF009","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540034-02","Gundersen Health System (R) Bronze Standard HSA $6000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB543402","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB543401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540034","Gundersen Health System (R) Bronze Standard HSA $6000","37833WI054","7114920342","WIN002","WIS006","WIF009","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540034-03","Gundersen Health System (R) Bronze Standard HSA $6000","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB543403","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB543401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510072","Prime Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN001","WIS001","WIF008","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510072-00","Prime Bronze Standard - PCP Copay $35","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$600","$100","$10","$4,000","$1,700","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB517200","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB517201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510072","Prime Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN001","WIS001","WIF008","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510072-01","Prime Bronze Standard - PCP Copay $35","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$600","$100","$10","$4,000","$1,700","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB517201","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB517201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510072","Prime Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN001","WIS001","WIF008","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510072-02","Prime Bronze Standard - PCP Copay $35","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB517202","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB517201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510072","Prime Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN001","WIS001","WIF008","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510072-03","Prime Bronze Standard - PCP Copay $35","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$600","$100","$10","$4,000","$1,700","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB517203","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB517201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510073","Elite Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN002","WIS002","WIF008","Existing","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510073-00","Elite Bronze Standard - PCP Copay $35","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$600","$100","$10","$4,000","$1,700","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB517300","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB517301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510073","Elite Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN002","WIS002","WIF008","Existing","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510073-01","Elite Bronze Standard - PCP Copay $35","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$600","$100","$10","$4,000","$1,700","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB517301","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB517301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510073","Elite Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN002","WIS002","WIF008","Existing","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510073-02","Elite Bronze Standard - PCP Copay $35","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB517302","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB517301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510073","Elite Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN002","WIS002","WIF008","Existing","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510073-03","Elite Bronze Standard - PCP Copay $35","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$600","$100","$10","$4,000","$1,700","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB517303","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB517301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510074","Beloit One Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN003","WIS003","WIF008","Existing","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510074-00","Beloit One Bronze Standard - PCP Copay $35","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$600","$100","$10","$4,000","$1,700","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB517400","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB517401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510074","Beloit One Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN003","WIS003","WIF008","Existing","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510074-01","Beloit One Bronze Standard - PCP Copay $35","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$600","$100","$10","$4,000","$1,700","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB517401","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB517401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510074","Beloit One Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN003","WIS003","WIF008","Existing","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510074-02","Beloit One Bronze Standard - PCP Copay $35","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB517402","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB517401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510074","Beloit One Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN003","WIS003","WIF008","Existing","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510074-03","Beloit One Bronze Standard - PCP Copay $35","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$600","$100","$10","$4,000","$1,700","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB517403","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB517401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510075","ProHealth Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN002","WIS004","WIF008","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510075-00","ProHealth Bronze Standard - PCP Copay $35","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$600","$100","$10","$4,000","$1,700","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB517500","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB517501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510075","ProHealth Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN002","WIS004","WIF008","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510075-01","ProHealth Bronze Standard - PCP Copay $35","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$600","$100","$10","$4,000","$1,700","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB517501","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB517501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510075","ProHealth Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN002","WIS004","WIF008","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510075-02","ProHealth Bronze Standard - PCP Copay $35","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB517502","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB517501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510075","ProHealth Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN002","WIS004","WIF008","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510075-03","ProHealth Bronze Standard - PCP Copay $35","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$600","$100","$10","$4,000","$1,700","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB517503","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB517501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510076","Pioneer One Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN004","WIS005","WIF008","Existing","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510076-00","Pioneer One Bronze Standard - PCP Copay $35","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$600","$100","$10","$4,000","$1,700","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB517600","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB517601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510076","Pioneer One Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN004","WIS005","WIF008","Existing","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510076-01","Pioneer One Bronze Standard - PCP Copay $35","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$600","$100","$10","$4,000","$1,700","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB517601","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB517601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510076","Pioneer One Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN004","WIS005","WIF008","Existing","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510076-02","Pioneer One Bronze Standard - PCP Copay $35","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB517602","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB517601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510076","Pioneer One Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN004","WIS005","WIF008","Existing","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510076-03","Pioneer One Bronze Standard - PCP Copay $35","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$600","$100","$10","$4,000","$1,700","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB517603","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB517601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510084","Gundersen Health System (R) Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN002","WIS006","WIF008","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510084-00","Gundersen Health System (R) Bronze Standard - PCP Copay $35","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$600","$100","$10","$4,000","$1,700","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB518400","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB518401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510084","Gundersen Health System (R) Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN002","WIS006","WIF008","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510084-01","Gundersen Health System (R) Bronze Standard - PCP Copay $35","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$600","$100","$10","$4,000","$1,700","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB518401","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB518401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510084","Gundersen Health System (R) Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN002","WIS006","WIF008","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510084-02","Gundersen Health System (R) Bronze Standard - PCP Copay $35","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB518402","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB518401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540006","Elite Silver HSA $3000","37833WI054","7114920342","WIN002","WIS002","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540006-01","Elite Silver HSA $3000","Standard Silver On Exchange Plan",,"0.660384893410427","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$10","$3,000","$0","$1,300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$7350 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES540601","https://unityhealth.com/2018/Elite/Brochure/Silver/ES540601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540006","Elite Silver HSA $3000","37833WI054","7114920342","WIN002","WIS002","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540006-02","Elite Silver HSA $3000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES540602","https://unityhealth.com/2018/Elite/Brochure/Silver/ES540601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540036","Elite Silver HSA $5050","37833WI054","7114920342","WIN002","WIS002","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540036-02","Elite Silver HSA $5050","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES543602","https://unityhealth.com/2018/Elite/Brochure/Silver/ES543601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540036","Elite Silver HSA $5050","37833WI054","7114920342","WIN002","WIS002","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540036-03","Elite Silver HSA $5050","Limited Cost Sharing Plan Variation",,"0.661204330687207","Yes","Yes","No","100%",,"$5,050","$0","$0","$10","$5,050","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES543603","https://unityhealth.com/2018/Elite/Brochure/Silver/ES543601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540036","Elite Silver HSA $5050","37833WI054","7114920342","WIN002","WIS002","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540036-04","Elite Silver HSA $3150","73% AV Level Silver Plan",,"0.739196123449302","Yes","Yes","No","100%",,"$3,150","$0","$0","$10","$3,150","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$5850 per person","$6300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$5850 per person","$6300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES543604","https://unityhealth.com/2018/Elite/Brochure/Silver/ES543601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540036","Elite Silver HSA $5050","37833WI054","7114920342","WIN002","WIS002","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540036-05","Elite Silver Deductible $1050","87% AV Level Silver Plan",,"0.879955976224215","Yes","Yes","No","100%",,"$1,050","$0","$0","$10","$1,050","$0","$0","$0","$1,050","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","$2100 per person","$2100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","$2100 per person","$2100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES543605","https://unityhealth.com/2018/Elite/Brochure/Silver/ES543601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540037","Beloit One Silver HSA $5050","37833WI054","7114920342","WIN003","WIS003","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540037-00","Beloit One Silver HSA $5050","Standard Silver Off Exchange Plan",,"0.661204330687207","Yes","Yes","No","100%",,"$5,050","$0","$0","$10","$5,050","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS543700","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS543701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510084","Gundersen Health System (R) Bronze Standard - PCP Copay $35","37833WI051","7114920342","WIN002","WIS006","WIF008","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510084-03","Gundersen Health System (R) Bronze Standard - PCP Copay $35","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$600","$100","$10","$4,000","$1,700","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB518403","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB518401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540001","Prime Gold HSA $1800","37833WI054","7114920342","WIN001","WIS001","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540001-00","Prime Gold HSA $1800","Standard Gold Off Exchange Plan",,"0.763438531418891","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$10","$1,800","$0","$500","$0","$1,800","$0","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$7350 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG540100","https://unityhealth.com/2018/Prime/Brochure/Gold/PG540101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540001","Prime Gold HSA $1800","37833WI054","7114920342","WIN001","WIS001","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540001-01","Prime Gold HSA $1800","Standard Gold On Exchange Plan",,"0.763438531418891","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$10","$1,800","$0","$500","$0","$1,800","$0","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$7350 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG540101","https://unityhealth.com/2018/Prime/Brochure/Gold/PG540101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540001","Prime Gold HSA $1800","37833WI054","7114920342","WIN001","WIS001","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540001-02","Prime Gold HSA $1800","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG540102","https://unityhealth.com/2018/Prime/Brochure/Gold/PG540101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540001","Prime Gold HSA $1800","37833WI054","7114920342","WIN001","WIS001","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540001-03","Prime Gold HSA $1800","Limited Cost Sharing Plan Variation",,"0.763438531418891","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$10","$1,800","$0","$500","$0","$1,800","$0","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$7350 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG540103","https://unityhealth.com/2018/Prime/Brochure/Gold/PG540101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540003","Prime Bronze HSA $6550","37833WI054","7114920342","WIN001","WIS001","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540003-00","Prime Bronze HSA $6550","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB540300","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB540301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540003","Prime Bronze HSA $6550","37833WI054","7114920342","WIN001","WIS001","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540003-01","Prime Bronze HSA $6550","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB540301","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB540301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540003","Prime Bronze HSA $6550","37833WI054","7114920342","WIN001","WIS001","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540003-02","Prime Bronze HSA $6550","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB540302","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB540301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540003","Prime Bronze HSA $6550","37833WI054","7114920342","WIN001","WIS001","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540003-03","Prime Bronze HSA $6550","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB540303","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB540301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540023","Prime Bronze HSA $5000","37833WI054","7114920342","WIN001","WIS001","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540023-00","Prime Bronze HSA $5000","Standard Bronze Off Exchange Plan",,"0.618986343736706","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$10","$5,000","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$7350 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB542300","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB542301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540023","Prime Bronze HSA $5000","37833WI054","7114920342","WIN001","WIS001","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540023-01","Prime Bronze HSA $5000","Standard Bronze On Exchange Plan",,"0.618986343736706","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$10","$5,000","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$7350 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB542301","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB542301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540023","Prime Bronze HSA $5000","37833WI054","7114920342","WIN001","WIS001","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540023-02","Prime Bronze HSA $5000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB542302","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB542301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540023","Prime Bronze HSA $5000","37833WI054","7114920342","WIN001","WIS001","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540023-03","Prime Bronze HSA $5000","Limited Cost Sharing Plan Variation",,"0.618986343736706","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$10","$5,000","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$7350 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Bronze/PB542303","https://unityhealth.com/2018/Prime/Brochure/Bronze/PB542301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540002","Prime Silver HSA $3000","37833WI054","7114920342","WIN001","WIS001","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540002-00","Prime Silver HSA $3000","Standard Silver Off Exchange Plan",,"0.660384893410427","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$10","$3,000","$0","$1,300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$7350 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS540200","https://unityhealth.com/2018/Prime/Brochure/Silver/PS540201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540002","Prime Silver HSA $3000","37833WI054","7114920342","WIN001","WIS001","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540002-01","Prime Silver HSA $3000","Standard Silver On Exchange Plan",,"0.660384893410427","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$10","$3,000","$0","$1,300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$7350 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS540201","https://unityhealth.com/2018/Prime/Brochure/Silver/PS540201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540002","Prime Silver HSA $3000","37833WI054","7114920342","WIN001","WIS001","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540002-02","Prime Silver HSA $3000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS540202","https://unityhealth.com/2018/Prime/Brochure/Silver/PS540201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540002","Prime Silver HSA $3000","37833WI054","7114920342","WIN001","WIS001","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540002-03","Prime Silver HSA $3000","Limited Cost Sharing Plan Variation",,"0.660384893410427","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$10","$3,000","$0","$1,300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$7350 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS540203","https://unityhealth.com/2018/Prime/Brochure/Silver/PS540201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540002","Prime Silver HSA $3000","37833WI054","7114920342","WIN001","WIS001","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540002-04","Prime Silver HSA $2125","73% AV Level Silver Plan",,"0.739481241168873","Yes","Yes","No","100%",,"$2,125","$0","$1,900","$10","$2,125","$0","$1,000","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$5850 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,125","$4250 per person","$4250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS540204","https://unityhealth.com/2018/Prime/Brochure/Silver/PS540201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540002","Prime Silver HSA $3000","37833WI054","7114920342","WIN001","WIS001","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540002-05","Prime Silver Deductible $675","87% AV Level Silver Plan",,"0.879734804863259","Yes","Yes","No","100%",,"$675","$0","$500","$10","$675","$0","$500","$0","$675","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2400 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$1350 per person","$1350 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS540205","https://unityhealth.com/2018/Prime/Brochure/Silver/PS540201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540002","Prime Silver HSA $3000","37833WI054","7114920342","WIN001","WIS001","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540002-06","Prime Silver Deductible $230","94% AV Level Silver Plan",,"0.949999831961608","Yes","Yes","No","100%",,"$230","$0","$200","$10","$230","$0","$200","$0","$230","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$850 per person","$850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$230","$460 per person","$460 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS540206","https://unityhealth.com/2018/Prime/Brochure/Silver/PS540201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540006","Elite Silver HSA $3000","37833WI054","7114920342","WIN002","WIS002","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540006-03","Elite Silver HSA $3000","Limited Cost Sharing Plan Variation",,"0.660384893410427","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$10","$3,000","$0","$1,300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$7350 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES540603","https://unityhealth.com/2018/Elite/Brochure/Silver/ES540601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540006","Elite Silver HSA $3000","37833WI054","7114920342","WIN002","WIS002","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540006-04","Elite Silver HSA $2125","73% AV Level Silver Plan",,"0.739481241168873","Yes","Yes","No","100%",,"$2,125","$0","$1,900","$10","$2,125","$0","$1,000","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$5850 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,125","$4250 per person","$4250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES540604","https://unityhealth.com/2018/Elite/Brochure/Silver/ES540601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540035","Prime Silver HSA $5050","37833WI054","7114920342","WIN001","WIS001","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540035-00","Prime Silver HSA $5050","Standard Silver Off Exchange Plan",,"0.661204330687207","Yes","Yes","No","100%",,"$5,050","$0","$0","$10","$5,050","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS543500","https://unityhealth.com/2018/Prime/Brochure/Silver/PS543501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540035","Prime Silver HSA $5050","37833WI054","7114920342","WIN001","WIS001","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540035-01","Prime Silver HSA $5050","Standard Silver On Exchange Plan",,"0.661204330687207","Yes","Yes","No","100%",,"$5,050","$0","$0","$10","$5,050","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS543501","https://unityhealth.com/2018/Prime/Brochure/Silver/PS543501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540035","Prime Silver HSA $5050","37833WI054","7114920342","WIN001","WIS001","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540035-02","Prime Silver HSA $5050","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS543502","https://unityhealth.com/2018/Prime/Brochure/Silver/PS543501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540035","Prime Silver HSA $5050","37833WI054","7114920342","WIN001","WIS001","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540035-03","Prime Silver HSA $5050","Limited Cost Sharing Plan Variation",,"0.661204330687207","Yes","Yes","No","100%",,"$5,050","$0","$0","$10","$5,050","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS543503","https://unityhealth.com/2018/Prime/Brochure/Silver/PS543501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540035","Prime Silver HSA $5050","37833WI054","7114920342","WIN001","WIS001","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540035-04","Prime Silver HSA $3150","73% AV Level Silver Plan",,"0.739196123449302","Yes","Yes","No","100%",,"$3,150","$0","$0","$10","$3,150","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$5850 per person","$6300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$5850 per person","$6300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS543504","https://unityhealth.com/2018/Prime/Brochure/Silver/PS543501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540035","Prime Silver HSA $5050","37833WI054","7114920342","WIN001","WIS001","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540035-05","Prime Silver Deductible $1050","87% AV Level Silver Plan",,"0.879955976224215","Yes","Yes","No","100%",,"$1,050","$0","$0","$10","$1,050","$0","$0","$0","$1,050","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","$2100 per person","$2100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","$2100 per person","$2100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS543505","https://unityhealth.com/2018/Prime/Brochure/Silver/PS543501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540035","Prime Silver HSA $5050","37833WI054","7114920342","WIN001","WIS001","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540035-06","Prime Silver Deductible $400","94% AV Level Silver Plan",,"0.949008163174539","Yes","Yes","No","100%",,"$400","$0","$0","$10","$400","$0","$0","$0","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$800 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$800 per person","$800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Prime/SBC/Silver/PS543506","https://unityhealth.com/2018/Prime/Brochure/Silver/PS543501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540005","Elite Gold HSA $1800","37833WI054","7114920342","WIN002","WIS002","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540005-00","Elite Gold HSA $1800","Standard Gold Off Exchange Plan",,"0.763438531418891","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$10","$1,800","$0","$500","$0","$1,800","$0","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$7350 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG540500","https://unityhealth.com/2018/Elite/Brochure/Gold/EG540501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540005","Elite Gold HSA $1800","37833WI054","7114920342","WIN002","WIS002","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540005-01","Elite Gold HSA $1800","Standard Gold On Exchange Plan",,"0.763438531418891","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$10","$1,800","$0","$500","$0","$1,800","$0","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$7350 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG540501","https://unityhealth.com/2018/Elite/Brochure/Gold/EG540501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540005","Elite Gold HSA $1800","37833WI054","7114920342","WIN002","WIS002","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540005-02","Elite Gold HSA $1800","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG540502","https://unityhealth.com/2018/Elite/Brochure/Gold/EG540501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540005","Elite Gold HSA $1800","37833WI054","7114920342","WIN002","WIS002","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540005-03","Elite Gold HSA $1800","Limited Cost Sharing Plan Variation",,"0.763438531418891","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$10","$1,800","$0","$500","$0","$1,800","$0","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$7350 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG540503","https://unityhealth.com/2018/Elite/Brochure/Gold/EG540501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540007","Elite Bronze HSA $6550","37833WI054","7114920342","WIN002","WIS002","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540007-00","Elite Bronze HSA $6550","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB540700","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB540701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540007","Elite Bronze HSA $6550","37833WI054","7114920342","WIN002","WIS002","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540007-01","Elite Bronze HSA $6550","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB540701","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB540701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540007","Elite Bronze HSA $6550","37833WI054","7114920342","WIN002","WIS002","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540007-02","Elite Bronze HSA $6550","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB540702","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB540701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540007","Elite Bronze HSA $6550","37833WI054","7114920342","WIN002","WIS002","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540007-03","Elite Bronze HSA $6550","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB540703","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB540701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540025","Elite Bronze HSA $5000","37833WI054","7114920342","WIN002","WIS002","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540025-00","Elite Bronze HSA $5000","Standard Bronze Off Exchange Plan",,"0.618986343736706","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$10","$5,000","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$7350 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB542500","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB542501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540025","Elite Bronze HSA $5000","37833WI054","7114920342","WIN002","WIS002","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540025-01","Elite Bronze HSA $5000","Standard Bronze On Exchange Plan",,"0.618986343736706","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$10","$5,000","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$7350 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB542501","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB542501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540025","Elite Bronze HSA $5000","37833WI054","7114920342","WIN002","WIS002","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540025-02","Elite Bronze HSA $5000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB542502","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB542501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540025","Elite Bronze HSA $5000","37833WI054","7114920342","WIN002","WIS002","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540025-03","Elite Bronze HSA $5000","Limited Cost Sharing Plan Variation",,"0.618986343736706","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$10","$5,000","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$7350 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Bronze/EB542503","https://unityhealth.com/2018/Elite/Brochure/Bronze/EB542501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540006","Elite Silver HSA $3000","37833WI054","7114920342","WIN002","WIS002","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540006-00","Elite Silver HSA $3000","Standard Silver Off Exchange Plan",,"0.660384893410427","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$10","$3,000","$0","$1,300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$7350 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES540600","https://unityhealth.com/2018/Elite/Brochure/Silver/ES540601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540006","Elite Silver HSA $3000","37833WI054","7114920342","WIN002","WIS002","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540006-05","Elite Silver Deductible $675","87% AV Level Silver Plan",,"0.879734804863259","Yes","Yes","No","100%",,"$675","$0","$500","$10","$675","$0","$500","$0","$675","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2400 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$1350 per person","$1350 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES540605","https://unityhealth.com/2018/Elite/Brochure/Silver/ES540601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540006","Elite Silver HSA $3000","37833WI054","7114920342","WIN002","WIS002","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540006-06","Elite Silver Deductible $230","94% AV Level Silver Plan",,"0.949999831961608","Yes","Yes","No","100%",,"$230","$0","$200","$10","$230","$0","$200","$0","$230","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$850 per person","$850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$230","$460 per person","$460 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES540606","https://unityhealth.com/2018/Elite/Brochure/Silver/ES540601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540036","Elite Silver HSA $5050","37833WI054","7114920342","WIN002","WIS002","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540036-00","Elite Silver HSA $5050","Standard Silver Off Exchange Plan",,"0.661204330687207","Yes","Yes","No","100%",,"$5,050","$0","$0","$10","$5,050","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES543600","https://unityhealth.com/2018/Elite/Brochure/Silver/ES543601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540036","Elite Silver HSA $5050","37833WI054","7114920342","WIN002","WIS002","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540036-01","Elite Silver HSA $5050","Standard Silver On Exchange Plan",,"0.661204330687207","Yes","Yes","No","100%",,"$5,050","$0","$0","$10","$5,050","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES543601","https://unityhealth.com/2018/Elite/Brochure/Silver/ES543601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540036","Elite Silver HSA $5050","37833WI054","7114920342","WIN002","WIS002","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540036-06","Elite Silver Deductible $400","94% AV Level Silver Plan",,"0.949008163174539","Yes","Yes","No","100%",,"$400","$0","$0","$10","$400","$0","$0","$0","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$800 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$800 per person","$800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/Elite/SBC/Silver/ES543606","https://unityhealth.com/2018/Elite/Brochure/Silver/ES543601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540014","Beloit One Gold HSA $1800","37833WI054","7114920342","WIN003","WIS003","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540014-00","Beloit One Gold HSA $1800","Standard Gold Off Exchange Plan",,"0.763438531418891","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$10","$1,800","$0","$500","$0","$1,800","$0","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$7350 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG541400","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG541401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540014","Beloit One Gold HSA $1800","37833WI054","7114920342","WIN003","WIS003","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540014-01","Beloit One Gold HSA $1800","Standard Gold On Exchange Plan",,"0.763438531418891","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$10","$1,800","$0","$500","$0","$1,800","$0","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$7350 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG541401","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG541401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540014","Beloit One Gold HSA $1800","37833WI054","7114920342","WIN003","WIS003","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540014-02","Beloit One Gold HSA $1800","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG541402","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG541401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540014","Beloit One Gold HSA $1800","37833WI054","7114920342","WIN003","WIS003","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540014-03","Beloit One Gold HSA $1800","Limited Cost Sharing Plan Variation",,"0.763438531418891","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$10","$1,800","$0","$500","$0","$1,800","$0","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$7350 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG541403","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG541401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540010","Beloit One Bronze HSA $6550","37833WI054","7114920342","WIN003","WIS003","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540010-00","Beloit One Bronze HSA $6550","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB541000","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB541001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540010","Beloit One Bronze HSA $6550","37833WI054","7114920342","WIN003","WIS003","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540010-01","Beloit One Bronze HSA $6550","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB541001","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB541001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540010","Beloit One Bronze HSA $6550","37833WI054","7114920342","WIN003","WIS003","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540010-02","Beloit One Bronze HSA $6550","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB541002","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB541001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540010","Beloit One Bronze HSA $6550","37833WI054","7114920342","WIN003","WIS003","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540010-03","Beloit One Bronze HSA $6550","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB541003","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB541001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540027","Beloit One Bronze HSA $5000","37833WI054","7114920342","WIN003","WIS003","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540027-00","Beloit One Bronze HSA $5000","Standard Bronze Off Exchange Plan",,"0.618986343736706","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$10","$5,000","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$7350 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB542700","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB542701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540027","Beloit One Bronze HSA $5000","37833WI054","7114920342","WIN003","WIS003","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540027-01","Beloit One Bronze HSA $5000","Standard Bronze On Exchange Plan",,"0.618986343736706","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$10","$5,000","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$7350 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB542701","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB542701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540027","Beloit One Bronze HSA $5000","37833WI054","7114920342","WIN003","WIS003","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540027-02","Beloit One Bronze HSA $5000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB542702","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB542701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540027","Beloit One Bronze HSA $5000","37833WI054","7114920342","WIN003","WIS003","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540027-03","Beloit One Bronze HSA $5000","Limited Cost Sharing Plan Variation",,"0.618986343736706","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$10","$5,000","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$7350 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Bronze/BOB542703","https://unityhealth.com/2018/BeloitOne/Brochure/Bronze/BOB542701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540009","Beloit One Silver HSA $3000","37833WI054","7114920342","WIN003","WIS003","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540009-00","Beloit One Silver HSA $3000","Standard Silver Off Exchange Plan",,"0.660384893410427","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$10","$3,000","$0","$1,300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$7350 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS540900","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS540901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540009","Beloit One Silver HSA $3000","37833WI054","7114920342","WIN003","WIS003","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540009-01","Beloit One Silver HSA $3000","Standard Silver On Exchange Plan",,"0.660384893410427","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$10","$3,000","$0","$1,300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$7350 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS540901","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS540901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540009","Beloit One Silver HSA $3000","37833WI054","7114920342","WIN003","WIS003","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540009-02","Beloit One Silver HSA $3000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS540902","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS540901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540009","Beloit One Silver HSA $3000","37833WI054","7114920342","WIN003","WIS003","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540009-03","Beloit One Silver HSA $3000","Limited Cost Sharing Plan Variation",,"0.660384893410427","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$10","$3,000","$0","$1,300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$7350 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS540903","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS540901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540009","Beloit One Silver HSA $3000","37833WI054","7114920342","WIN003","WIS003","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540009-04","Beloit One Silver HSA $2125","73% AV Level Silver Plan",,"0.739481241168873","Yes","Yes","No","100%",,"$2,125","$0","$1,900","$10","$2,125","$0","$1,000","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$5850 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,125","$4250 per person","$4250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS540904","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS540901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540009","Beloit One Silver HSA $3000","37833WI054","7114920342","WIN003","WIS003","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540009-05","Beloit One Silver Deductible $675","87% AV Level Silver Plan",,"0.879734804863259","Yes","Yes","No","100%",,"$675","$0","$500","$10","$675","$0","$500","$0","$675","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2400 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$1350 per person","$1350 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS540905","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS540901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540009","Beloit One Silver HSA $3000","37833WI054","7114920342","WIN003","WIS003","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540009-06","Beloit One Silver Deductible $230","94% AV Level Silver Plan",,"0.949999831961608","Yes","Yes","No","100%",,"$230","$0","$200","$10","$230","$0","$200","$0","$230","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$850 per person","$850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$230","$460 per person","$460 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS540906","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS540901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540017","ProHealth Silver HSA $3000","37833WI054","7114920342","WIN002","WIS004","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540017-01","ProHealth Silver HSA $3000","Standard Silver On Exchange Plan",,"0.660384893410427","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$10","$3,000","$0","$1,300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$7350 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS541701","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS541701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540017","ProHealth Silver HSA $3000","37833WI054","7114920342","WIN002","WIS004","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540017-02","ProHealth Silver HSA $3000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS541702","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS541701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540018","Pioneer One Silver HSA $3000","37833WI054","7114920342","WIN004","WIS005","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540018-04","Pioneer One Silver HSA $2125","73% AV Level Silver Plan",,"0.739481241168873","Yes","Yes","No","100%",,"$2,125","$0","$1,900","$10","$2,125","$0","$1,000","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$5850 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,125","$4250 per person","$4250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS541804","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS541801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540018","Pioneer One Silver HSA $3000","37833WI054","7114920342","WIN004","WIS005","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540018-05","Pioneer One Silver Deductible $675","87% AV Level Silver Plan",,"0.879734804863259","Yes","Yes","No","100%",,"$675","$0","$500","$10","$675","$0","$500","$0","$675","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2400 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$1350 per person","$1350 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS541805","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS541801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540018","Pioneer One Silver HSA $3000","37833WI054","7114920342","WIN004","WIS005","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540018-06","Pioneer One Silver Deductible $230","94% AV Level Silver Plan",,"0.949999831961608","Yes","Yes","No","100%",,"$230","$0","$200","$10","$230","$0","$200","$0","$230","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$850 per person","$850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$230","$460 per person","$460 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS541806","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS541801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540040","Gundersen Health System (R) Silver HSA $5050","37833WI054","7114920342","WIN002","WIS006","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540040-01","Gundersen Health System (R) Silver HSA $5050","Standard Silver On Exchange Plan",,"0.661204330687207","Yes","Yes","No","100%",,"$5,050","$0","$0","$10","$5,050","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS544001","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS544001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540040","Gundersen Health System (R) Silver HSA $5050","37833WI054","7114920342","WIN002","WIS006","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540040-02","Gundersen Health System (R) Silver HSA $5050","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS544002","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS544001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540037","Beloit One Silver HSA $5050","37833WI054","7114920342","WIN003","WIS003","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540037-01","Beloit One Silver HSA $5050","Standard Silver On Exchange Plan",,"0.661204330687207","Yes","Yes","No","100%",,"$5,050","$0","$0","$10","$5,050","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS543701","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS543701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540037","Beloit One Silver HSA $5050","37833WI054","7114920342","WIN003","WIS003","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540037-02","Beloit One Silver HSA $5050","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS543702","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS543701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540037","Beloit One Silver HSA $5050","37833WI054","7114920342","WIN003","WIS003","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540037-03","Beloit One Silver HSA $5050","Limited Cost Sharing Plan Variation",,"0.661204330687207","Yes","Yes","No","100%",,"$5,050","$0","$0","$10","$5,050","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS543703","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS543701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540037","Beloit One Silver HSA $5050","37833WI054","7114920342","WIN003","WIS003","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540037-04","Beloit One Silver HSA $3150","73% AV Level Silver Plan",,"0.739196123449302","Yes","Yes","No","100%",,"$3,150","$0","$0","$10","$3,150","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$5850 per person","$6300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$5850 per person","$6300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS543704","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS543701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540038","ProHealth Silver HSA $5050","37833WI054","7114920342","WIN002","WIS004","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540038-01","ProHealth Silver HSA $5050","Standard Silver On Exchange Plan",,"0.661204330687207","Yes","Yes","No","100%",,"$5,050","$0","$0","$10","$5,050","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS543801","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS543801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540038","ProHealth Silver HSA $5050","37833WI054","7114920342","WIN002","WIS004","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540038-02","ProHealth Silver HSA $5050","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS543802","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS543801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540038","ProHealth Silver HSA $5050","37833WI054","7114920342","WIN002","WIS004","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540038-03","ProHealth Silver HSA $5050","Limited Cost Sharing Plan Variation",,"0.661204330687207","Yes","Yes","No","100%",,"$5,050","$0","$0","$10","$5,050","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS543803","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS543801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540038","ProHealth Silver HSA $5050","37833WI054","7114920342","WIN002","WIS004","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540038-04","ProHealth Silver HSA $3150","73% AV Level Silver Plan",,"0.739196123449302","Yes","Yes","No","100%",,"$3,150","$0","$0","$10","$3,150","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$5850 per person","$6300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$5850 per person","$6300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS543804","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS543801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540037","Beloit One Silver HSA $5050","37833WI054","7114920342","WIN003","WIS003","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540037-05","Beloit One Silver Deductible $1050","87% AV Level Silver Plan",,"0.879955976224215","Yes","Yes","No","100%",,"$1,050","$0","$0","$10","$1,050","$0","$0","$0","$1,050","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","$2100 per person","$2100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","$2100 per person","$2100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS543705","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS543701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540037","Beloit One Silver HSA $5050","37833WI054","7114920342","WIN003","WIS003","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540037-06","Beloit One Silver Deductible $400","94% AV Level Silver Plan",,"0.949008163174539","Yes","Yes","No","100%",,"$400","$0","$0","$10","$400","$0","$0","$0","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$800 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$800 per person","$800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Silver/BOS543706","https://unityhealth.com/2018/BeloitOne/Brochure/Silver/BOS543701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540015","ProHealth Gold HSA $1800","37833WI054","7114920342","WIN002","WIS004","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540015-00","ProHealth Gold HSA $1800","Standard Gold Off Exchange Plan",,"0.763438531418891","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$10","$1,800","$0","$500","$0","$1,800","$0","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$7350 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG541500","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG541501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540015","ProHealth Gold HSA $1800","37833WI054","7114920342","WIN002","WIS004","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540015-01","ProHealth Gold HSA $1800","Standard Gold On Exchange Plan",,"0.763438531418891","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$10","$1,800","$0","$500","$0","$1,800","$0","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$7350 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG541501","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG541501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540015","ProHealth Gold HSA $1800","37833WI054","7114920342","WIN002","WIS004","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540015-02","ProHealth Gold HSA $1800","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG541502","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG541501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540015","ProHealth Gold HSA $1800","37833WI054","7114920342","WIN002","WIS004","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540015-03","ProHealth Gold HSA $1800","Limited Cost Sharing Plan Variation",,"0.763438531418891","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$10","$1,800","$0","$500","$0","$1,800","$0","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$7350 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG541503","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG541501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540019","ProHealth Bronze HSA $6550","37833WI054","7114920342","WIN002","WIS004","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540019-00","ProHealth Bronze HSA $6550","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB541900","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB541901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540019","ProHealth Bronze HSA $6550","37833WI054","7114920342","WIN002","WIS004","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540019-01","ProHealth Bronze HSA $6550","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB541901","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB541901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540019","ProHealth Bronze HSA $6550","37833WI054","7114920342","WIN002","WIS004","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540019-02","ProHealth Bronze HSA $6550","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB541902","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB541901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540019","ProHealth Bronze HSA $6550","37833WI054","7114920342","WIN002","WIS004","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540019-03","ProHealth Bronze HSA $6550","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB541903","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB541901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540029","ProHealth Bronze HSA $5000","37833WI054","7114920342","WIN002","WIS004","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540029-00","ProHealth Bronze HSA $5000","Standard Bronze Off Exchange Plan",,"0.618986343736706","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$10","$5,000","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$7350 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB542900","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB542901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540029","ProHealth Bronze HSA $5000","37833WI054","7114920342","WIN002","WIS004","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540029-01","ProHealth Bronze HSA $5000","Standard Bronze On Exchange Plan",,"0.618986343736706","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$10","$5,000","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$7350 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB542901","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB542901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540029","ProHealth Bronze HSA $5000","37833WI054","7114920342","WIN002","WIS004","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540029-02","ProHealth Bronze HSA $5000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB542902","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB542901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540029","ProHealth Bronze HSA $5000","37833WI054","7114920342","WIN002","WIS004","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540029-03","ProHealth Bronze HSA $5000","Limited Cost Sharing Plan Variation",,"0.618986343736706","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$10","$5,000","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$7350 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Bronze/PHB542903","https://unityhealth.com/2018/ProHealth/Brochure/Bronze/PHB542901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540017","ProHealth Silver HSA $3000","37833WI054","7114920342","WIN002","WIS004","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540017-00","ProHealth Silver HSA $3000","Standard Silver Off Exchange Plan",,"0.660384893410427","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$10","$3,000","$0","$1,300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$7350 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS541700","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS541701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540017","ProHealth Silver HSA $3000","37833WI054","7114920342","WIN002","WIS004","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540017-03","ProHealth Silver HSA $3000","Limited Cost Sharing Plan Variation",,"0.660384893410427","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$10","$3,000","$0","$1,300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$7350 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS541703","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS541701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540017","ProHealth Silver HSA $3000","37833WI054","7114920342","WIN002","WIS004","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540017-04","ProHealth Silver HSA $2125","73% AV Level Silver Plan",,"0.739481241168873","Yes","Yes","No","100%",,"$2,125","$0","$1,900","$10","$2,125","$0","$1,000","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$5850 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,125","$4250 per person","$4250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS541704","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS541701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540017","ProHealth Silver HSA $3000","37833WI054","7114920342","WIN002","WIS004","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540017-05","ProHealth Silver Deductible $675","87% AV Level Silver Plan",,"0.879734804863259","Yes","Yes","No","100%",,"$675","$0","$500","$10","$675","$0","$500","$0","$675","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2400 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$1350 per person","$1350 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS541705","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS541701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540017","ProHealth Silver HSA $3000","37833WI054","7114920342","WIN002","WIS004","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540017-06","ProHealth Silver Deductible $230","94% AV Level Silver Plan",,"0.949999831961608","Yes","Yes","No","100%",,"$230","$0","$200","$10","$230","$0","$200","$0","$230","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$850 per person","$850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$230","$460 per person","$460 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS541706","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS541701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540038","ProHealth Silver HSA $5050","37833WI054","7114920342","WIN002","WIS004","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540038-00","ProHealth Silver HSA $5050","Standard Silver Off Exchange Plan",,"0.661204330687207","Yes","Yes","No","100%",,"$5,050","$0","$0","$10","$5,050","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS543800","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS543801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540038","ProHealth Silver HSA $5050","37833WI054","7114920342","WIN002","WIS004","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540038-05","ProHealth Silver Deductible $1050","87% AV Level Silver Plan",,"0.879955976224215","Yes","Yes","No","100%",,"$1,050","$0","$0","$10","$1,050","$0","$0","$0","$1,050","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","$2100 per person","$2100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","$2100 per person","$2100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS543805","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS543801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540038","ProHealth Silver HSA $5050","37833WI054","7114920342","WIN002","WIS004","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540038-06","ProHealth Silver Deductible $400","94% AV Level Silver Plan",,"0.949008163174539","Yes","Yes","No","100%",,"$400","$0","$0","$10","$400","$0","$0","$0","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$800 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$800 per person","$800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/ProHealth/SBC/Silver/PHS543806","https://unityhealth.com/2018/ProHealth/Brochure/Silver/PHS543801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540016","Pioneer One Gold HSA $1800","37833WI054","7114920342","WIN004","WIS005","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540016-00","Pioneer One Gold HSA $1800","Standard Gold Off Exchange Plan",,"0.763438531418891","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$10","$1,800","$0","$500","$0","$1,800","$0","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$7350 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG541600","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG541601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540016","Pioneer One Gold HSA $1800","37833WI054","7114920342","WIN004","WIS005","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540016-01","Pioneer One Gold HSA $1800","Standard Gold On Exchange Plan",,"0.763438531418891","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$10","$1,800","$0","$500","$0","$1,800","$0","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$7350 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG541601","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG541601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540016","Pioneer One Gold HSA $1800","37833WI054","7114920342","WIN004","WIS005","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540016-02","Pioneer One Gold HSA $1800","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG541602","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG541601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540016","Pioneer One Gold HSA $1800","37833WI054","7114920342","WIN004","WIS005","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540016-03","Pioneer One Gold HSA $1800","Limited Cost Sharing Plan Variation",,"0.763438531418891","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$10","$1,800","$0","$500","$0","$1,800","$0","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$7350 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG541603","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG541601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540020","Pioneer One Bronze HSA $6550","37833WI054","7114920342","WIN004","WIS005","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540020-00","Pioneer One Bronze HSA $6550","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB542000","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB542001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540020","Pioneer One Bronze HSA $6550","37833WI054","7114920342","WIN004","WIS005","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540020-01","Pioneer One Bronze HSA $6550","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB542001","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB542001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540020","Pioneer One Bronze HSA $6550","37833WI054","7114920342","WIN004","WIS005","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540020-02","Pioneer One Bronze HSA $6550","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB542002","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB542001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540020","Pioneer One Bronze HSA $6550","37833WI054","7114920342","WIN004","WIS005","WIF009","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540020-03","Pioneer One Bronze HSA $6550","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB542003","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB542001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540031","Pioneer One Bronze HSA $5000","37833WI054","7114920342","WIN004","WIS005","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540031-00","Pioneer One Bronze HSA $5000","Standard Bronze Off Exchange Plan",,"0.618986343736706","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$10","$5,000","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$7350 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB543100","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB543101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540031","Pioneer One Bronze HSA $5000","37833WI054","7114920342","WIN004","WIS005","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540031-01","Pioneer One Bronze HSA $5000","Standard Bronze On Exchange Plan",,"0.618986343736706","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$10","$5,000","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$7350 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB543101","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB543101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540031","Pioneer One Bronze HSA $5000","37833WI054","7114920342","WIN004","WIS005","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540031-02","Pioneer One Bronze HSA $5000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB543102","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB543101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540031","Pioneer One Bronze HSA $5000","37833WI054","7114920342","WIN004","WIS005","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540031-03","Pioneer One Bronze HSA $5000","Limited Cost Sharing Plan Variation",,"0.618986343736706","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$10","$5,000","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$7350 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Bronze/POB543103","https://unityhealth.com/2018/PioneerOne/Brochure/Bronze/POB543101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540018","Pioneer One Silver HSA $3000","37833WI054","7114920342","WIN004","WIS005","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540018-00","Pioneer One Silver HSA $3000","Standard Silver Off Exchange Plan",,"0.660384893410427","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$10","$3,000","$0","$1,300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$7350 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS541800","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS541801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540018","Pioneer One Silver HSA $3000","37833WI054","7114920342","WIN004","WIS005","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540018-01","Pioneer One Silver HSA $3000","Standard Silver On Exchange Plan",,"0.660384893410427","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$10","$3,000","$0","$1,300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$7350 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS541801","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS541801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540018","Pioneer One Silver HSA $3000","37833WI054","7114920342","WIN004","WIS005","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540018-02","Pioneer One Silver HSA $3000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS541802","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS541801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540018","Pioneer One Silver HSA $3000","37833WI054","7114920342","WIN004","WIS005","WIF012","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540018-03","Pioneer One Silver HSA $3000","Limited Cost Sharing Plan Variation",,"0.660384893410427","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$10","$3,000","$0","$1,300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$7350 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS541803","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS541801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540039","Pioneer One Silver HSA $5050","37833WI054","7114920342","WIN004","WIS005","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540039-00","Pioneer One Silver HSA $5050","Standard Silver Off Exchange Plan",,"0.661204330687207","Yes","Yes","No","100%",,"$5,050","$0","$0","$10","$5,050","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS543900","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS543901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540039","Pioneer One Silver HSA $5050","37833WI054","7114920342","WIN004","WIS005","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540039-01","Pioneer One Silver HSA $5050","Standard Silver On Exchange Plan",,"0.661204330687207","Yes","Yes","No","100%",,"$5,050","$0","$0","$10","$5,050","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS543901","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS543901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540039","Pioneer One Silver HSA $5050","37833WI054","7114920342","WIN004","WIS005","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540039-02","Pioneer One Silver HSA $5050","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS543902","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS543901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540039","Pioneer One Silver HSA $5050","37833WI054","7114920342","WIN004","WIS005","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540039-03","Pioneer One Silver HSA $5050","Limited Cost Sharing Plan Variation",,"0.661204330687207","Yes","Yes","No","100%",,"$5,050","$0","$0","$10","$5,050","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS543903","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS543901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540039","Pioneer One Silver HSA $5050","37833WI054","7114920342","WIN004","WIS005","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540039-04","Pioneer One Silver HSA $3150","73% AV Level Silver Plan",,"0.739196123449302","Yes","Yes","No","100%",,"$3,150","$0","$0","$10","$3,150","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$5850 per person","$6300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$5850 per person","$6300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS543904","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS543901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540039","Pioneer One Silver HSA $5050","37833WI054","7114920342","WIN004","WIS005","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540039-05","Pioneer One Silver Deductible $1050","87% AV Level Silver Plan",,"0.879955976224215","Yes","Yes","No","100%",,"$1,050","$0","$0","$10","$1,050","$0","$0","$0","$1,050","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","$2100 per person","$2100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","$2100 per person","$2100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS543905","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS543901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540039","Pioneer One Silver HSA $5050","37833WI054","7114920342","WIN004","WIS005","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540039-06","Pioneer One Silver Deductible $400","94% AV Level Silver Plan",,"0.949008163174539","Yes","Yes","No","100%",,"$400","$0","$0","$10","$400","$0","$0","$0","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$800 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$800 per person","$800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Silver/POS543906","https://unityhealth.com/2018/PioneerOne/Brochure/Silver/POS543901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540041","Gundersen Health System (R) Gold HSA $1800","37833WI054","7114920342","WIN002","WIS006","WIF010","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540041-00","Gundersen Health System (R) Gold HSA $1800","Standard Gold Off Exchange Plan",,"0.763438531418891","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$10","$1,800","$0","$500","$0","$1,800","$0","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$7350 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG544100","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG544101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540041","Gundersen Health System (R) Gold HSA $1800","37833WI054","7114920342","WIN002","WIS006","WIF010","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540041-01","Gundersen Health System (R) Gold HSA $1800","Standard Gold On Exchange Plan",,"0.763438531418891","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$10","$1,800","$0","$500","$0","$1,800","$0","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$7350 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG544101","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG544101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540041","Gundersen Health System (R) Gold HSA $1800","37833WI054","7114920342","WIN002","WIS006","WIF010","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540041-02","Gundersen Health System (R) Gold HSA $1800","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG544102","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG544101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540041","Gundersen Health System (R) Gold HSA $1800","37833WI054","7114920342","WIN002","WIS006","WIF010","New","HMO","Gold","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540041-03","Gundersen Health System (R) Gold HSA $1800","Limited Cost Sharing Plan Variation",,"0.763438531418891","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$10","$1,800","$0","$500","$0","$1,800","$0","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$7350 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG544103","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG544101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540043","Gundersen Health System (R) Bronze HSA $6550","37833WI054","7114920342","WIN002","WIS006","WIF009","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540043-00","Gundersen Health System (R) Bronze HSA $6550","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB544300","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB544301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540043","Gundersen Health System (R) Bronze HSA $6550","37833WI054","7114920342","WIN002","WIS006","WIF009","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540043-01","Gundersen Health System (R) Bronze HSA $6550","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB544301","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB544301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540043","Gundersen Health System (R) Bronze HSA $6550","37833WI054","7114920342","WIN002","WIS006","WIF009","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540043-02","Gundersen Health System (R) Bronze HSA $6550","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB544302","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB544301"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0140001","Tradition $500 - 10%","38166WI014",,"WIN002","WIS002","WIF007","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel  Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0140001-00","Tradition $500 - 10%","Standard Platinum Off Exchange Plan",,"0.919029296179982","No","Yes","No","100%",,"$500","$20","$480","$1,000","$500","$490","$10","$1,000","$500","$0","$100","$600",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Tradition/Tradition 500-10.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/tradition"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540040","Gundersen Health System (R) Silver HSA $5050","37833WI054","7114920342","WIN002","WIS006","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540040-06","Gundersen Health System (R) Silver Deductible $400","94% AV Level Silver Plan",,"0.949008163174539","Yes","Yes","No","100%",,"$400","$0","$0","$10","$400","$0","$0","$0","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$800 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$800 per person","$800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS544006","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS544001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540043","Gundersen Health System (R) Bronze HSA $6550","37833WI054","7114920342","WIN002","WIS006","WIF009","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540043-03","Gundersen Health System (R) Bronze HSA $6550","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB544303","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB544301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540033","Gundersen Health System (R) Bronze HSA $5000","37833WI054","7114920342","WIN002","WIS006","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540033-00","Gundersen Health System (R) Bronze HSA $5000","Standard Bronze Off Exchange Plan",,"0.618986343736706","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$10","$5,000","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$7350 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB543300","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB543301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540033","Gundersen Health System (R) Bronze HSA $5000","37833WI054","7114920342","WIN002","WIS006","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540033-01","Gundersen Health System (R) Bronze HSA $5000","Standard Bronze On Exchange Plan",,"0.618986343736706","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$10","$5,000","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$7350 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB543301","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB543301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540033","Gundersen Health System (R) Bronze HSA $5000","37833WI054","7114920342","WIN002","WIS006","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540033-02","Gundersen Health System (R) Bronze HSA $5000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB543302","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB543301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540033","Gundersen Health System (R) Bronze HSA $5000","37833WI054","7114920342","WIN002","WIS006","WIF011","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540033-03","Gundersen Health System (R) Bronze HSA $5000","Limited Cost Sharing Plan Variation",,"0.618986343736706","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$10","$5,000","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$7350 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$7350 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Bronze/GHSB543303","https://unityhealth.com/2018/GHS/Brochure/Bronze/GHSB543301"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540042","Gundersen Health System (R) Silver HSA $3000","37833WI054","7114920342","WIN002","WIS006","WIF012","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540042-00","Gundersen Health System (R) Silver HSA $3000","Standard Silver Off Exchange Plan",,"0.660384893410427","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$10","$3,000","$0","$1,300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$7350 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS544200","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS544201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540042","Gundersen Health System (R) Silver HSA $3000","37833WI054","7114920342","WIN002","WIS006","WIF012","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540042-01","Gundersen Health System (R) Silver HSA $3000","Standard Silver On Exchange Plan",,"0.660384893410427","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$10","$3,000","$0","$1,300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$7350 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS544201","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS544201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540042","Gundersen Health System (R) Silver HSA $3000","37833WI054","7114920342","WIN002","WIS006","WIF012","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540042-02","Gundersen Health System (R) Silver HSA $3000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS544202","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS544201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540042","Gundersen Health System (R) Silver HSA $3000","37833WI054","7114920342","WIN002","WIS006","WIF012","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540042-03","Gundersen Health System (R) Silver HSA $3000","Limited Cost Sharing Plan Variation",,"0.660384893410427","Yes","Yes","No","100%",,"$3,000","$0","$2,900","$10","$3,000","$0","$1,300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$7350 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS544203","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS544201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540042","Gundersen Health System (R) Silver HSA $3000","37833WI054","7114920342","WIN002","WIS006","WIF012","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540042-04","Gundersen Health System (R) Silver HSA $2125","73% AV Level Silver Plan",,"0.739481241168873","Yes","Yes","No","100%",,"$2,125","$0","$1,900","$10","$2,125","$0","$1,000","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$5850 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,125","$4250 per person","$4250 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS544204","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS544201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540042","Gundersen Health System (R) Silver HSA $3000","37833WI054","7114920342","WIN002","WIS006","WIF012","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540042-05","Gundersen Health System (R) Silver Deductible $675","87% AV Level Silver Plan",,"0.879734804863259","Yes","Yes","No","100%",,"$675","$0","$500","$10","$675","$0","$500","$0","$675","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2400 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$1350 per person","$1350 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS544205","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS544201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540042","Gundersen Health System (R) Silver HSA $3000","37833WI054","7114920342","WIN002","WIS006","WIF012","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540042-06","Gundersen Health System (R) Silver Deductible $230","94% AV Level Silver Plan",,"0.949999831961608","Yes","Yes","No","100%",,"$230","$0","$200","$10","$230","$0","$200","$0","$230","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$425","$850 per person","$850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$230","$460 per person","$460 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS544206","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS544201"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540040","Gundersen Health System (R) Silver HSA $5050","37833WI054","7114920342","WIN002","WIS006","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540040-00","Gundersen Health System (R) Silver HSA $5050","Standard Silver Off Exchange Plan",,"0.661204330687207","Yes","Yes","No","100%",,"$5,050","$0","$0","$10","$5,050","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS544000","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS544001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540040","Gundersen Health System (R) Silver HSA $5050","37833WI054","7114920342","WIN002","WIS006","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540040-03","Gundersen Health System (R) Silver HSA $5050","Limited Cost Sharing Plan Variation",,"0.661204330687207","Yes","Yes","No","100%",,"$5,050","$0","$0","$10","$5,050","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$7350 per person","$10100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS544003","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS544001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540040","Gundersen Health System (R) Silver HSA $5050","37833WI054","7114920342","WIN002","WIS006","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540040-04","Gundersen Health System (R) Silver HSA $3150","73% AV Level Silver Plan",,"0.739196123449302","Yes","Yes","No","100%",,"$3,150","$0","$0","$10","$3,150","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$5850 per person","$6300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$5850 per person","$6300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS544004","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS544001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0540040","Gundersen Health System (R) Silver HSA $5050","37833WI054","7114920342","WIN002","WIS006","WIF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal","37833WI0540040-05","Gundersen Health System (R) Silver Deductible $1050","87% AV Level Silver Plan",,"0.879955976224215","Yes","Yes","No","100%",,"$1,050","$0","$0","$10","$1,050","$0","$0","$0","$1,050","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","$2100 per person","$2100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","$2100 per person","$2100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/2018/GHS/SBC/Silver/GHSS544005","https://unityhealth.com/2018/GHS/Brochure/Silver/GHSS544001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510061","Pioneer One Gold First $500","37833WI051","7114920342","WIN004","WIS005","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510061-03","Pioneer One Gold First $500","Limited Cost Sharing Plan Variation","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG516103","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG516101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510081","Gundersen Health System (R) Gold First $500","37833WI051","7114920342","WIN002","WIS006","WIF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510081-00","Gundersen Health System (R) Gold First $500","Standard Gold Off Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG518100","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG518101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510081","Gundersen Health System (R) Gold First $500","37833WI051","7114920342","WIN002","WIS006","WIF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510081-01","Gundersen Health System (R) Gold First $500","Standard Gold On Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG518101","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG518101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510081","Gundersen Health System (R) Gold First $500","37833WI051","7114920342","WIN002","WIS006","WIF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510081-02","Gundersen Health System (R) Gold First $500","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG518102","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG518101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510057","Prime Gold First $500","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510057-00","Prime Gold First $500","Standard Gold Off Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG515700","https://unityhealth.com/2018/Prime/Brochure/Gold/PG515701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510057","Prime Gold First $500","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510057-01","Prime Gold First $500","Standard Gold On Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG515701","https://unityhealth.com/2018/Prime/Brochure/Gold/PG515701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380064","Prime Gold First $500 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380064-02","Prime Gold First $500 with Dental","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG386402","https://unityhealth.com/2018/Prime/Brochure/Gold/PG386401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380064","Prime Gold First $500 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380064-03","Prime Gold First $500 with Dental","Limited Cost Sharing Plan Variation","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG386403","https://unityhealth.com/2018/Prime/Brochure/Gold/PG386401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380065","Elite Gold First $500 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380065-00","Elite Gold First $500 with Dental","Standard Gold Off Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG386500","https://unityhealth.com/2018/Elite/Brochure/Gold/EG386501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380065","Elite Gold First $500 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380065-01","Elite Gold First $500 with Dental","Standard Gold On Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG386501","https://unityhealth.com/2018/Elite/Brochure/Gold/EG386501"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180015","Select $2,000 - 20%","38166WI018",,"WIN001","WIS001","WIF021","New","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180015-00","Select $2,000 - 20%","Standard Gold Off Exchange Plan",,"0.760462454780469","No","Yes","No","100%",,"$2,000","$100","$0","$2,100","$800","$2,000","$0","$2,800","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,400","$5400 per person","$10800 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Off-Exchange/Select 200020OffE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0140002","Tradition $2,000 - Copay","38166WI014",,"WIN002","WIS002","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel  Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0140002-00","Tradition $2,000 - Copay","Standard Gold Off Exchange Plan",,"0.81277464281443","No","Yes","No","100%",,"$2,000","$100","$0","$2,100","$300","$2,000","$0","$2,400","$1,700","$100","$0","$1,800",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Tradition/Tradition 2000-Copay.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/tradition"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510057","Prime Gold First $500","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510057-02","Prime Gold First $500","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG515702","https://unityhealth.com/2018/Prime/Brochure/Gold/PG515701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510057","Prime Gold First $500","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510057-03","Prime Gold First $500","Limited Cost Sharing Plan Variation","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG515703","https://unityhealth.com/2018/Prime/Brochure/Gold/PG515701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510058","Elite Gold First $500","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510058-00","Elite Gold First $500","Standard Gold Off Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG515800","https://unityhealth.com/2018/Elite/Brochure/Gold/EG515801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510058","Elite Gold First $500","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510058-01","Elite Gold First $500","Standard Gold On Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG515801","https://unityhealth.com/2018/Elite/Brochure/Gold/EG515801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510058","Elite Gold First $500","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510058-02","Elite Gold First $500","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG515802","https://unityhealth.com/2018/Elite/Brochure/Gold/EG515801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510058","Elite Gold First $500","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510058-03","Elite Gold First $500","Limited Cost Sharing Plan Variation","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG515803","https://unityhealth.com/2018/Elite/Brochure/Gold/EG515801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510059","Beloit One Gold First $500","37833WI051","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510059-00","Beloit One Gold First $500","Standard Gold Off Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG515900","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG515901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510059","Beloit One Gold First $500","37833WI051","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510059-01","Beloit One Gold First $500","Standard Gold On Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG515901","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG515901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510059","Beloit One Gold First $500","37833WI051","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510059-02","Beloit One Gold First $500","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG515902","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG515901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510059","Beloit One Gold First $500","37833WI051","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510059-03","Beloit One Gold First $500","Limited Cost Sharing Plan Variation","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG515903","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG515901"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510060","ProHealth Gold First $500","37833WI051","7114920342","WIN002","WIS004","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510060-00","ProHealth Gold First $500","Standard Gold Off Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG516000","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG516001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510060","ProHealth Gold First $500","37833WI051","7114920342","WIN002","WIS004","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510060-01","ProHealth Gold First $500","Standard Gold On Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG516001","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG516001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510060","ProHealth Gold First $500","37833WI051","7114920342","WIN002","WIS004","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510060-02","ProHealth Gold First $500","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG516002","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG516001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510060","ProHealth Gold First $500","37833WI051","7114920342","WIN002","WIS004","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510060-03","ProHealth Gold First $500","Limited Cost Sharing Plan Variation","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG516003","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG516001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510061","Pioneer One Gold First $500","37833WI051","7114920342","WIN004","WIS005","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510061-00","Pioneer One Gold First $500","Standard Gold Off Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG516100","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG516101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510061","Pioneer One Gold First $500","37833WI051","7114920342","WIN004","WIS005","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510061-01","Pioneer One Gold First $500","Standard Gold On Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG516101","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG516101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510061","Pioneer One Gold First $500","37833WI051","7114920342","WIN004","WIS005","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510061-02","Pioneer One Gold First $500","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG516102","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG516101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0510081","Gundersen Health System (R) Gold First $500","37833WI051","7114920342","WIN002","WIS006","WIF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9995",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0510081-03","Gundersen Health System (R) Gold First $500","Limited Cost Sharing Plan Variation","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG518103","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG518101"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380064","Prime Gold First $500 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380064-00","Prime Gold First $500 with Dental","Standard Gold Off Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG386400","https://unityhealth.com/2018/Prime/Brochure/Gold/PG386401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380064","Prime Gold First $500 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380064-01","Prime Gold First $500 with Dental","Standard Gold On Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Prime/SBC/Gold/PG386401","https://unityhealth.com/2018/Prime/Brochure/Gold/PG386401"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380065","Elite Gold First $500 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380065-02","Elite Gold First $500 with Dental","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG386502","https://unityhealth.com/2018/Elite/Brochure/Gold/EG386501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380065","Elite Gold First $500 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380065-03","Elite Gold First $500 with Dental","Limited Cost Sharing Plan Variation","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/Elite/SBC/Gold/EG386503","https://unityhealth.com/2018/Elite/Brochure/Gold/EG386501"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380066","Beloit One Gold First $500 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380066-00","Beloit One Gold First $500 with Dental","Standard Gold Off Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG386600","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG386601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380066","Beloit One Gold First $500 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380066-01","Beloit One Gold First $500 with Dental","Standard Gold On Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG386601","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG386601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380066","Beloit One Gold First $500 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380066-02","Beloit One Gold First $500 with Dental","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG386602","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG386601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380066","Beloit One Gold First $500 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380066-03","Beloit One Gold First $500 with Dental","Limited Cost Sharing Plan Variation","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/BeloitOne/SBC/Gold/BOG386603","https://unityhealth.com/2018/BeloitOne/Brochure/Gold/BOG386601"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380067","ProHealth Gold First $500 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380067-00","ProHealth Gold First $500 with Dental","Standard Gold Off Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG386700","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG386701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380067","ProHealth Gold First $500 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380067-01","ProHealth Gold First $500 with Dental","Standard Gold On Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG386701","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG386701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380067","ProHealth Gold First $500 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380067-02","ProHealth Gold First $500 with Dental","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG386702","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG386701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380067","ProHealth Gold First $500 with Dental","37833WI038","7114920342","WIN002","WIS004","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380067-03","ProHealth Gold First $500 with Dental","Limited Cost Sharing Plan Variation","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/ProHealth/SBC/Gold/PHG386703","https://unityhealth.com/2018/ProHealth/Brochure/Gold/PHG386701"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380068","Pioneer One Gold First $500 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380068-00","Pioneer One Gold First $500 with Dental","Standard Gold Off Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG386800","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG386801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380068","Pioneer One Gold First $500 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380068-01","Pioneer One Gold First $500 with Dental","Standard Gold On Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG386801","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG386801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380068","Pioneer One Gold First $500 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380068-02","Pioneer One Gold First $500 with Dental","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG386802","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG386801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380068","Pioneer One Gold First $500 with Dental","37833WI038","7114920342","WIN004","WIS005","WIF001","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380068-03","Pioneer One Gold First $500 with Dental","Limited Cost Sharing Plan Variation","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/PioneerOne/SBC/Gold/POG386803","https://unityhealth.com/2018/PioneerOne/Brochure/Gold/POG386801"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380080","Gundersen Health System (R) Gold First $500 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380080-00","Gundersen Health System (R) Gold First $500 with Dental","Standard Gold Off Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG388000","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG388001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380080","Gundersen Health System (R) Gold First $500 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380080-01","Gundersen Health System (R) Gold First $500 with Dental","Standard Gold On Exchange Plan","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG388001","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG388001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380080","Gundersen Health System (R) Gold First $500 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380080-02","Gundersen Health System (R) Gold First $500 with Dental","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG388002","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG388001"
"2018","WI","37833","HIOS","2017-08-17 02:20:39","Individual","No","39-1450766","37833WI0380080","Gundersen Health System (R) Gold First $500 with Dental","37833WI038","7114920342","WIN002","WIS006","WIF001","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","As a member, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9593",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com/","https://unityhealth.com/drugformulary/metal-choice","37833WI0380080-03","Gundersen Health System (R) Gold First $500 with Dental","Limited Cost Sharing Plan Variation","81.45%","0.758595787804264","No","Yes","No","100%",,"$3,300","$200","$1,300","$10","$0","$1,200","$0","$0","$600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/2018/GHS/SBC/Gold/GHSG388003","https://unityhealth.com/2018/GHS/Brochure/Gold/GHSG388001"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180001","Select $1,500 - 20%","38166WI018",,"WIN001","WIS001","WIF020","Existing","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180001-00","Select $1,500 - 20%","Standard Gold Off Exchange Plan",,"0.80558889388592","No","Yes","No","100%",,"$1,500","$40","$1,960","$3,500","$800","$1,600","$0","$2,400","$1,500","$0","$70","$1,570",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Off-Exchange/Select 150020OffE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0140001","Tradition $500 - 10%","38166WI014",,"WIN002","WIS002","WIF007","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel  Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0140001-01","Tradition $500 - 10%","Standard Platinum On Exchange Plan",,"0.919029296179982","No","Yes","No","100%",,"$500","$20","$480","$1,000","$500","$490","$10","$1,000","$500","$0","$100","$600",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Tradition/Tradition 500-10.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/tradition"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180001","Select $1,500 - 20%","38166WI018",,"WIN001","WIS001","WIF020","Existing","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180001-01","Select $1,500 - 20%","Standard Gold On Exchange Plan",,"0.80558889388592","No","Yes","No","100%",,"$1,500","$40","$1,960","$3,500","$800","$1,600","$0","$2,400","$1,500","$0","$70","$1,570",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select On-Exchange/Select 150020OnE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180001","Select $1,500 - 20%","38166WI018",,"WIN001","WIS001","WIF020","Existing","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180001-02","Select $1,500 - 20%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Zero/Select 150020Zero.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0140004","Tradition $1,250 - 20%","38166WI014",,"WIN002","WIS002","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel  Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0140004-00","Tradition $1,250 - 20%","Standard Gold Off Exchange Plan",,"0.808950908812464","No","Yes","No","100%",,"$1,250","$50","$2,200","$3,500","$800","$600","$0","$1,400","$1,250","$0","$100","$1,350",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Tradition/Tradition 1250-20.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/tradition"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0140004","Tradition $1,250 - 20%","38166WI014",,"WIN002","WIS002","WIF005","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel  Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0140004-01","Tradition $1,250 - 20%","Standard Gold On Exchange Plan",,"0.808950908812464","No","Yes","No","100%",,"$1,250","$50","$2,200","$3,500","$800","$600","$0","$1,400","$1,250","$0","$100","$1,350",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Tradition/Tradition 1250-20.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/tradition"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180001","Select $1,500 - 20%","38166WI018",,"WIN001","WIS001","WIF020","Existing","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180001-03","Select $1,500 - 20%","Limited Cost Sharing Plan Variation",,"0.80558889388592","No","Yes","No","100%",,"$1,500","$40","$1,960","$3,500","$800","$1,600","$0","$2,400","$1,500","$0","$70","$1,570",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Limited/Select 150020Limited CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0140023","Tradition $4,000 HDHP","38166WI014",,"WIN002","WIS002","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel  Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0140023-00","Tradition $4,000 HDHP","Standard Silver Off Exchange Plan",,"0.700980885295207","Yes","Yes","No","100%",,"$4,000","$0","$0","$4,000","$4,000","$0","$0","$4,000","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Tradition/Tradition 4000 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/tradition"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0140023","Tradition $4,000 HDHP","38166WI014",,"WIN002","WIS002","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel  Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0140023-01","Tradition $4,000 HDHP","Standard Silver On Exchange Plan",,"0.700980885295207","Yes","Yes","No","100%",,"$4,000","$0","$0","$4,000","$4,000","$0","$0","$4,000","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Tradition/Tradition 4000 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/tradition"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0140002","Tradition $2,000 - Copay","38166WI014",,"WIN002","WIS002","WIF010","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel  Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0140002-01","Tradition $2,000 - Copay","Standard Gold On Exchange Plan",,"0.81277464281443","No","Yes","No","100%",,"$2,000","$100","$0","$2,100","$300","$2,000","$0","$2,400","$1,700","$100","$0","$1,800",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Tradition/Tradition 2000-Copay.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/tradition"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180015","Select $2,000 - 20%","38166WI018",,"WIN001","WIS001","WIF021","New","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180015-01","Select $2,000 - 20%","Standard Gold On Exchange Plan",,"0.760462454780469","No","Yes","No","100%",,"$2,000","$100","$0","$2,100","$800","$2,000","$0","$2,800","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,400","$5400 per person","$10800 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select On-Exchange/Select 200020OnE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180015","Select $2,000 - 20%","38166WI018",,"WIN001","WIS001","WIF021","New","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180015-02","Select $2,000 - 20%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Zero/Select 200020Zero.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0140011","Tradition $3,000 - 25%","38166WI014",,"WIN002","WIS002","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel  Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0140011-00","Tradition $3,000 - 25%","Standard Silver Off Exchange Plan",,"0.716321376475796","No","Yes","No","100%",,"$3,000","$100","$2,300","$5,400","$800","$1,800","$0","$2,600","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$3,000","$3000 per person","$6000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Tradition/Tradition 3000-25.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/tradition"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0140011","Tradition $3,000 - 25%","38166WI014",,"WIN002","WIS002","WIF010","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel  Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0140011-01","Tradition $3,000 - 25%","Standard Silver On Exchange Plan",,"0.716321376475796","No","Yes","No","100%",,"$3,000","$100","$2,300","$5,400","$800","$1,800","$0","$2,600","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$3,000","$3000 per person","$6000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Tradition/Tradition 3000-25.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/tradition"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180012","Select $5,750 - 30%","38166WI018",,"WIN001","WIS001","WIF018","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180012-05","Select $1,500 ($5,750 - 30%)","87% AV Level Silver Plan",,"0.861072991394833","No","Yes","No","100%",,"$1,488","$12","$0","$1,500","$200","$1,300","$0","$1,500","$1,400","$90","$0","$1,490","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 1500B CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180004","Select $2,500 - 30%","38166WI018",,"WIN001","WIS001","WIF015","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180004-02","Select $2,500 - 30%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Zero/Select 250030Zero.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180004","Select $2,500 - 30%","38166WI018",,"WIN001","WIS001","WIF015","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180004-03","Select $2,500 - 30%","Limited Cost Sharing Plan Variation",,"0.717506509744517","No","Yes","No","100%",,"$2,500","$80","$2,900","$5,480","$800","$1,700","$0","$2,500","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Limited/Select 250030Limited.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180015","Select $2,000 - 20%","38166WI018",,"WIN001","WIS001","WIF021","New","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180015-03","Select $2,000 - 20%","Limited Cost Sharing Plan Variation",,"0.760462454780469","No","Yes","No","100%",,"$2,000","$100","$0","$2,100","$800","$2,000","$0","$2,800","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,400","$5400 per person","$10800 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Limited/Select 200020Limited.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180003","Select $3,000 - 25%","38166WI018",,"WIN001","WIS001","WIF015","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180003-00","Select $3,000 - 25%","Standard Silver Off Exchange Plan",,"0.717833198432412","No","Yes","No","100%",,"$3,000","$80","$2,300","$5,380","$800","$1,700","$0","$2,500","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$3,000","$3000 per person","$6000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Off-Exchange/Select 300025OffE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0140031","Tradition $5,000 - 10%","38166WI014",,"WIN002","WIS002","WIF010","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel  Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0140031-00","Tradition $5,000 - 10%","Standard Silver Off Exchange Plan",,"0.704168372869275","No","Yes","No","100%",,"$5,000","$100","$700","$5,800","$800","$1,800","$0","$2,600","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Tradition/Tradition 5000-10.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/tradition"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0140031","Tradition $5,000 - 10%","38166WI014",,"WIN002","WIS002","WIF010","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel  Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0140031-01","Tradition $5,000 - 10%","Standard Silver On Exchange Plan",,"0.704168372869275","No","Yes","No","100%",,"$5,000","$100","$700","$5,800","$800","$1,800","$0","$2,600","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Tradition/Tradition 5000-10.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/tradition"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180003","Select $3,000 - 25%","38166WI018",,"WIN001","WIS001","WIF015","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180003-01","Select $3,000 - 25%","Standard Silver On Exchange Plan",,"0.717833198432412","No","Yes","No","100%",,"$3,000","$80","$2,300","$5,380","$800","$1,700","$0","$2,500","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$3,000","$3000 per person","$6000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select On-Exchange/Select 300025OnE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180003","Select $3,000 - 25%","38166WI018",,"WIN001","WIS001","WIF015","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180003-02","Select $3,000 - 25%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Zero/Select 300025Zero.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0140027","Tradition $2,000 HDHP","38166WI014",,"WIN002","WIS002","WIF006","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel  Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0140027-00","Tradition $2,000 HDHP","Standard Gold Off Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$2,000","$2,000","$0","$0","$2,000","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$4000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$4000 per person","$4000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Tradition/Tradition 2000 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/tradition"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0140027","Tradition $2,000 HDHP","38166WI014",,"WIN002","WIS002","WIF006","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel  Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0140027-01","Tradition $2,000 HDHP","Standard Gold On Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$2,000","$2,000","$0","$0","$2,000","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$4000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$4000 per person","$4000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Tradition/Tradition 2000 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/tradition"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180003","Select $3,000 - 25%","38166WI018",,"WIN001","WIS001","WIF015","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180003-03","Select $3,000 - 25%","Limited Cost Sharing Plan Variation",,"0.717833198432412","No","Yes","No","100%",,"$3,000","$80","$2,300","$5,380","$800","$1,700","$0","$2,500","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$3,000","$3000 per person","$6000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Limited/Select 300025Limited.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180003","Select $3,000 - 25%","38166WI018",,"WIN001","WIS001","WIF015","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180003-04","Select $3,000 - 20% ($3,000 - 25%)","73% AV Level Silver Plan",,"0.737948407220027","No","Yes","No","100%",,"$3,000","$50","$1,900","$4,950","$800","$1,500","$0","$2,300","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11700 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 3000-20 CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0140012","Tradition $3,000 - 20% HDHP","38166WI014",,"WIN002","WIS002","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel  Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0140012-00","Tradition $3,000 - 20% HDHP","Standard Silver Off Exchange Plan",,"0.681544592305403","Yes","Yes","No","100%",,"$3,000","$70","$1,900","$4,970","$3,000","$1,000","$70","$4,070","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Tradition/Tradition 3000-20 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/tradition"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0140012","Tradition $3,000 - 20% HDHP","38166WI014",,"WIN002","WIS002","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel  Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0140012-01","Tradition $3,000 - 20% HDHP","Standard Silver On Exchange Plan",,"0.681544592305403","Yes","Yes","No","100%",,"$3,000","$70","$1,900","$4,970","$3,000","$1,000","$70","$4,070","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Tradition/Tradition 3000-20 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/tradition"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180003","Select $3,000 - 25%","38166WI018",,"WIN001","WIS001","WIF015","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180003-05","Select $750 - 10% ($3,000 - 25%)","87% AV Level Silver Plan",,"0.877886719896515","No","Yes","No","100%",,"$750","$50","$1,200","$2,000","$750","$1,000","$0","$1,750","$750","$0","$100","$850",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,150","$2150 per person","$4300 per group","$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 750-10 CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180003","Select $3,000 - 25%","38166WI018",,"WIN001","WIS001","WIF015","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180003-06","Select $250 - 10% ($3,000 - 25%)","94% AV Level Silver Plan",,"0.939753978973737","No","Yes","No","100%",,"$250","$20","$480","$750","$250","$499","$1","$750","$250","$0","$100","$350",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 250-10A CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180004","Select $2,500 - 30%","38166WI018",,"WIN001","WIS001","WIF015","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180004-00","Select $2,500 - 30%","Standard Silver Off Exchange Plan",,"0.717506509744517","No","Yes","No","100%",,"$2,500","$80","$2,900","$5,480","$800","$1,700","$0","$2,500","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Off-Exchange/Select 250030OffE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180004","Select $2,500 - 30%","38166WI018",,"WIN001","WIS001","WIF015","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180004-01","Select $2,500 - 30%","Standard Silver On Exchange Plan",,"0.717506509744517","No","Yes","No","100%",,"$2,500","$80","$2,900","$5,480","$800","$1,700","$0","$2,500","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select On-Exchange/Select 250030OnE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0140013","Tradition $6,000 - 20% HDHP","38166WI014",,"WIN002","WIS002","WIF011","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel  Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0140013-00","Tradition $6,000 - 20% HDHP","Standard Bronze Off Exchange Plan",,"0.606873218788479","Yes","Yes","No","100%",,"$6,000","$0","$550","$6,550","$6,000","$300","$0","$6,300","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Tradition/Tradition 6000-20 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/tradition"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0140013","Tradition $6,000 - 20% HDHP","38166WI014",,"WIN002","WIS002","WIF011","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel  Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0140013-01","Tradition $6,000 - 20% HDHP","Standard Bronze On Exchange Plan",,"0.606873218788479","Yes","Yes","No","100%",,"$6,000","$0","$550","$6,550","$6,000","$300","$0","$6,300","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Tradition/Tradition 6000-20 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/tradition"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180012","Select $5,750 - 30%","38166WI018",,"WIN001","WIS001","WIF018","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180012-02","Select $5,750 - 30%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Zero/Select 575030Zero.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180012","Select $5,750 - 30%","38166WI018",,"WIN001","WIS001","WIF018","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180012-03","Select $5,750 - 30%","Limited Cost Sharing Plan Variation",,"0.686149260917621","No","Yes","No","100%",,"$5,750","$100","$0","$5,850","$300","$2,400","$0","$2,700","$1,700","$200","$0","$1,900","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$5,750","$5750 per person","$11500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,750","$5750 per person","$11500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Limited/Select 575030Limited.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180012","Select $5,750 - 30%","38166WI018",,"WIN001","WIS001","WIF018","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180012-04","Select $5,500 ($5,750 - 30%)","73% AV Level Silver Plan",,"0.72354242350012","No","Yes","No","100%",,"$5,451","$49","$0","$5,500","$300","$2,400","$0","$2,700","$1,700","$200","$0","$1,900","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 5500 CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180004","Select $2,500 - 30%","38166WI018",,"WIN001","WIS001","WIF015","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180004-04","Select $2,400 - 30% ($2,500 - 30%)","73% AV Level Silver Plan",,"0.739220123562873","No","Yes","No","100%",,"$2,400","$40","$2,960","$5,400","$800","$1,700","$0","$2,500","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,400","$5400 per person","$10800 per group","$2,400","$2400 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 2400-30 CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180004","Select $2,500 - 30%","38166WI018",,"WIN001","WIS001","WIF015","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180004-05","Select $500 - 20% ($2,500 - 30%)","87% AV Level Silver Plan",,"0.879842558977375","No","Yes","No","100%",,"$500","$20","$1,480","$2,000","$500","$1,000","$20","$1,520","$500","$0","$200","$700",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 500-20 CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180004","Select $2,500 - 30%","38166WI018",,"WIN001","WIS001","WIF015","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180004-06","Select $250 - 10% ($2,500 - 30%)","94% AV Level Silver Plan",,"0.939753978973737","No","Yes","No","100%",,"$250","$20","$480","$750","$250","$499","$1","$750","$250","$0","$100","$350",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 250-10B CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180002","Select $3,750 HDHP","38166WI018",,"WIN001","WIS001","WIF017","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180002-04","Select $3,250 ($3,750 HDHP)","73% AV Level Silver Plan",,"0.734355954395736","Yes","Yes","No","100%",,"$3,250","$0","$0","$3,250","$3,250","$0","$0","$3,250","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 3250 CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0160005","Reliance $2,000 - Copay","38166WI016",,"WIN003","WIS003","WIF010","Existing","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0160005-00","Reliance $2,000 - Copay","Standard Gold Off Exchange Plan",,"0.81277464281443","No","Yes","No","100%",,"$2,000","$100","$0","$2,100","$300","$2,000","$0","$2,400","$1,700","$100","$0","$1,800",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Reliance/Reliance 2000-Copay.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/reliance"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0160005","Reliance $2,000 - Copay","38166WI016",,"WIN003","WIS003","WIF010","Existing","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0160005-01","Reliance $2,000 - Copay","Standard Gold On Exchange Plan",,"0.81277464281443","No","Yes","No","100%",,"$2,000","$100","$0","$2,100","$300","$2,000","$0","$2,400","$1,700","$100","$0","$1,800",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Reliance/Reliance 2000-Copay.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/reliance"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180010","Select $6,500","38166WI018",,"WIN001","WIS001","WIF016","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180010-01","Select $6,500","Standard Bronze On Exchange Plan",,"0.599043397262708","Yes","Yes","No","100%",,"$6,500","$300","$0","$6,800","$700","$1,800","$0","$2,500","$1,800","$50","$0","$1,850",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select On-Exchange/Select 6500OnE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180010","Select $6,500","38166WI018",,"WIN001","WIS001","WIF016","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180010-02","Select $6,500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Zero/Select 6500Zero.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN001","WIS001","WIF018","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180009-00","Select $4,500 - 30%","Standard Silver Off Exchange Plan",,"0.716132569290931","No","Yes","No","100%",,"$4,500","$100","$0","$4,600","$300","$2,300","$0","$2,600","$1,700","$100","$0","$1,800","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Off-Exchange/Select 450030OffE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN001","WIS001","WIF018","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180009-01","Select $4,500 - 30%","Standard Silver On Exchange Plan",,"0.716132569290931","No","Yes","No","100%",,"$4,500","$100","$0","$4,600","$300","$2,300","$0","$2,600","$1,700","$100","$0","$1,800","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select On-Exchange/Select 450030OnE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN001","WIS001","WIF018","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180009-02","Select $4,500 - 30%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Zero/Select 450030Zero.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN001","WIS001","WIF018","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180009-03","Select $4,500 - 30%","Limited Cost Sharing Plan Variation",,"0.716132569290931","No","Yes","No","100%",,"$4,500","$100","$0","$4,600","$300","$2,300","$0","$2,600","$1,700","$100","$0","$1,800","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Limited/Select 450030Limited.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN001","WIS001","WIF018","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180009-04","Select $4,000 - 25% ($4,500 - 30%)","73% AV Level Silver Plan",,"0.739603898613619","No","Yes","No","100%",,"$4,000","$100","$0","$4,100","$300","$2,300","$0","$2,600","$1,700","$100","$0","$1,800","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$4,000","$4000 per person","$8000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 4000-25 CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN001","WIS001","WIF018","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180009-05","Select $1,500 ($4,500 - 30%)","87% AV Level Silver Plan",,"0.869437638781634","No","Yes","No","100%",,"$1,488","$12","$0","$1,500","$200","$1,300","$0","$1,500","$1,400","$80","$0","$1,480","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 1500A CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN001","WIS001","WIF018","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180009-06","Select $500 ($4,500 - 30%)","94% AV Level Silver Plan",,"0.943913219782317","No","Yes","No","100%",,"$495","$5","$0","$500","$100","$400","$0","$500","$500","$0","$0","$500","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 500 CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180013","Select $5,000 - 10%","38166WI018",,"WIN001","WIS001","WIF022","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180013-00","Select $5,000 - 10%","Standard Silver Off Exchange Plan",,"0.683732432097693","No","Yes","No","100%",,"$500","$100","$0","$5,100","$900","$2,000","$0","$2,900","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Off-Exchange/Select 500010OffE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180013","Select $5,000 - 10%","38166WI018",,"WIN001","WIS001","WIF022","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180013-01","Select $5,000 - 10%","Standard Silver On Exchange Plan",,"0.683732432097693","No","Yes","No","100%",,"$500","$100","$0","$5,100","$900","$2,000","$0","$2,900","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select On-Exchange/Select 500010OnE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180013","Select $5,000 - 10%","38166WI018",,"WIN001","WIS001","WIF022","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180013-02","Select $5,000 - 10%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Zero/Select 500010Zero.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180013","Select $5,000 - 10%","38166WI018",,"WIN001","WIS001","WIF022","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180013-03","Select $5,000 - 10%","Limited Cost Sharing Plan Variation",,"0.683732432097693","No","Yes","No","100%",,"$500","$100","$0","$5,100","$900","$2,000","$0","$2,900","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Limited/Select 500010Limited.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180013","Select $5,000 - 10%","38166WI018",,"WIN001","WIS001","WIF022","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180013-04","Select $3,000 - 10% ($5,000 - 10%)","73% AV Level Silver Plan",,"0.737708162688996","No","Yes","No","100%",,"$3,000","$100","$0","$3,100","$900","$2,000","$0","$2,900","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$3,000","$3000 per person","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 3000-10 CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180013","Select $5,000 - 10%","38166WI018",,"WIN001","WIS001","WIF022","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180013-05","Select $1,000 -10% ($5,000 - 10%)","87% AV Level Silver Plan",,"0.874028785001129","No","Yes","No","100%",,"$1,000","$100","$0","$1,100","$500","$700","$0","$1,200","$1,000","$0","$0","$1,000",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 1000-10 B CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180013","Select $5,000 - 10%","38166WI018",,"WIN001","WIS001","WIF022","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180013-06","Select $350 -10% ($5,000 - 10%)","94% AV Level Silver Plan",,"0.931684614979412","No","Yes","No","100%",,"$350","$50","$0","$400","$350","$350","$0","$700","$350","$0","$0","$350",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","$350","$350 per person","$700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 350-10A CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180012","Select $5,750 - 30%","38166WI018",,"WIN001","WIS001","WIF018","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180012-00","Select $5,750 - 30%","Standard Silver Off Exchange Plan",,"0.686149260917621","No","Yes","No","100%",,"$5,750","$100","$0","$5,850","$300","$2,400","$0","$2,700","$1,700","$200","$0","$1,900","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$5,750","$5750 per person","$11500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,750","$5750 per person","$11500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Off-Exchange/Select 575030OffE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180012","Select $5,750 - 30%","38166WI018",,"WIN001","WIS001","WIF018","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180012-01","Select $5,750 - 30%","Standard Silver On Exchange Plan",,"0.686149260917621","No","Yes","No","100%",,"$5,750","$100","$0","$5,850","$300","$2,400","$0","$2,700","$1,700","$200","$0","$1,900","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$5,750","$5750 per person","$11500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,750","$5750 per person","$11500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select On-Exchange/Select 575030OnE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180012","Select $5,750 - 30%","38166WI018",,"WIN001","WIS001","WIF018","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180012-06","Select $600 ($5,750 - 30%)","94% AV Level Silver Plan",,"0.932281423115227","No","Yes","No","100%",,"$595","$5","$0","$600","$100","$500","$0","$600","$600","$0","$0","$600","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 600 CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180010","Select $6,500","38166WI018",,"WIN001","WIS001","WIF016","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180010-00","Select $6,500","Standard Bronze Off Exchange Plan",,"0.599043397262708","Yes","Yes","No","100%",,"$6,500","$300","$0","$6,800","$700","$1,800","$0","$2,500","$1,800","$50","$0","$1,850",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Off-Exchange/Select 6500OffE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0160002","Reliance $1,250 - 20%","38166WI016",,"WIN003","WIS003","WIF005","Existing","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0160002-00","Reliance $1,250 - 20%","Standard Gold Off Exchange Plan",,"0.808950908812464","No","Yes","No","100%",,"$1,250","$50","$2,200","$3,500","$800","$600","$0","$1,400","$1,250","$0","$100","$1,350",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Reliance/Reliance 1250-20.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/reliance"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0160002","Reliance $1,250 - 20%","38166WI016",,"WIN003","WIS003","WIF005","Existing","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0160002-01","Reliance $1,250 - 20%","Standard Gold On Exchange Plan",,"0.808950908812464","No","Yes","No","100%",,"$1,250","$50","$2,200","$3,500","$800","$600","$0","$1,400","$1,250","$0","$100","$1,350",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Reliance/Reliance 1250-20.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/reliance"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180002","Select $3,750 HDHP","38166WI018",,"WIN001","WIS001","WIF017","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180002-03","Select $3,750 HDHP","Limited Cost Sharing Plan Variation",,"0.711569711975446","Yes","Yes","No","100%",,"$3,750","$0","$0","$3,750","$3,750","$0","$0","$3,750","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Limited/Select 3750HDHPLimited.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180010","Select $6,500","38166WI018",,"WIN001","WIS001","WIF016","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180010-03","Select $6,500","Limited Cost Sharing Plan Variation",,"0.599043397262708","Yes","Yes","No","100%",,"$6,500","$300","$0","$6,800","$700","$1,800","$0","$2,500","$1,800","$50","$0","$1,850",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Limited/Select 6500Limited.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0160011","Reliance $3,000 - 25%","38166WI016",,"WIN003","WIS003","WIF010","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0160011-01","Reliance $3,000 - 25%","Standard Silver On Exchange Plan",,"0.716321376475796","No","Yes","No","100%",,"$3,000","$100","$2,300","$5,400","$800","$1,800","$0","$2,600","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$3,000","$3000 per person","$6000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Reliance/Reliance 3000-25.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/reliance"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180007","Select $5,500 HDHP","38166WI018",,"WIN001","WIS001","WIF016","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180007-00","Select $5,500 HDHP","Standard Bronze Off Exchange Plan",,"0.617829538277129","Yes","Yes","No","100%",,"$5,500","$200","$0","$5,700","$5,500","$400","$0","$5,900","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Off-Exchange/Select 5500HDHP-OffE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180007","Select $5,500 HDHP","38166WI018",,"WIN001","WIS001","WIF016","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180007-01","Select $5,500 HDHP","Standard Bronze On Exchange Plan",,"0.617829538277129","Yes","Yes","No","100%",,"$5,500","$200","$0","$5,700","$5,500","$400","$0","$5,900","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select On-Exchange/Select 5500HDHP-OnE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0160031","Reliance $5,000 - 10%","38166WI016",,"WIN003","WIS003","WIF010","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0160031-00","Reliance $5,000 - 10%","Standard Silver Off Exchange Plan",,"0.704168372869275","No","Yes","No","100%",,"$5,000","$100","$700","$5,800","$800","$1,800","$0","$2,600","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Reliance/Reliance 5000-10.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/reliance"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0160031","Reliance $5,000 - 10%","38166WI016",,"WIN003","WIS003","WIF010","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0160031-01","Reliance $5,000 - 10%","Standard Silver On Exchange Plan",,"0.704168372869275","No","Yes","No","100%",,"$5,000","$100","$700","$5,800","$800","$1,800","$0","$2,600","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Reliance/Reliance 5000-10.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/reliance"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180007","Select $5,500 HDHP","38166WI018",,"WIN001","WIS001","WIF016","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180007-02","Select $5,500 HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Zero/Select 5500HDHP-Zero.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0150023","Independence $4,000 HDHP","38166WI015",,"WIN004","WIS004","WIF006","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0150023-01","Independence $4,000 HDHP","Standard Silver On Exchange Plan",,"0.700980885295207","Yes","Yes","No","100%",,"$4,000","$0","$0","$4,000","$4,000","$0","$0","$4,000","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","$14,000","$14000 per person","$28000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Independence/Independence 4000 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/independence"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180008","Select Protection","38166WI018",,"WIN001","WIS001","WIF017","Existing","EPO","Catastrophic","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180008-00","Select Protection","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$7,350","$500","$0","$0","$500","$1,900","$0","$0","$1,900",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Off-Exchange/Select Protection-OffE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180008","Select Protection","38166WI018",,"WIN001","WIS001","WIF017","Existing","EPO","Catastrophic","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180008-01","Select Protection","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$7,350","$500","$0","$0","$500","$1,900","$0","$0","$1,900",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select On-Exchange/Select Protection-OnE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180014","Select $7,350","38166WI018",,"WIN001","WIS001","WIF017","New","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180014-00","Select $7,350","Standard Bronze Off Exchange Plan",,"0.585436865833666","Yes","Yes","No","100%",,"$7,350","$0","$0","$7,350","$900","$0","$0","$900","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Off-Exchange/Select 7350OffE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180014","Select $7,350","38166WI018",,"WIN001","WIS001","WIF017","New","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180014-01","Select $7,350","Standard Bronze On Exchange Plan",,"0.585436865833666","Yes","Yes","No","100%",,"$7,350","$0","$0","$7,350","$900","$0","$0","$900","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select On-Exchange/Select 7350OnE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180014","Select $7,350","38166WI018",,"WIN001","WIS001","WIF017","New","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180014-02","Select $7,350","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Zero/Select 7350Zero.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180014","Select $7,350","38166WI018",,"WIN001","WIS001","WIF017","New","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180014-03","Select $7,350","Limited Cost Sharing Plan Variation",,"0.585436865833666","Yes","Yes","No","100%",,"$7,350","$0","$0","$7,350","$900","$0","$0","$900","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Limited/Select 7350Limited.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180016","Select $6,000 - 30%","38166WI018",,"WIN001","WIS001","WIF019","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180016-00","Select $6,000 - 30%","Standard Silver Off Exchange Plan",,"0.660298982279077","No","Yes","No","100%",,"$6,000","$100","$0","$6,100","$800","$1,800","$0","$2,600","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group","$6,000","$6000 per person","$12000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Off-Exchange/Select 600030OffE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180016","Select $6,000 - 30%","38166WI018",,"WIN001","WIS001","WIF019","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180016-01","Select $6,000 - 30%","Standard Silver On Exchange Plan",,"0.660298982279077","No","Yes","No","100%",,"$6,000","$100","$0","$6,100","$800","$1,800","$0","$2,600","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group","$6,000","$6000 per person","$12000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select On-Exchange/Select 600030OnE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180016","Select $6,000 - 30%","38166WI018",,"WIN001","WIS001","WIF019","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180016-02","Select $6,000 - 30%","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Zero/Select 600030Zero.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180016","Select $6,000 - 30%","38166WI018",,"WIN001","WIS001","WIF019","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180016-03","Select $6,000 - 30%","Limited Cost Sharing Plan Variation",,"0.660298982279077","No","Yes","No","100%",,"$6,000","$100","$0","$6,100","$800","$1,800","$0","$2,600","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group","$6,000","$6000 per person","$12000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Limited/Select 600030Limited.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180016","Select $6,000 - 30%","38166WI018",,"WIN001","WIS001","WIF019","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180016-04","Select $3,500-30% ($6,000-30%)","73% AV Level Silver Plan",,"0.728805328316293","No","Yes","No","100%",,"$3,500","$80","$0","$3,580","$800","$1,700","$0","$2,500","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 3500-30 CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180016","Select $6,000 - 30%","38166WI018",,"WIN001","WIS001","WIF019","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180016-05","Select $1,000-10% ($6,000-30%)","87% AV Level Silver Plan",,"0.867019994067222","No","Yes","No","100%",,"$1,000","$20","$980","$2,000","$800","$1,000","$0","$1,800","$1,000","$0","$70","$1,070",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 1000-10 A CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180016","Select $6,000 - 30%","38166WI018",,"WIN001","WIS001","WIF019","New","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180016-06","Select $350-10% ($6,000-30%)","94% AV Level Silver Plan",,"0.935991328304248","No","Yes","No","100%",,"$350","$20","$330","$700","$350","$300","$0","$650","$350","$0","$100","$450",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","$350","$350 per person","$700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 350-10B CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180002","Select $3,750 HDHP","38166WI018",,"WIN001","WIS001","WIF017","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180002-00","Select $3,750 HDHP","Standard Silver Off Exchange Plan",,"0.711569711975446","Yes","Yes","No","100%",,"$3,750","$0","$0","$3,750","$3,750","$0","$0","$3,750","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Off-Exchange/Select 3750HDHPOffE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0160001","Reliance $500 - 10%","38166WI016",,"WIN003","WIS003","WIF007","Existing","EPO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0160001-00","Reliance $500 - 10%","Standard Platinum Off Exchange Plan",,"0.919029296179982","No","Yes","No","100%",,"$500","$20","$480","$1,000","$500","$490","$10","$1,000","$500","$0","$100","$600",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Reliance/Reliance 500-10.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/reliance"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0160001","Reliance $500 - 10%","38166WI016",,"WIN003","WIS003","WIF007","Existing","EPO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0160001-01","Reliance $500 - 10%","Standard Platinum On Exchange Plan",,"0.919029296179982","No","Yes","No","100%",,"$500","$20","$480","$1,000","$500","$490","$10","$1,000","$500","$0","$100","$600",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Reliance/Reliance 500-10.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/reliance"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180002","Select $3,750 HDHP","38166WI018",,"WIN001","WIS001","WIF017","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180002-01","Select $3,750 HDHP","Standard Silver On Exchange Plan",,"0.711569711975446","Yes","Yes","No","100%",,"$3,750","$0","$0","$3,750","$3,750","$0","$0","$3,750","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select On-Exchange/Select 3750HDHPOnE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180002","Select $3,750 HDHP","38166WI018",,"WIN001","WIS001","WIF017","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180002-02","Select $3,750 HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Zero/Select 3750HDHPZero.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180002","Select $3,750 HDHP","38166WI018",,"WIN001","WIS001","WIF017","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180002-05","Select $1,250 ($3,750 HDHP)","87% AV Level Silver Plan",,"0.862986553804247","Yes","Yes","No","100%",,"$1,250","$0","$0","$1,250","$900","$0","$0","$900","$1,250","$0","$0","$1,250",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 1250 CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180002","Select $3,750 HDHP","38166WI018",,"WIN001","WIS001","WIF017","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180002-06","Select $450 ($3,750 HDHP)","94% AV Level Silver Plan",,"0.943356902872246","Yes","Yes","No","100%",,"$450","$0","$0","$450","$450","$0","$0","$450","$450","$0","$0","$450",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select CS/Select 450 CS.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0160011","Reliance $3,000 - 25%","38166WI016",,"WIN003","WIS003","WIF010","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0160011-00","Reliance $3,000 - 25%","Standard Silver Off Exchange Plan",,"0.716321376475796","No","Yes","No","100%",,"$3,000","$100","$2,300","$5,400","$800","$1,800","$0","$2,600","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$3,000","$3000 per person","$6000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Reliance/Reliance 3000-25.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/reliance"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180007","Select $5,500 HDHP","38166WI018",,"WIN001","WIS001","WIF016","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180007-03","Select $5,500 HDHP","Limited Cost Sharing Plan Variation",,"0.617829538277129","Yes","Yes","No","100%",,"$5,500","$200","$0","$5,700","$5,500","$400","$0","$5,900","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Limited/Select 5500HDHP-Limited.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0160027","Reliance $2,000 HDHP","38166WI016",,"WIN003","WIS003","WIF006","Existing","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0160027-00","Reliance $2,000 HDHP","Standard Gold Off Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$2,000","$2,000","$0","$0","$2,000","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$4000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$4000 per person","$4000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Reliance/Reliance 2000 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/reliance"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0160027","Reliance $2,000 HDHP","38166WI016",,"WIN003","WIS003","WIF006","Existing","EPO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0160027-01","Reliance $2,000 HDHP","Standard Gold On Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$2,000","$2,000","$0","$0","$2,000","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$4000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$4000 per person","$4000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Reliance/Reliance 2000 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/reliance"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180006","Select $6,000 HDHP","38166WI018",,"WIN001","WIS001","WIF016","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180006-00","Select $6,000 HDHP","Standard Bronze Off Exchange Plan",,"0.611866130078361","Yes","Yes","No","100%",,"$6,000","$350","$0","$6,350","$6,000","$200","$0","$6,200","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Off-Exchange/Select 6000HDHP-OffE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180006","Select $6,000 HDHP","38166WI018",,"WIN001","WIS001","WIF016","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180006-01","Select $6,000 HDHP","Standard Bronze On Exchange Plan",,"0.611866130078361","Yes","Yes","No","100%",,"$6,000","$350","$0","$6,350","$6,000","$200","$0","$6,200","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select On-Exchange/Select 6000HDHP-OnE.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0160012","Reliance $3,000 - 20% HDHP","38166WI016",,"WIN003","WIS003","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0160012-00","Reliance $3,000 - 20% HDHP","Standard Silver Off Exchange Plan",,"0.681544592305403","Yes","Yes","No","100%",,"$3,000","$70","$1,900","$4,970","$3,000","$1,000","$70","$4,070","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Reliance/Reliance 3000-20 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/reliance"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0160012","Reliance $3,000 - 20% HDHP","38166WI016",,"WIN003","WIS003","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0160012-01","Reliance $3,000 - 20% HDHP","Standard Silver On Exchange Plan",,"0.681544592305403","Yes","Yes","No","100%",,"$3,000","$70","$1,900","$4,970","$3,000","$1,000","$70","$4,070","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Reliance/Reliance 3000-20 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/reliance"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180006","Select $6,000 HDHP","38166WI018",,"WIN001","WIS001","WIF016","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180006-02","Select $6,000 HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Zero/Select 6000HDHP-Zero.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","Individual","No","39-1572880","38166WI0180006","Select $6,000 HDHP","38166WI018",,"WIN001","WIS001","WIF016","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for  knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care only","Yes","Urgent and Emergent Care only","No","https://ww3.securityhealth.org/onlinepayment","https://www.securityhealth.org/4tierformulary","38166WI0180006-03","Select $6,000 HDHP","Limited Cost Sharing Plan Variation",,"0.611866130078361","Yes","Yes","No","100%",,"$6,000","$350","$0","$6,350","$6,000","$200","$0","$6,200","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2018-SBC/Select Limited/Select 6000HDHP-Limited.ashx","https://www.securityhealth.org/find-your-plan/individual-and-family/2018-individual-and-family-plans"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0160023","Reliance $4,000 HDHP","38166WI016",,"WIN003","WIS003","WIF006","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0160023-00","Reliance $4,000 HDHP","Standard Silver Off Exchange Plan",,"0.700980885295207","Yes","Yes","No","100%",,"$4,000","$0","$0","$4,000","$4,000","$0","$0","$4,000","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Reliance/Reliance 4000 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/reliance"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0160023","Reliance $4,000 HDHP","38166WI016",,"WIN003","WIS003","WIF006","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0160023-01","Reliance $4,000 HDHP","Standard Silver On Exchange Plan",,"0.700980885295207","Yes","Yes","No","100%",,"$4,000","$0","$0","$4,000","$4,000","$0","$0","$4,000","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Reliance/Reliance 4000 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/reliance"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0160013","Reliance $6,000 - 20% HDHP","38166WI016",,"WIN003","WIS003","WIF011","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0160013-00","Reliance $6,000 - 20% HDHP","Standard Bronze Off Exchange Plan",,"0.606873218788479","Yes","Yes","No","100%",,"$6,000","$0","$550","$6,550","$6,000","$300","$0","$6,300","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Reliance/Reliance 6000-20 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/reliance"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0160013","Reliance $6,000 - 20% HDHP","38166WI016",,"WIN003","WIS003","WIF011","Existing","EPO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0160013-01","Reliance $6,000 - 20% HDHP","Standard Bronze On Exchange Plan",,"0.606873218788479","Yes","Yes","No","100%",,"$6,000","$0","$550","$6,550","$6,000","$300","$0","$6,300","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Reliance/Reliance 6000-20 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/reliance"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0150001","Independence $500 - 10%","38166WI015",,"WIN004","WIS004","WIF007","Existing","POS","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0150001-00","Independence $500 - 10%","Standard Platinum Off Exchange Plan",,"0.919029296179982","No","Yes","No","100%",,"$500","$20","$480","$1,000","$500","$490","$10","$1,000","$500","$0","$100","$600",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$2,500","$2500 per person","$5000 per group","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","10.00%",,,,,"$750","$750 per person","$1500 per group","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Independence/Independence 500-10.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/independence"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0150001","Independence $500 - 10%","38166WI015",,"WIN004","WIS004","WIF007","Existing","POS","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0150001-01","Independence $500 - 10%","Standard Platinum On Exchange Plan",,"0.919029296179982","No","Yes","No","100%",,"$500","$20","$480","$1,000","$500","$490","$10","$1,000","$500","$0","$100","$600",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$2,500","$2500 per person","$5000 per group","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","10.00%",,,,,"$750","$750 per person","$1500 per group","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Independence/Independence 500-10.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/independence"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0150002","Independence $1,250 - 20%","38166WI015",,"WIN004","WIS004","WIF005","Existing","POS","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0150002-00","Independence $1,250 - 20%","Standard Gold Off Exchange Plan",,"0.808950908812464","No","Yes","No","100%",,"$1,250","$50","$2,200","$3,500","$800","$600","$0","$1,400","$1,250","$0","$100","$1,350",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,500","$12500 per person","$25000 per group","$17,500","$17500 per person","$35000 per group","$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","$3,250","$3250 per person","$6500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Independence/Independence 1250-20.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/independence"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0150002","Independence $1,250 - 20%","38166WI015",,"WIN004","WIS004","WIF005","Existing","POS","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0150002-01","Independence $1,250 - 20%","Standard Gold On Exchange Plan",,"0.808950908812464","No","Yes","No","100%",,"$1,250","$50","$2,200","$3,500","$800","$600","$0","$1,400","$1,250","$0","$100","$1,350",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,500","$12500 per person","$25000 per group","$17,500","$17500 per person","$35000 per group","$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","$3,250","$3250 per person","$6500 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Independence/Independence 1250-20.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/independence"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0150005","Independence $2,000 - Copay","38166WI015",,"WIN004","WIS004","WIF010","Existing","POS","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0150005-00","Independence $2,000 - Copay","Standard Gold Off Exchange Plan",,"0.81277464281443","No","Yes","No","100%",,"$2,000","$100","$0","$2,100","$300","$2,000","$0","$2,400","$1,700","$100","$0","$1,800",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","$14,000","$14000 per person","$28000 per group","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Independence/Independence 2000-Copay.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/independence"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0150005","Independence $2,000 - Copay","38166WI015",,"WIN004","WIS004","WIF010","Existing","POS","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0150005-01","Independence $2,000 - Copay","Standard Gold On Exchange Plan",,"0.81277464281443","No","Yes","No","100%",,"$2,000","$100","$0","$2,100","$300","$2,000","$0","$2,400","$1,700","$100","$0","$1,800",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","$14,000","$14000 per person","$28000 per group","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Independence/Independence 2000-Copay.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/independence"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0150011","Independence $3,000 - 25%","38166WI015",,"WIN004","WIS004","WIF010","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0150011-00","Independence $3,000 - 25%","Standard Silver Off Exchange Plan",,"0.716321376475796","No","Yes","No","100%",,"$3,000","$100","$2,300","$5,400","$800","$1,800","$0","$2,600","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","$23,975","$23975 per person","$47950 per group","$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$4,500","$4500 per person","$9000 per group","$7,500","$7500 per person","$15000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Independence/Independence 3000-25.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/independence"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0150011","Independence $3,000 - 25%","38166WI015",,"WIN004","WIS004","WIF010","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0150011-01","Independence $3,000 - 25%","Standard Silver On Exchange Plan",,"0.716321376475796","No","Yes","No","100%",,"$3,000","$100","$2,300","$5,400","$800","$1,800","$0","$2,600","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","$23,975","$23975 per person","$47950 per group","$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$4,500","$4500 per person","$9000 per group","$7,500","$7500 per person","$15000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Independence/Independence 3000-25.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/independence"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0150031","Independence $5,000 - 10%","38166WI015",,"WIN004","WIS004","WIF010","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0150031-00","Independence $5,000 - 10%","Standard Silver Off Exchange Plan",,"0.704168372869275","No","Yes","No","100%",,"$5,000","$100","$700","$5,800","$800","$1,800","$0","$2,600","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$16,250","$16250 per person","$32500 per group","$22,750","$22750 per person","$45500 per group","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"$7,500","$7500 per person","$15000 per group","$12,500","$12500 per person","$25000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Independence/Independence 5000-10.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/independence"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0150031","Independence $5,000 - 10%","38166WI015",,"WIN004","WIS004","WIF010","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0150031-01","Independence $5,000 - 10%","Standard Silver On Exchange Plan",,"0.704168372869275","No","Yes","No","100%",,"$5,000","$100","$700","$5,800","$800","$1,800","$0","$2,600","$1,900","$0","$0","$1,900",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$16,250","$16250 per person","$32500 per group","$22,750","$22750 per person","$45500 per group","$5,000","$5000 per person","$10000 per group","10.00%",,,,,"$7,500","$7500 per person","$15000 per group","$12,500","$12500 per person","$25000 per group","$0","$0 per person","$0 per group","33.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Independence/Independence 5000-10.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/independence"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0150027","Indepdence $2,000 HDHP","38166WI015",,"WIN004","WIS004","WIF006","Existing","POS","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0150027-00","Indepdence $2,000 HDHP","Standard Gold Off Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$2,000","$2,000","$0","$0","$2,000","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$5,000","$10000 per person","$10000 per group","$7,000","$14000 per person","$14000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"$3,000","$6000 per person","$6000 per group","$5,000","$10000 per person","$10000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Independence/Independence 2000 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/independence"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0150027","Indepdence $2,000 HDHP","38166WI015",,"WIN004","WIS004","WIF006","Existing","POS","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0150027-01","Indepdence $2,000 HDHP","Standard Gold On Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$2,000","$2,000","$0","$0","$2,000","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$5,000","$10000 per person","$10000 per group","$7,000","$14000 per person","$14000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"$3,000","$6000 per person","$6000 per group","$5,000","$10000 per person","$10000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Independence/Independence 2000 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/independence"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0150012","Independence $3,000 - 20% HDHP","38166WI015",,"WIN004","WIS004","WIF003","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0150012-00","Independence $3,000 - 20% HDHP","Standard Silver Off Exchange Plan",,"0.681544592305403","Yes","Yes","No","100%",,"$3,000","$70","$1,900","$4,970","$3,000","$1,000","$70","$4,070","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,000","$21000 per person","$42000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$4,500","$4500 per person","$9000 per group","$7,500","$7500 per person","$15000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Independence/Independence 3000-20 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/independence"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0150012","Independence $3,000 - 20% HDHP","38166WI015",,"WIN004","WIS004","WIF003","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0150012-01","Independence $3,000 - 20% HDHP","Standard Silver On Exchange Plan",,"0.681544592305403","Yes","Yes","No","100%",,"$3,000","$70","$1,900","$4,970","$3,000","$1,000","$70","$4,070","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,000","$21000 per person","$42000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$4,500","$4500 per person","$9000 per group","$7,500","$7500 per person","$15000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Independence/Independence 3000-20 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/independence"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0150023","Independence $4,000 HDHP","38166WI015",,"WIN004","WIS004","WIF006","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0150023-00","Independence $4,000 HDHP","Standard Silver Off Exchange Plan",,"0.700980885295207","Yes","Yes","No","100%",,"$4,000","$0","$0","$4,000","$4,000","$0","$0","$4,000","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","$14,000","$14000 per person","$28000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Independence/Independence 4000 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/independence"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0150013","Independence $6,000 - 20% HDHP","38166WI015",,"WIN004","WIS004","WIF011","Existing","POS","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0150013-00","Independence $6,000 - 20% HDHP","Standard Bronze Off Exchange Plan",,"0.606873218788479","Yes","Yes","No","100%",,"$6,000","$0","$550","$6,550","$6,000","$300","$0","$6,300","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","$22,925","$22925 per person","$45850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","$16,000","$16000 per person","$32000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Independence/Independence 6000-20 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/independence"
"2018","WI","38166","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1572880","38166WI0150013","Independence $6,000 - 20% HDHP","38166WI015",,"WIN004","WIS004","WIF011","Existing","POS","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery  Hand Specialist for carpal tunnel   Neurosurgery for back pain/surgery",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9956",,,"2018-01-01","2018-12-31","Yes","Urgent and Emergent Care","Yes","Urgent and Emergent Care","No",,"https://www.securityhealth.org/4tierformulary","38166WI0150013-01","Independence $6,000 - 20% HDHP","Standard Bronze On Exchange Plan",,"0.606873218788479","Yes","Yes","No","100%",,"$6,000","$0","$550","$6,550","$6,000","$300","$0","$6,300","$1,900","$0","$0","$1,900",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","$22,925","$22925 per person","$45850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","$16,000","$16000 per person","$32000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2018-SBC/Independence/Independence 6000-20 HDHP.ashx","https://www.securityhealth.org/employer-coverage/2018/small-group/independence"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010124","Dean Gold Copay Plus 1500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010124-00","Dean Gold Copay Plus 1500X","Standard Gold Off Exchange Plan",,"0.817959386173544","No","Yes","No","100%",,"$1,500","$0","$1,500","$60","$1,500","$1,200","$80","$20","$1,500","$100","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldCopayPlus1500X00_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010124","Dean Gold Copay Plus 1500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010124-01","Dean Gold Copay Plus 1500X","Standard Gold On Exchange Plan",,"0.817959386173544","No","Yes","No","100%",,"$1,500","$0","$1,500","$60","$1,500","$1,200","$80","$20","$1,500","$100","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldCopayPlus1500X01_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010124","Dean Gold Copay Plus 1500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010124-02","Dean Gold Copay Plus 1500X","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldCopayPlus1500X02_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010124","Dean Gold Copay Plus 1500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010124-03","Dean Gold Copay Plus 1500X","Limited Cost Sharing Plan Variation",,"0.817959386173544","No","Yes","No","100%",,"$1,500","$0","$1,500","$60","$1,500","$1,200","$80","$20","$1,500","$100","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldCopayPlus1500X03_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 3250X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010095-00","Dean Silver Copay Plus 3250X","Standard Silver Off Exchange Plan",,"0.71824239586189","No","Yes","No","100%",,"$3,300","$40","$2,800","$60","$1,900","$1,200","$0","$20","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3250X00_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 3250X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010095-01","Dean Silver Copay Plus 3250X","Standard Silver On Exchange Plan",,"0.71824239586189","No","Yes","No","100%",,"$3,300","$40","$2,800","$60","$1,900","$1,200","$0","$20","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3250X01_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 3250X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010095-02","Dean Silver Copay Plus 3250X","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3250X02_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 3250X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010095-03","Dean Silver Copay Plus 3250X","Limited Cost Sharing Plan Variation",,"0.71824239586189","No","Yes","No","100%",,"$3,300","$40","$2,800","$60","$1,900","$1,200","$0","$20","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3250X03_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 3250X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010095-04","Dean Silver Copay Plus 3250X","73% AV Level Silver Plan",,"0.739062398242294","No","Yes","No","100%",,"$3,300","$0","$2,300","$60","$1,900","$1,200","$0","$20","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$5550 per person","$11100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3250X04_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 3250X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010095-05","Dean Silver Copay Plus 3250X","87% AV Level Silver Plan",,"0.868317080952671","No","Yes","No","100%",,"$400","$40","$1,200","$60","$400","$1,200","$100","$20","$400","$100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3250X05_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 3250X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010095-06","Dean Silver Copay Plus 3250X","94% AV Level Silver Plan",,"0.933705860149021","No","Yes","No","100%",,"$100","$30","$600","$60","$100","$600","$40","$20","$100","$100","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3250X06_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 4750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010098-00","Dean Silver Classic 4750X","Standard Silver Off Exchange Plan",,"0.662901830519738","No","Yes","No","100%",,"$4,800","$40","$1,500","$60","$2,600","$1,000","$0","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic4750X00_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 4750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010098-01","Dean Silver Classic 4750X","Standard Silver On Exchange Plan",,"0.662901830519738","No","Yes","No","100%",,"$4,800","$40","$1,500","$60","$2,600","$1,000","$0","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic4750X01_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 4750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010098-02","Dean Silver Classic 4750X","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic4750X02_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 4750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010098-03","Dean Silver Classic 4750X","Limited Cost Sharing Plan Variation",,"0.662901830519738","No","Yes","No","100%",,"$4,800","$40","$1,500","$60","$2,600","$1,000","$0","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic4750X03_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 4750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010098-04","Dean Silver Classic 4750X","73% AV Level Silver Plan",,"0.72150564768446","No","Yes","No","100%",,"$3,500","$40","$900","$60","$2,600","$1,000","$0","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,450","$3450 per person","$6900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic4750X04_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 4750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010098-05","Dean Silver Classic 4750X","87% AV Level Silver Plan",,"0.86196494837841","No","Yes","No","100%",,"$800","$40","$600","$60","$800","$1,000","$90","$20","$800","$0","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic4750X05_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 4750X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010098-06","Dean Silver Classic 4750X","94% AV Level Silver Plan",,"0.932586158807008","No","Yes","No","100%",,"$200","$0","$600","$60","$200","$500","$60","$20","$200","$0","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic4750X06_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010108","Dean Gold Value Copay 3500X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010108-00","Dean Gold Value Copay 3500X","Standard Gold Off Exchange Plan",,"0.767183795683683","Yes","Yes","No","100%",,"$3,500","$0","$0","$60","$3,100","$400","$0","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldValueCopay3500X00_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010108","Dean Gold Value Copay 3500X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010108-01","Dean Gold Value Copay 3500X","Standard Gold On Exchange Plan",,"0.767183795683683","Yes","Yes","No","100%",,"$3,500","$0","$0","$60","$3,100","$400","$0","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldValueCopay3500X01_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010108","Dean Gold Value Copay 3500X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010108-02","Dean Gold Value Copay 3500X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldValueCopay3500X02_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010108","Dean Gold Value Copay 3500X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010108-03","Dean Gold Value Copay 3500X","Limited Cost Sharing Plan Variation",,"0.767183795683683","Yes","Yes","No","100%",,"$3,500","$0","$0","$60","$3,100","$400","$0","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldValueCopay3500X03_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5000X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010099-00","Dean Silver Value Copay 5000X","Standard Silver Off Exchange Plan",,"0.66556352694137","No","Yes","No","100%",,"$5,000","$40","$2,200","$60","$5,000","$500","$200","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5000X00_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5000X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010099-01","Dean Silver Value Copay 5000X","Standard Silver On Exchange Plan",,"0.66556352694137","No","Yes","No","100%",,"$5,000","$40","$2,200","$60","$5,000","$500","$200","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5000X01_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5000X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010099-02","Dean Silver Value Copay 5000X","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5000X02_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5000X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010099-03","Dean Silver Value Copay 5000X","Limited Cost Sharing Plan Variation",,"0.66556352694137","No","Yes","No","100%",,"$5,000","$40","$2,200","$60","$5,000","$500","$200","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5000X03_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5000X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010099-04","Dean Silver Value Copay 5000X","73% AV Level Silver Plan",,"0.721824449390517","No","Yes","No","100%",,"$3,000","$40","$1,900","$60","$3,000","$500","$1,000","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5000X04_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5000X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010099-05","Dean Silver Value Copay 5000X","87% AV Level Silver Plan",,"0.860468791826447","No","Yes","No","100%",,"$800","$40","$600","$60","$800","$400","$900","$20","$800","$0","$60","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5000X05_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5000X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010099-06","Dean Silver Value Copay 5000X","94% AV Level Silver Plan",,"0.930412857600999","No","Yes","No","100%",,"$100","$40","$600","$60","$100","$200","$600","$20","$100","$0","$90","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5000X06_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010119","Dean Bronze Value Copay 7350X","38345WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010119-00","Dean Bronze Value Copay 7350X","Standard Bronze Off Exchange Plan",,"0.602617873629345","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$6,100","$200","$0","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeValueCopay7350X00_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010119","Dean Bronze Value Copay 7350X","38345WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010119-01","Dean Bronze Value Copay 7350X","Standard Bronze On Exchange Plan",,"0.602617873629345","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$6,100","$200","$0","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeValueCopay7350X01_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010119","Dean Bronze Value Copay 7350X","38345WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010119-02","Dean Bronze Value Copay 7350X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeValueCopay7350X02_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010119","Dean Bronze Value Copay 7350X","38345WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010119-03","Dean Bronze Value Copay 7350X","Limited Cost Sharing Plan Variation",,"0.602617873629345","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$6,100","$200","$0","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeValueCopay7350X03_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3500X","38345WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0010122-00","Dean Silver HSA-E 3500X","Standard Silver Off Exchange Plan",,"0.661115260165412","Yes","Yes","No","100%",,"$3,500","$0","$1,800","$60","$3,500","$0","$700","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3500X00_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3500X","38345WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0010122-01","Dean Silver HSA-E 3500X","Standard Silver On Exchange Plan",,"0.661115260165412","Yes","Yes","No","100%",,"$3,500","$0","$1,800","$60","$3,500","$0","$700","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3500X01_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3500X","38345WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0010122-02","Dean Silver HSA-E 3500X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3500X02_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3500X","38345WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0010122-03","Dean Silver HSA-E 3500X","Limited Cost Sharing Plan Variation",,"0.661115260165412","Yes","Yes","No","100%",,"$3,500","$0","$1,800","$60","$3,500","$0","$700","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3500X03_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3500X","38345WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0010122-04","Dean Silver HSA-E 3500X","73% AV Level Silver Plan",,"0.730146679152217","Yes","Yes","No","100%",,"$2,000","$0","$2,100","$60","$2,000","$0","$1,000","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3500X04_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3500X","38345WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0010122-05","Dean Silver HSA-E 3500X","87% AV Level Silver Plan",,"0.860237987144013","Yes","Yes","No","100%",,"$1,000","$0","$600","$60","$1,000","$0","$300","$20","$1,000","$0","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3500X05_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3500X","38345WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0010122-06","Dean Silver HSA-E 3500X","94% AV Level Silver Plan",,"0.930735229129535","Yes","Yes","No","100%",,"$300","$0","$600","$60","$300","$0","$300","$20","$300","$0","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3500X06_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010126","Dean Bronze HSA-E 6550X","38345WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0010126-00","Dean Bronze HSA-E 6550X","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,600","$0","$0","$60","$6,600","$0","$0","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeHSA-E6550X00_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010126","Dean Bronze HSA-E 6550X","38345WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0010126-01","Dean Bronze HSA-E 6550X","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,600","$0","$0","$60","$6,600","$0","$0","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeHSA-E6550X01_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010126","Dean Bronze HSA-E 6550X","38345WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0010126-02","Dean Bronze HSA-E 6550X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeHSA-E6550X02_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010126","Dean Bronze HSA-E 6550X","38345WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0010126-03","Dean Bronze HSA-E 6550X","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,600","$0","$0","$60","$6,600","$0","$0","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeHSA-E6550X03_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010063","Dean Catastrophic Safety Net","38345WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010063-00","Dean Catastrophic Safety Net","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$7,000","$0","$0","$20","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_CatastrophicSafetyNet00_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0010063","Dean Catastrophic Safety Net","38345WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0010063-01","Dean Catastrophic Safety Net","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$7,000","$0","$0","$20","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_CatastrophicSafetyNet01_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080034","Dean Focus Network Gold Value Copay 3500X","38345WI008",,"WIN002","WIS002","WIF003","New","EPO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0080034-00","Dean Focus Network Gold Value Copay 3500X","Standard Gold Off Exchange Plan",,"0.767183795683683","Yes","Yes","No","100%",,"$3,500","$0","$0","$60","$3,100","$400","$0","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkGoldValueCopay3500X00_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080034","Dean Focus Network Gold Value Copay 3500X","38345WI008",,"WIN002","WIS002","WIF003","New","EPO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0080034-01","Dean Focus Network Gold Value Copay 3500X","Standard Gold On Exchange Plan",,"0.767183795683683","Yes","Yes","No","100%",,"$3,500","$0","$0","$60","$3,100","$400","$0","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkGoldValueCopay3500X01_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080034","Dean Focus Network Gold Value Copay 3500X","38345WI008",,"WIN002","WIS002","WIF003","New","EPO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0080034-02","Dean Focus Network Gold Value Copay 3500X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkGoldValueCopay3500X02_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080034","Dean Focus Network Gold Value Copay 3500X","38345WI008",,"WIN002","WIS002","WIF003","New","EPO","Gold","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0080034-03","Dean Focus Network Gold Value Copay 3500X","Limited Cost Sharing Plan Variation",,"0.767183795683683","Yes","Yes","No","100%",,"$3,500","$0","$0","$60","$3,100","$400","$0","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkGoldValueCopay3500X03_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5000X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0080018-00","Dean Focus Network Silver Value Copay 5000X","Standard Silver Off Exchange Plan",,"0.66556352694137","No","Yes","No","100%",,"$5,000","$40","$2,200","$60","$5,000","$500","$200","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5000X00_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5000X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0080018-01","Dean Focus Network Silver Value Copay 5000X","Standard Silver On Exchange Plan",,"0.66556352694137","No","Yes","No","100%",,"$5,000","$40","$2,200","$60","$5,000","$500","$200","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5000X01_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5000X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0080018-02","Dean Focus Network Silver Value Copay 5000X","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5000X02_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5000X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0080018-03","Dean Focus Network Silver Value Copay 5000X","Limited Cost Sharing Plan Variation",,"0.66556352694137","No","Yes","No","100%",,"$5,000","$40","$2,200","$60","$5,000","$500","$200","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5000X03_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5000X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0080018-04","Dean Focus Network Silver Value Copay 5000X","73% AV Level Silver Plan",,"0.721824449390517","No","Yes","No","100%",,"$3,000","$40","$1,900","$60","$3,000","$500","$1,000","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5000X04_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5000X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0080018-05","Dean Focus Network Silver Value Copay 5000X","87% AV Level Silver Plan",,"0.860468791826447","No","Yes","No","100%",,"$800","$40","$600","$60","$800","$400","$900","$20","$800","$0","$60","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5000X05_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5000X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0080018-06","Dean Focus Network Silver Value Copay 5000X","94% AV Level Silver Plan",,"0.930412857600999","No","Yes","No","100%",,"$100","$40","$600","$60","$100","$200","$600","$20","$100","$0","$90","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5000X06_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080029","Dean Focus Network Bronze Value Copay 7350X","38345WI008",,"WIN002","WIS002","WIF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0080029-00","Dean Focus Network Bronze Value Copay 7350X","Standard Bronze Off Exchange Plan",,"0.602617873629345","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$6,100","$200","$0","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeValueCopay7350X00_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080029","Dean Focus Network Bronze Value Copay 7350X","38345WI008",,"WIN002","WIS002","WIF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0080029-01","Dean Focus Network Bronze Value Copay 7350X","Standard Bronze On Exchange Plan",,"0.602617873629345","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$6,100","$200","$0","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeValueCopay7350X01_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080029","Dean Focus Network Bronze Value Copay 7350X","38345WI008",,"WIN002","WIS002","WIF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0080029-02","Dean Focus Network Bronze Value Copay 7350X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeValueCopay7350X02_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080029","Dean Focus Network Bronze Value Copay 7350X","38345WI008",,"WIN002","WIS002","WIF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/prime-4-tier-formulary","38345WI0080029-03","Dean Focus Network Bronze Value Copay 7350X","Limited Cost Sharing Plan Variation",,"0.602617873629345","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$6,100","$200","$0","$20","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeValueCopay7350X03_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3500X","38345WI008",,"WIN002","WIS002","WIF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0080032-00","Dean Focus Network Silver HSA-E 3500X","Standard Silver Off Exchange Plan",,"0.661115260165412","Yes","Yes","No","100%",,"$3,500","$0","$1,800","$60","$3,500","$0","$700","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3500X00_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3500X","38345WI008",,"WIN002","WIS002","WIF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0080032-01","Dean Focus Network Silver HSA-E 3500X","Standard Silver On Exchange Plan",,"0.661115260165412","Yes","Yes","No","100%",,"$3,500","$0","$1,800","$60","$3,500","$0","$700","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3500X01_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3500X","38345WI008",,"WIN002","WIS002","WIF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0080032-02","Dean Focus Network Silver HSA-E 3500X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3500X02_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3500X","38345WI008",,"WIN002","WIS002","WIF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0080032-03","Dean Focus Network Silver HSA-E 3500X","Limited Cost Sharing Plan Variation",,"0.661115260165412","Yes","Yes","No","100%",,"$3,500","$0","$1,800","$60","$3,500","$0","$700","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3500X03_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3500X","38345WI008",,"WIN002","WIS002","WIF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0080032-04","Dean Focus Network Silver HSA-E 3500X","73% AV Level Silver Plan",,"0.730146679152217","Yes","Yes","No","100%",,"$2,000","$0","$2,100","$60","$2,000","$0","$1,000","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3500X04_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3500X","38345WI008",,"WIN002","WIS002","WIF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0080032-05","Dean Focus Network Silver HSA-E 3500X","87% AV Level Silver Plan",,"0.860237987144013","Yes","Yes","No","100%",,"$1,000","$0","$600","$60","$1,000","$0","$300","$20","$1,000","$0","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3500X05_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3500X","38345WI008",,"WIN002","WIS002","WIF004","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0080032-06","Dean Focus Network Silver HSA-E 3500X","94% AV Level Silver Plan",,"0.930735229129535","Yes","Yes","No","100%",,"$300","$0","$600","$60","$300","$0","$300","$20","$300","$0","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3500X06_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080033","Dean Focus Network Bronze HSA-E 6550X","38345WI008",,"WIN002","WIS002","WIF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0080033-00","Dean Focus Network Bronze HSA-E 6550X","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,600","$0","$0","$60","$6,600","$0","$0","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeHSA-E6550X00_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080033","Dean Focus Network Bronze HSA-E 6550X","38345WI008",,"WIN002","WIS002","WIF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0080033-01","Dean Focus Network Bronze HSA-E 6550X","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,600","$0","$0","$60","$6,600","$0","$0","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeHSA-E6550X01_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080033","Dean Focus Network Bronze HSA-E 6550X","38345WI008",,"WIN002","WIS002","WIF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0080033-02","Dean Focus Network Bronze HSA-E 6550X","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeHSA-E6550X02_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","38345","HIOS","2017-10-12 02:20:18","Individual","No","39-1535024","38345WI0080033","Dean Focus Network Bronze HSA-E 6550X","38345WI008",,"WIN002","WIS002","WIF005","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","https://www.deancare.com/HDHP-HSA-ACA-formulary","38345WI0080033-03","Dean Focus Network Bronze HSA-E 6550X","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,600","$0","$0","$60","$6,600","$0","$0","$20","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeHSA-E6550X03_0118.PDF","http://www.deancare.com/health-insurance/individual-and-family-plans/"
"2018","WI","49941","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","49941WI0050003","DentaSpan Family High Option","49941WI005","7083617077","WIN001","WIS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","49941WI0050003-00","DentaSpan Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdswi.dentalcareplus.com","http://hiopbdswi.dentalcareplus.com"
"2018","WI","49941","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","49941WI0040001","DentaTrust-PPO Pediatric High Option","49941WI004","7083617077","WIN001","WIS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","49941WI0040001-00","DentaTrust-PPO Pediatric High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtwi.dentalcareplus.com","http://hixpbdtwi.dentalcareplus.com"
"2018","WI","49941","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","49941WI0040001","DentaTrust-PPO Pediatric High Option","49941WI004","7083617077","WIN001","WIS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","49941WI0040001-01","DentaTrust-PPO Pediatric High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtwi.dentalcareplus.com","http://hixpbdtwi.dentalcareplus.com"
"2018","WI","49941","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","49941WI0050003","DentaSpan Family High Option","49941WI005","7083617077","WIN001","WIS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","49941WI0050003-01","DentaSpan Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdswi.dentalcareplus.com","http://hixpbdswi.dentalcareplus.com"
"2018","WI","49941","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","49941WI0050004","DentaSpan Family Low Option","49941WI005","7083617077","WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","49941WI0050004-00","DentaSpan Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdswi.dentalcareplus.com","http://hiopbdswi.dentalcareplus.com"
"2018","WI","49941","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","49941WI0040002","DentaTrust-PPO Pediatric Low Option","49941WI004","7083617077","WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","49941WI0040002-00","DentaTrust-PPO Pediatric Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtwi.dentalcareplus.com","http://hixpbdtwi.dentalcareplus.com"
"2018","WI","49941","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","49941WI0040002","DentaTrust-PPO Pediatric Low Option","49941WI004","7083617077","WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","49941WI0040002-01","DentaTrust-PPO Pediatric Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtwi.dentalcareplus.com","http://hixpbdtwi.dentalcareplus.com"
"2018","WI","49941","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","49941WI0050004","DentaSpan Family Low Option","49941WI005","7083617077","WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","49941WI0050004-01","DentaSpan Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdswi.dentalcareplus.com","http://hixpbdswi.dentalcareplus.com"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020019","Medica Individual Choice Gold Copay Plus","57845WI002",,"WIN002","WIS002","WIF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020019-02","Medica Individual Choice Gold Copay Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICGPCWIZ&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020019","Medica Individual Choice Gold Copay Plus","57845WI002",,"WIN002","WIS002","WIF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020019-03","Medica Individual Choice Gold Copay Plus","Limited Cost Sharing Plan Variation",,"0.804018566628916","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICGPCWIL&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","49941","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","49941WI0060003","DentaSpan Dental-Family High Option-Off Exchange","49941WI006","7083617077","WIN001","WIS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","49941WI0060003-00","DentaSpan Dental-Family High Option-Off Exchange","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdswi.dentalcareplus.com","http://hiopbdswi.dentalcareplus.com"
"2018","WI","49941","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","49941WI0060004","DentaSpan Dental-Family Low Option-Off Exchange","49941WI006","7083617077","WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","49941WI0060004-00","DentaSpan Dental-Family Low Option-Off Exchange","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdswi.dentalcareplus.com","http://hiopbdswi.dentalcareplus.com"
"2018","WI","49941","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","49941WI0060001","DentaSpan Pediatric High Option- Off Exchange","49941WI006","7083617077","WIN001","WIS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","49941WI0060001-00","DentaSpan Pediatric High Option- Off Exchange","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdswi.dentalcareplus.com","http://hiopbdswi.dentalcareplus.com"
"2018","WI","49941","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","49941WI0040003","DentaTrust-PPO Family High Option","49941WI004","7083617077","WIN001","WIS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","49941WI0040003-00","DentaTrust-PPO Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtwi.dentalcareplus.com","http://hixpbdtwi.dentalcareplus.com"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030001","Engage by Medica Gold Copay","57845WI003",,"WIN003","WIS003","WIF001","New","PPO","Gold","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030001-03","Engage by Medica Gold Copay","Limited Cost Sharing Plan Variation",,"0.778949933378138","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","per person not applicable","$2250 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMGCWIL&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030019","Engage by Medica Gold Copay Plus","57845WI003",,"WIN003","WIS003","WIF002","New","PPO","Gold","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030019-00","Engage by Medica Gold Copay Plus","Standard Gold Off Exchange Plan",,"0.804018566628916","Yes","Yes","No","100%",,"$1,000","$300","$400","$60","$1,000","$500","$300","$0","$1,000","$300","$30","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMGPCWI&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030019","Engage by Medica Gold Copay Plus","57845WI003",,"WIN003","WIS003","WIF002","New","PPO","Gold","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030019-01","Engage by Medica Gold Copay Plus","Standard Gold On Exchange Plan",,"0.804018566628916","Yes","Yes","No","100%",,"$1,000","$300","$400","$60","$1,000","$500","$300","$0","$1,000","$300","$30","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMGPCWI&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030019","Engage by Medica Gold Copay Plus","57845WI003",,"WIN003","WIS003","WIF002","New","PPO","Gold","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030019-02","Engage by Medica Gold Copay Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMGPCWIZ&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030019","Engage by Medica Gold Copay Plus","57845WI003",,"WIN003","WIS003","WIF002","New","PPO","Gold","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030019-03","Engage by Medica Gold Copay Plus","Limited Cost Sharing Plan Variation",,"0.804018566628916","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMGPCWIL&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","49941","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","49941WI0040003","DentaTrust-PPO Family High Option","49941WI004","7083617077","WIN001","WIS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","49941WI0040003-01","DentaTrust-PPO Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtwi.dentalcareplus.com","http://hixpbdtwi.dentalcareplus.com"
"2018","WI","49941","HIOS","2017-08-10 02:20:26","SHOP (Small Group)","Yes","31-1185262","49941WI0060002","DentaSpan Pediatric Low Option- Off Exchange","49941WI006","7083617077","WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","49941WI0060002-00","DentaSpan Pediatric Low Option- Off Exchange","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdswi.dentalcareplus.com","http://hiopbdswi.dentalcareplus.com"
"2018","WI","49941","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","49941WI0040004","DentaTrust-PPO Family Low Option","49941WI004","7083617077","WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","49941WI0040004-00","DentaTrust-PPO Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtwi.dentalcareplus.com","http://hixpbdtwi.dentalcareplus.com"
"2018","WI","49941","HIOS","2017-08-10 02:20:26","Individual","Yes","31-1185262","49941WI0040004","DentaTrust-PPO Family Low Option","49941WI004","7083617077","WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","49941WI0040004-01","DentaTrust-PPO Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtwi.dentalcareplus.com","http://hixpbdtwi.dentalcareplus.com"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020001","Medica Individual Choice Gold Copay","57845WI002",,"WIN002","WIS002","WIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020001-00","Medica Individual Choice Gold Copay","Standard Gold Off Exchange Plan",,"0.778949933378138","Yes","Yes","No","100%",,"$750","$10","$3,100","$60","$750","$500","$500","$0","$750","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","per person not applicable","$2250 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICGCWI&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020001","Medica Individual Choice Gold Copay","57845WI002",,"WIN002","WIS002","WIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020001-01","Medica Individual Choice Gold Copay","Standard Gold On Exchange Plan",,"0.778949933378138","Yes","Yes","No","100%",,"$750","$10","$3,100","$60","$750","$500","$500","$0","$750","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","per person not applicable","$2250 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICGCWI&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020001","Medica Individual Choice Gold Copay","57845WI002",,"WIN002","WIS002","WIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020001-02","Medica Individual Choice Gold Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICGCWIZ&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020001","Medica Individual Choice Gold Copay","57845WI002",,"WIN002","WIS002","WIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020001-03","Medica Individual Choice Gold Copay","Limited Cost Sharing Plan Variation",,"0.778949933378138","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","per person not applicable","$2250 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICGCWIL&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020019","Medica Individual Choice Gold Copay Plus","57845WI002",,"WIN002","WIS002","WIF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020019-00","Medica Individual Choice Gold Copay Plus","Standard Gold Off Exchange Plan",,"0.804018566628916","Yes","Yes","No","100%",,"$1,000","$300","$400","$60","$1,000","$500","$300","$0","$1,000","$300","$30","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICGPCWI&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020019","Medica Individual Choice Gold Copay Plus","57845WI002",,"WIN002","WIS002","WIF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020019-01","Medica Individual Choice Gold Copay Plus","Standard Gold On Exchange Plan",,"0.804018566628916","Yes","Yes","No","100%",,"$1,000","$300","$400","$60","$1,000","$500","$300","$0","$1,000","$300","$30","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICGPCWI&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030001","Engage by Medica Gold Copay","57845WI003",,"WIN003","WIS003","WIF001","New","PPO","Gold","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030001-00","Engage by Medica Gold Copay","Standard Gold Off Exchange Plan",,"0.778949933378138","Yes","Yes","No","100%",,"$750","$10","$3,100","$60","$750","$500","$500","$0","$750","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","per person not applicable","$2250 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMGCWI&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030001","Engage by Medica Gold Copay","57845WI003",,"WIN003","WIS003","WIF001","New","PPO","Gold","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030001-01","Engage by Medica Gold Copay","Standard Gold On Exchange Plan",,"0.778949933378138","Yes","Yes","No","100%",,"$750","$10","$3,100","$60","$750","$500","$500","$0","$750","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","per person not applicable","$2250 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMGCWI&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030001","Engage by Medica Gold Copay","57845WI003",,"WIN003","WIS003","WIF001","New","PPO","Gold","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030001-02","Engage by Medica Gold Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMGCWIZ&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020013","Medica Individual Choice Catastrophic","57845WI002",,"WIN002","WIS002","WIF007","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020013-00","Medica Individual Choice Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICCWI&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020013","Medica Individual Choice Catastrophic","57845WI002",,"WIN002","WIS002","WIF007","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020013-01","Medica Individual Choice Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICCWI&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030013","Engage by Medica Catastrophic","57845WI003",,"WIN003","WIS003","WIF007","New","PPO","Catastrophic","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030013-00","Engage by Medica Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMCWI&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030013","Engage by Medica Catastrophic","57845WI003",,"WIN003","WIS003","WIF007","New","PPO","Catastrophic","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030013-01","Engage by Medica Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMCWI&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of-network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020003-00","Medica Individual Choice Silver Copay","Standard Silver Off Exchange Plan",,"0.68768656753985","Yes","Yes","No","100%",,"$3,500","$10","$3,100","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICSCWI&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of-network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020003-01","Medica Individual Choice Silver Copay","Standard Silver On Exchange Plan",,"0.68768656753985","Yes","Yes","No","100%",,"$3,500","$10","$3,100","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICSCWI&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of-network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020003-02","Medica Individual Choice Silver Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICSCWIZ&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of-network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020003-03","Medica Individual Choice Silver Copay","Limited Cost Sharing Plan Variation",,"0.68768656753985","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICSCWIL&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of-network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020003-04","Medica Individual Choice Silver Copay","73% AV Level Silver Plan",,"0.728378078020517","Yes","Yes","No","100%",,"$2,500","$10","$2,600","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICSCWI73&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of-network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020003-05","Medica Individual Choice Silver Copay","87% AV Level Silver Plan",,"0.867990381647021","Yes","Yes","No","100%",,"$500","$0","$1,500","$60","$500","$500","$400","$0","$500","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1500 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICSCWI87&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of-network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020003-06","Medica Individual Choice Silver Copay","94% AV Level Silver Plan",,"0.930441983785859","Yes","Yes","No","100%",,"$100","$10","$600","$60","$100","$500","$100","$0","$100","$100","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","5.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICSCWI94&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030003","Engage by Medica Silver Copay","57845WI003",,"WIN003","WIS003","WIF003","New","PPO","Silver","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of-network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030003-00","Engage by Medica Silver Copay","Standard Silver Off Exchange Plan",,"0.68768656753985","Yes","Yes","No","100%",,"$3,500","$10","$3,100","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMSCWI&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030003","Engage by Medica Silver Copay","57845WI003",,"WIN003","WIS003","WIF003","New","PPO","Silver","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of-network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030003-01","Engage by Medica Silver Copay","Standard Silver On Exchange Plan",,"0.68768656753985","Yes","Yes","No","100%",,"$3,500","$10","$3,100","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMSCWI&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030003","Engage by Medica Silver Copay","57845WI003",,"WIN003","WIS003","WIF003","New","PPO","Silver","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of-network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030003-02","Engage by Medica Silver Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMSCWIZ&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030003","Engage by Medica Silver Copay","57845WI003",,"WIN003","WIS003","WIF003","New","PPO","Silver","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of-network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030003-03","Engage by Medica Silver Copay","Limited Cost Sharing Plan Variation",,"0.68768656753985","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMSCWIL&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030003","Engage by Medica Silver Copay","57845WI003",,"WIN003","WIS003","WIF003","New","PPO","Silver","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of-network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030003-04","Engage by Medica Silver Copay","73% AV Level Silver Plan",,"0.728378078020517","Yes","Yes","No","100%",,"$2,500","$10","$2,600","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMSCWI73&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030003","Engage by Medica Silver Copay","57845WI003",,"WIN003","WIS003","WIF003","New","PPO","Silver","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of-network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030003-05","Engage by Medica Silver Copay","87% AV Level Silver Plan",,"0.867990381647021","Yes","Yes","No","100%",,"$500","$0","$1,500","$60","$500","$500","$400","$0","$500","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1500 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMSCWI87&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030003","Engage by Medica Silver Copay","57845WI003",,"WIN003","WIS003","WIF003","New","PPO","Silver","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out-of-network coverage","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030003-06","Engage by Medica Silver Copay","94% AV Level Silver Plan",,"0.930441983785859","Yes","Yes","No","100%",,"$100","$10","$600","$60","$100","$500","$100","$0","$100","$100","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","5.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMSCWI94&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020005","Medica Individual Choice Bronze Copay","57845WI002",,"WIN002","WIS002","WIF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020005-00","Medica Individual Choice Bronze Copay","Standard Bronze Off Exchange Plan",,"0.60854298019876","Yes","Yes","No","100%",,"$6,850","$0","$500","$60","$2,300","$1,000","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICBCWI&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020005","Medica Individual Choice Bronze Copay","57845WI002",,"WIN002","WIS002","WIF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020005-01","Medica Individual Choice Bronze Copay","Standard Bronze On Exchange Plan",,"0.60854298019876","Yes","Yes","No","100%",,"$6,850","$0","$500","$60","$2,300","$1,000","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICBCWI&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020005","Medica Individual Choice Bronze Copay","57845WI002",,"WIN002","WIS002","WIF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020005-02","Medica Individual Choice Bronze Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICBCWIZ&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020005","Medica Individual Choice Bronze Copay","57845WI002",,"WIN002","WIS002","WIF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020005-03","Medica Individual Choice Bronze Copay","Limited Cost Sharing Plan Variation",,"0.60854298019876","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICBCWIL&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020011","Medica Individual Choice Bronze H S A","57845WI002",,"WIN002","WIS002","WIF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020011-00","Medica Individual Choice Bronze H S A","Standard Bronze Off Exchange Plan",,"0.60472271107099","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICBHWI&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020011","Medica Individual Choice Bronze H S A","57845WI002",,"WIN002","WIS002","WIF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020011-01","Medica Individual Choice Bronze H S A","Standard Bronze On Exchange Plan",,"0.60472271107099","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICBHWI&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020011","Medica Individual Choice Bronze H S A","57845WI002",,"WIN002","WIS002","WIF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020011-02","Medica Individual Choice Bronze H S A","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICBHWIZ&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020011","Medica Individual Choice Bronze H S A","57845WI002",,"WIN002","WIS002","WIF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020011-03","Medica Individual Choice Bronze H S A","Limited Cost Sharing Plan Variation",,"0.60472271107099","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICBHWIL&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020023","Medica Individual Choice Bronze H S A Plus","57845WI002",,"WIN002","WIS002","WIF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020023-00","Medica Individual Choice Bronze H S A Plus","Standard Bronze Off Exchange Plan",,"0.648961269523038","Yes","Yes","No","100%",,"$2,600","$0","$3,400","$60","$2,600","$0","$1,800","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICBPHWI&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020023","Medica Individual Choice Bronze H S A Plus","57845WI002",,"WIN002","WIS002","WIF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020023-01","Medica Individual Choice Bronze H S A Plus","Standard Bronze On Exchange Plan",,"0.648961269523038","Yes","Yes","No","100%",,"$2,600","$0","$3,400","$60","$2,600","$0","$1,800","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICBPHWI&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020023","Medica Individual Choice Bronze H S A Plus","57845WI002",,"WIN002","WIS002","WIF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020023-02","Medica Individual Choice Bronze H S A Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICBPHWIZ&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0020023","Medica Individual Choice Bronze H S A Plus","57845WI002",,"WIN002","WIS002","WIF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0020023-03","Medica Individual Choice Bronze H S A Plus","Limited Cost Sharing Plan Variation",,"0.648961269523038","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICBPHWIL&uid=FFM","https://www.medica.com/2018individualchoiceWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030005","Engage by Medica Bronze Copay","57845WI003",,"WIN003","WIS003","WIF004","New","PPO","Bronze","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030005-00","Engage by Medica Bronze Copay","Standard Bronze Off Exchange Plan",,"0.60854298019876","Yes","Yes","No","100%",,"$6,850","$0","$500","$60","$2,300","$1,000","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMBCWI&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030005","Engage by Medica Bronze Copay","57845WI003",,"WIN003","WIS003","WIF004","New","PPO","Bronze","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030005-01","Engage by Medica Bronze Copay","Standard Bronze On Exchange Plan",,"0.60854298019876","Yes","Yes","No","100%",,"$6,850","$0","$500","$60","$2,300","$1,000","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMBCWI&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030005","Engage by Medica Bronze Copay","57845WI003",,"WIN003","WIS003","WIF004","New","PPO","Bronze","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030005-02","Engage by Medica Bronze Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMBCWIZ&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030005","Engage by Medica Bronze Copay","57845WI003",,"WIN003","WIS003","WIF004","New","PPO","Bronze","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","57845WI0030005-03","Engage by Medica Bronze Copay","Limited Cost Sharing Plan Variation",,"0.60854298019876","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMBCWIL&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030011","Engage by Medica Bronze HSA","57845WI003",,"WIN003","WIS003","WIF005","New","PPO","Bronze","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"https://www.medica.com/IFBPharmacy","57845WI0030011-00","Engage by Medica Bronze HSA","Standard Bronze Off Exchange Plan",,"0.60472271107099","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMBHWI&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030011","Engage by Medica Bronze HSA","57845WI003",,"WIN003","WIS003","WIF005","New","PPO","Bronze","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"https://www.medica.com/IFBPharmacy","57845WI0030011-01","Engage by Medica Bronze HSA","Standard Bronze On Exchange Plan",,"0.60472271107099","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMBHWI&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030011","Engage by Medica Bronze HSA","57845WI003",,"WIN003","WIS003","WIF005","New","PPO","Bronze","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"https://www.medica.com/IFBPharmacy","57845WI0030011-02","Engage by Medica Bronze HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMBHWIZ&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030011","Engage by Medica Bronze HSA","57845WI003",,"WIN003","WIS003","WIF005","New","PPO","Bronze","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"https://www.medica.com/IFBPharmacy","57845WI0030011-03","Engage by Medica Bronze HSA","Limited Cost Sharing Plan Variation",,"0.60472271107099","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMBHWIL&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030023","Engage by Medica Bronze HSA Plus","57845WI003",,"WIN003","WIS003","WIF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"https://www.medica.com/IFBPharmacy","57845WI0030023-00","Engage by Medica Bronze HSA Plus","Standard Bronze Off Exchange Plan",,"0.648961269523038","Yes","Yes","No","100%",,"$2,600","$0","$3,400","$60","$2,600","$0","$1,800","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMBPHWI&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030023","Engage by Medica Bronze HSA Plus","57845WI003",,"WIN003","WIS003","WIF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"https://www.medica.com/IFBPharmacy","57845WI0030023-01","Engage by Medica Bronze HSA Plus","Standard Bronze On Exchange Plan",,"0.648961269523038","Yes","Yes","No","100%",,"$2,600","$0","$3,400","$60","$2,600","$0","$1,800","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMBPHWI&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030023","Engage by Medica Bronze HSA Plus","57845WI003",,"WIN003","WIS003","WIF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"https://www.medica.com/IFBPharmacy","57845WI0030023-02","Engage by Medica Bronze HSA Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMBPHWIZ&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","57845","HIOS","2017-08-17 02:20:39","Individual","No","41-1843804","57845WI0030023","Engage by Medica Bronze HSA Plus","57845WI003",,"WIN003","WIS003","WIF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","Yes","Any specialist in the Engage by Medica network.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"https://www.medica.com/IFBPharmacy","57845WI0030023-03","Engage by Medica Bronze HSA Plus","Limited Cost Sharing Plan Variation",,"0.648961269523038","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1EMBPHWIL&uid=FFM","https://www.medica.com/2018engageWI"
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090001","MercyCare HMO Gold Option A","58326WI009",,"WIN001","WIS002","WIF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090001-00","MercyCare HMO Gold Option A","Standard Gold Off Exchange Plan","81.44%","0.814424223706624","No","Yes","No","100%",,"$1,500","$20","$2,480","$60","$1,489","$1,392","$372","$55","$256","$18","$64","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Gold-Option-A-58326WI0090001-00-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090001","MercyCare HMO Gold Option A","58326WI009",,"WIN001","WIS002","WIF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090001-01","MercyCare HMO Gold Option A","Standard Gold On Exchange Plan","81.44%","0.814424223706624","No","Yes","No","100%",,"$1,500","$20","$2,480","$60","$1,489","$1,392","$372","$55","$256","$18","$64","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Gold-Option-A-58326WI0090001-00-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090001","MercyCare HMO Gold Option A","58326WI009",,"WIN001","WIS002","WIF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090001-02","MercyCare HMO Gold Option A","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Gold-Option-A-Zero-Cost-Share-58326WI0090001-02-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090001","MercyCare HMO Gold Option A","58326WI009",,"WIN001","WIS002","WIF012","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090001-03","MercyCare HMO Gold Option A","Limited Cost Sharing Plan Variation","81.44%","0.814424223706624","No","Yes","No","100%",,"$1,500","$20","$2,480","$60","$1,489","$1,392","$372","$55","$256","$18","$64","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Gold-Option-A-58326WI0090001-03-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090012","MercyCare HMO Gold Option B Simple Choice Plan","58326WI009",,"WIN001","WIS002","WIF005","Existing","HMO","Gold","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090012-00","MercyCare HMO Gold Option B Simple Choice Plan","Standard Gold Off Exchange Plan","80.65%","0.806461580880611","No","Yes","No","100%",,"$1,400","$100","$2,480","$60","$1,400","$1,170","$372","$55","$256","$150","$64","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Gold-Option-B-58326WI0090012-00-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090012","MercyCare HMO Gold Option B Simple Choice Plan","58326WI009",,"WIN001","WIS002","WIF005","Existing","HMO","Gold","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090012-01","MercyCare HMO Gold Option B Simple Choice Plan","Standard Gold On Exchange Plan","80.65%","0.806461580880611","No","Yes","No","100%",,"$1,400","$100","$2,480","$60","$1,400","$1,170","$372","$55","$256","$150","$64","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Gold-Option-B-58326WI0090012-00-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090012","MercyCare HMO Gold Option B Simple Choice Plan","58326WI009",,"WIN001","WIS002","WIF005","Existing","HMO","Gold","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090012-02","MercyCare HMO Gold Option B Simple Choice Plan","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Gold-Option-B-Zero-Cost-Share-58326WI0090012-02-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090012","MercyCare HMO Gold Option B Simple Choice Plan","58326WI009",,"WIN001","WIS002","WIF005","Existing","HMO","Gold","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090012-03","MercyCare HMO Gold Option B Simple Choice Plan","Limited Cost Sharing Plan Variation","80.65%","0.806461580880611","No","Yes","No","100%",,"$1,400","$100","$2,480","$60","$1,400","$1,170","$372","$55","$256","$150","$64","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Gold-Option-B-58326WI0090012-03-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090013","MercyCare HMO Gold Option C","58326WI009",,"WIN001","WIS002","WIF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090013-00","MercyCare HMO Gold Option C","Standard Gold Off Exchange Plan","80.83%","0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$60","$2,000","$0","$0","$55","$613","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Gold-Option-C-58326WI0090013-00-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090013","MercyCare HMO Gold Option C","58326WI009",,"WIN001","WIS002","WIF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090013-01","MercyCare HMO Gold Option C","Standard Gold On Exchange Plan","80.83%","0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$60","$2,000","$0","$0","$55","$613","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Gold-Option-C-58326WI0090013-00-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090013","MercyCare HMO Gold Option C","58326WI009",,"WIN001","WIS002","WIF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090013-02","MercyCare HMO Gold Option C","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Gold-Option-C-Zero-Cost-Share-58326WI0090013-02-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090013","MercyCare HMO Gold Option C","58326WI009",,"WIN001","WIS002","WIF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090013-03","MercyCare HMO Gold Option C","Limited Cost Sharing Plan Variation","80.83%","0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$60","$2,000","$0","$0","$55","$613","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Gold-Option-C-58326WI0090013-03-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-00","MercyCare HMO Silver Option A","Standard Silver Off Exchange Plan","71.89%","0.718853494367382","No","Yes","No","100%",,"$3,630","$0","$3,720","$60","$1,303","$1,560","$558","$55","$224","$210","$96","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,750","$5750 per person","$11500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-A-58326WI009002-00-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-01","MercyCare HMO Silver Option A","Standard Silver On Exchange Plan","71.89%","0.718853494367382","No","Yes","No","100%",,"$3,630","$0","$3,720","$60","$1,303","$1,560","$558","$55","$224","$210","$96","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,750","$5750 per person","$11500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-A-58326WI009002-00-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-02","MercyCare HMO Silver Option A","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-A-Zero-Cost-Share-58326WI0090002-02-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-03","MercyCare HMO Silver Option A","Limited Cost Sharing Plan Variation","71.89%","0.718853494367382","No","Yes","No","100%",,"$3,630","$0","$3,720","$60","$1,303","$1,560","$558","$55","$224","$210","$96","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,750","$5750 per person","$11500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-A-58326WI009002-03-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-04","MercyCare HMO Silver Option A","73% AV Level Silver Plan","73.99%","0.739870415908446","No","Yes","No","100%",,"$2,880","$0","$3,720","$60","$1,303","$1,560","$558","$55","$224","$210","$96","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-A-73-58326WI009002-04-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090019","MercyCare HMO Bronze Option C","58326WI009",,"WIN001","WIS002","WIF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090019-00","MercyCare HMO Bronze Option C","Standard Bronze Off Exchange Plan","60.49%","0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$613","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Bronze-Option-C-58326WI0019-00-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090019","MercyCare HMO Bronze Option C","58326WI009",,"WIN001","WIS002","WIF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090019-01","MercyCare HMO Bronze Option C","Standard Bronze On Exchange Plan","60.49%","0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$613","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Bronze-Option-C-58326WI0019-00-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-05","MercyCare HMO Silver Option A","87% AV Level Silver Plan","86.93%","0.869299395982544","No","Yes","No","100%",,"$750","$0","$1,250","$60","$750","$1,005","$245","$55","$256","$150","$64","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-A-87-58326WI009002-05-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF012","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-06","MercyCare HMO Silver Option A","94% AV Level Silver Plan","94.41%","0.944112080617666","No","Yes","No","100%",,"$0","$110","$0","$60","$0","$750","$0","$55","$0","$90","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-A-94-58326WI009002-06-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B Simple Choice Plan","58326WI009",,"WIN001","WIS002","WIF006","Existing","HMO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-00","MercyCare HMO Silver Option B Simple Choice Plan","Standard Silver Off Exchange Plan","71.05%","0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,989","$1,485","$372","$55","$256","$195","$64","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-B-58326WI0090015-00-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B Simple Choice Plan","58326WI009",,"WIN001","WIS002","WIF006","Existing","HMO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-01","MercyCare HMO Silver Option B Simple Choice Plan","Standard Silver On Exchange Plan","71.05%","0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,989","$1,485","$372","$55","$256","$195","$64","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-B-58326WI0090015-00-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B Simple Choice Plan","58326WI009",,"WIN001","WIS002","WIF006","Existing","HMO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-02","MercyCare HMO Silver Option B Simple Choice Plan","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-B-Zero-Cost-Share-58326WI0090015-02-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B Simple Choice Plan","58326WI009",,"WIN001","WIS002","WIF006","Existing","HMO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-03","MercyCare HMO Silver Option B Simple Choice Plan","Limited Cost Sharing Plan Variation","71.05%","0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,989","$1,485","$372","$55","$256","$195","$64","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-B-58326WI0090015-03-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B Simple Choice Plan","58326WI009",,"WIN001","WIS002","WIF006","Existing","HMO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-04","MercyCare HMO Silver Option B Simple Choice Plan","73% AV Level Silver Plan","73.95%","0.739471608611116","No","Yes","No","100%",,"$3,000","$120","$2,480","$60","$1,689","$1,485","$372","$55","$256","$195","$64","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-B-73-58326WI0090002-04-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B Simple Choice Plan","58326WI009",,"WIN001","WIS002","WIF006","Existing","HMO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-05","MercyCare HMO Silver Option B Simple Choice Plan","87% AV Level Silver Plan","87.61%","0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$700","$610","$372","$55","$256","$75","$64","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-B-87-58326WI0090002-05-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B Simple Choice Plan","58326WI009",,"WIN001","WIS002","WIF006","Existing","HMO","Silver","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-06","MercyCare HMO Silver Option B Simple Choice Plan","94% AV Level Silver Plan","94.69%","0.946922790208574","No","Yes","No","100%",,"$250","$22","$622","$60","$250","$218","$101","$55","$250","$30","$14","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-B-94-58326WI0090002-06-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-00","MercyCare HMO Silver Option C","Standard Silver Off Exchange Plan","70.10%","0.700980885295207","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$55","$613","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-C-58326WI0090016-00-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-01","MercyCare HMO Silver Option C","Standard Silver On Exchange Plan","70.10%","0.700980885295207","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$55","$613","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-C-58326WI0090016-00-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-02","MercyCare HMO Silver Option C","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-C-Zero-Cost-Share-58326WI0090016-02-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-03","MercyCare HMO Silver Option C","Limited Cost Sharing Plan Variation","70.10%","0.700980885295207","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$55","$613","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-C-58326WI0090016-03-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-04","MercyCare HMO Silver Option C","73% AV Level Silver Plan","72.73%","0.727271335519319","Yes","Yes","No","100%",,"$3,400","$0","$0","$60","$3,400","$0","$0","$55","$613","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-C-73-58326WI0090016-04-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090020","MercyCare HMO Bronze Option D Simple Choice Plan","58326WI009",,"WIN001","WIS002","WIF003","New","HMO","Expanded Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090020-01","MercyCare HMO Bronze Option D Simple Choice Plan","Standard Bronze On Exchange Plan","61.97%","0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$55","$576","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Bronze-Option-D-58326WI0090020-00-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090020","MercyCare HMO Bronze Option D Simple Choice Plan","58326WI009",,"WIN001","WIS002","WIF003","New","HMO","Expanded Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090020-02","MercyCare HMO Bronze Option D Simple Choice Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Bronze-Option-D-Zero-Cost-Share-58326WI0090020-02-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090020","MercyCare HMO Bronze Option D Simple Choice Plan","58326WI009",,"WIN001","WIS002","WIF003","New","HMO","Expanded Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090020-03","MercyCare HMO Bronze Option D Simple Choice Plan","Limited Cost Sharing Plan Variation","61.97%","0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$55","$576","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Bronze-Option-D-58326WI0090020-03-2018.pdf",
"2018","WI","69589","HIOS","2017-05-20 02:20:32","Individual","Yes","13-5123390","69589WI0090002","Guardian Essentials for Families and Individuals","69589WI009",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","69589WI0090002-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/wisconsin/","https://dentalexchange.guardianlife.com/our-plans/wisconsin/"
"2018","WI","69589","HIOS","2017-05-20 02:20:32","Individual","Yes","13-5123390","69589WI0090002","Guardian Essentials for Families and Individuals","69589WI009",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","69589WI0090002-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/wisconsin/","https://dentalexchange.guardianlife.com/our-plans/wisconsin/"
"2018","WI","69589","HIOS","2017-05-20 02:20:32","Individual","Yes","13-5123390","69589WI0070002","Guardian Select for Families and Individuals","69589WI007",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","69589WI0070002-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/wisconsin/","https://dentalexchange.guardianlife.com/our-plans/wisconsin/"
"2018","WI","69589","HIOS","2017-05-20 02:20:32","Individual","Yes","13-5123390","69589WI0070002","Guardian Select for Families and Individuals","69589WI007",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","69589WI0070002-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/wisconsin/","https://dentalexchange.guardianlife.com/our-plans/wisconsin/"
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-05","MercyCare HMO Silver Option C","87% AV Level Silver Plan","86.30%","0.862986553804247","Yes","Yes","No","100%",,"$1,250","$0","$0","$60","$1,250","$0","$0","$55","$613","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-C-87-58326WI0090016-05-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-06","MercyCare HMO Silver Option C","94% AV Level Silver Plan","94.34%","0.943356902872246","Yes","Yes","No","100%",,"$450","$0","$0","$60","$450","$0","$0","$55","$450","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Silver-Option-C-94-58326WI0090016-06-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090006","MercyCare HMO Bronze Option A","58326WI009",,"WIN001","WIS002","WIF009","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090006-00","MercyCare HMO Bronze Option A","Standard Bronze Off Exchange Plan","60.25%","0.602509626756005","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$5,000","$0","$2,155","$55","$429","$0","$184","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Bronze-Option-A-58326WI0090006-00-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090006","MercyCare HMO Bronze Option A","58326WI009",,"WIN001","WIS002","WIF009","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090006-01","MercyCare HMO Bronze Option A","Standard Bronze On Exchange Plan","60.25%","0.602509626756005","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$5,000","$0","$2,155","$55","$429","$0","$184","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Bronze-Option-A-58326WI0090006-00-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090006","MercyCare HMO Bronze Option A","58326WI009",,"WIN001","WIS002","WIF009","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090006-02","MercyCare HMO Bronze Option A","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Bronze-Option-A-Zero-Cost-Share-58326WI0090006-02-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090006","MercyCare HMO Bronze Option A","58326WI009",,"WIN001","WIS002","WIF009","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090006-03","MercyCare HMO Bronze Option A","Limited Cost Sharing Plan Variation","60.25%","0.602509626756005","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$5,000","$0","$2,155","$55","$429","$0","$184","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Bronze-Option-A-58326WI0090006-03-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090018","MercyCare HMO Bronze Option B Simple Choice Plan","58326WI009",,"WIN001","WIS002","WIF010","Existing","HMO","Expanded Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090018-00","MercyCare HMO Bronze Option B Simple Choice Plan","Standard Bronze Off Exchange Plan","62.68%","0.6268275994915","Yes","Yes","No","100%",,"$2,375","$0","$4,975","$60","$3,535","$1,515","$2,058","$55","$170","$225","$113","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Bronze-Option-B-58326WI0090018-00-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090018","MercyCare HMO Bronze Option B Simple Choice Plan","58326WI009",,"WIN001","WIS002","WIF010","Existing","HMO","Expanded Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090018-01","MercyCare HMO Bronze Option B Simple Choice Plan","Standard Bronze On Exchange Plan","62.68%","0.6268275994915","Yes","Yes","No","100%",,"$2,375","$0","$4,975","$60","$3,535","$1,515","$2,058","$55","$170","$225","$113","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Bronze-Option-B-58326WI0090018-00-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090018","MercyCare HMO Bronze Option B Simple Choice Plan","58326WI009",,"WIN001","WIS002","WIF010","Existing","HMO","Expanded Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090018-02","MercyCare HMO Bronze Option B Simple Choice Plan","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Bronze-Option-B-Zero-Cost-Share-58326WI0090018-02-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090018","MercyCare HMO Bronze Option B Simple Choice Plan","58326WI009",,"WIN001","WIS002","WIF010","Existing","HMO","Expanded Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090018-03","MercyCare HMO Bronze Option B Simple Choice Plan","Limited Cost Sharing Plan Variation","62.68%","0.6268275994915","Yes","Yes","No","100%",,"$2,375","$0","$4,975","$60","$3,535","$1,515","$2,058","$55","$170","$225","$113","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Bronze-Option-B-58326WI0090018-03-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090019","MercyCare HMO Bronze Option C","58326WI009",,"WIN001","WIS002","WIF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090019-02","MercyCare HMO Bronze Option C","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Bronze-Option-C-Zero-Cost-Share-58326WI0090019-02-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090019","MercyCare HMO Bronze Option C","58326WI009",,"WIN001","WIS002","WIF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090019-03","MercyCare HMO Bronze Option C","Limited Cost Sharing Plan Variation","60.49%","0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$613","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Bronze-Option-C-58326WI0019-03-2018.pdf",
"2018","WI","58326","HIOS","2017-09-22 02:20:26","Individual","No","20-1482553","58326WI0090020","MercyCare HMO Bronze Option D Simple Choice Plan","58326WI009",,"WIN001","WIS002","WIF003","New","HMO","Expanded Bronze","Design 1","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,"2018-01-01","2018-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","https://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090020-00","MercyCare HMO Bronze Option D Simple Choice Plan","Standard Bronze Off Exchange Plan","61.97%","0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$55","$576","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mercycarehealthplans.com/wp-content/uploads/2017/07/HMO-Bronze-Option-D-58326WI0090020-00-2018.pdf",
"2018","WI","69589","HIOS","2017-05-20 02:20:32","Individual","Yes","13-5123390","69589WI0080002","Guardian Basics for Families and Individuals","69589WI008",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","69589WI0080002-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/wisconsin/","https://dentalexchange.guardianlife.com/our-plans/wisconsin/"
"2018","WI","69589","HIOS","2017-05-20 02:20:32","Individual","Yes","13-5123390","69589WI0080002","Guardian Basics for Families and Individuals","69589WI008",,"WIN001","WIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","69589WI0080002-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/wisconsin/","https://dentalexchange.guardianlife.com/our-plans/wisconsin/"
"2018","WI","79597","HIOS","2017-08-16 02:20:33","Individual","Yes","39-6094742","79597WI0030001","Delta Dental Individual and Family High Plan","79597WI003",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","79597WI0030001-00","Delta Dental Individual and Family High Plan","Standard High Off Exchange Plan","86.70%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,"$35","$35 per person","$105 per group",,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/2018_DDWI_Individual_High_Plan.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/2018_DDWI_Individual_High_Plan.pdf"
"2018","WI","79597","HIOS","2017-08-16 02:20:33","SHOP (Small Group)","Yes","39-6094742","79597WI0040001","Delta Dental PPO Plus Premier Family Plan High Option","79597WI004",,"WIN002","WIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes",,"","79597WI0040001-00","Delta Dental PPO Plus Premier Family Plan High Option","Standard High Off Exchange Plan","85.20%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2018/SG_FamilyHighPlan.pdf","http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2018/SG_FamilyHighPlan.pdf"
"2018","WI","79597","HIOS","2017-08-16 02:20:33","SHOP (Small Group)","Yes","39-6094742","79597WI0040001","Delta Dental PPO Plus Premier Family Plan High Option","79597WI004",,"WIN002","WIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes",,"","79597WI0040001-01","Delta Dental PPO Plus Premier Family Plan High Option","Standard High On Exchange Plan","85.20%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2018/SG_FamilyHighPlan.pdf","http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2018/SG_FamilyHighPlan.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470011","Prestige Silver Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470011-00","Prestige Silver Essential","Standard Silver Off Exchange Plan",,"0.709787981679662","Yes","Yes","No","100%",,"$3,500","$190","$3,220","$60","$0","$1,760","$0","$20","$970","$440","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silverE.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","79597","HIOS","2017-08-16 02:20:33","Individual","Yes","39-6094742","79597WI0030001","Delta Dental Individual and Family High Plan","79597WI003",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","79597WI0030001-01","Delta Dental Individual and Family High Plan","Standard High On Exchange Plan","86.70%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,"$35","$35 per person","$105 per group",,"$35","$35 per person","$105 per group","$35","$35 per person","$105 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/2018_DDWI_Individual_High_Plan.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/2018_DDWI_Individual_High_Plan.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470011","Prestige Silver Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470011-01","Prestige Silver Essential","Standard Silver On Exchange Plan",,"0.709787981679662","Yes","Yes","No","100%",,"$3,500","$190","$3,220","$60","$0","$1,760","$0","$20","$970","$440","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silverE.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470003-05","Prestige Silver 0","87% AV Level Silver Plan",,"0.860180717523562","Yes","Yes","No","100%",,"$980","$40","$0","$60","$840","$1,260","$0","$20","$980","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$975","$975 per person","$1950 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver087.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","79597","HIOS","2017-08-16 02:20:33","Individual","Yes","39-6094742","79597WI0030002","Delta Dental Individual and Family Low Plan Major","79597WI003",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","79597WI0030002-00","Delta Dental Individual and Family Low Plan Major","Standard Low Off Exchange Plan","71.80%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group","$90","$90 per person","$270 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/2018_DDWI_Individual_Low_Plan_Major.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/2018_DDWI_Individual_Low_Plan_Major.pdf"
"2018","WI","79597","HIOS","2017-08-16 02:20:33","SHOP (Small Group)","Yes","39-6094742","79597WI0040002","Delta Dental PPO Plus Premier Family Plan Low Option","79597WI004",,"WIN002","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes",,"","79597WI0040002-00","Delta Dental PPO Plus Premier Family Plan Low Option","Standard Low Off Exchange Plan","71.80%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group","$90","$90 per person","$270 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2018/SG_FamilyLowPlan.pdf","http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2018/SG_FamilyLowPlan.pdf"
"2018","WI","79597","HIOS","2017-08-16 02:20:33","SHOP (Small Group)","Yes","39-6094742","79597WI0040002","Delta Dental PPO Plus Premier Family Plan Low Option","79597WI004",,"WIN002","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes",,"","79597WI0040002-01","Delta Dental PPO Plus Premier Family Plan Low Option","Standard Low On Exchange Plan","71.80%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group","$90","$90 per person","$270 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2018/SG_FamilyLowPlan.pdf","http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2018/SG_FamilyLowPlan.pdf"
"2018","WI","79597","HIOS","2017-08-16 02:20:33","Individual","Yes","39-6094742","79597WI0030002","Delta Dental Individual and Family Low Plan Major","79597WI003",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","79597WI0030002-01","Delta Dental Individual and Family Low Plan Major","Standard Low On Exchange Plan","71.80%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group","$90","$90 per person","$270 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/2018_DDWI_Individual_Low_Plan_Major.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/2018_DDWI_Individual_Low_Plan_Major.pdf"
"2018","WI","79597","HIOS","2017-08-16 02:20:33","Individual","Yes","39-6094742","79597WI0030003","Delta Dental Individual and Family Low Plan","79597WI003",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","79597WI0030003-00","Delta Dental Individual and Family Low Plan","Standard Low Off Exchange Plan","71.80%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group","$90","$90 per person","$270 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/2018_DDWI_Individual_Low_Plan.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/2018_DDWI_Individual_Low_Plan.pdf"
"2018","WI","79597","HIOS","2017-08-16 02:20:33","SHOP (Small Group)","Yes","39-6094742","79597WI0040003","Delta Dental PPO Plus Premier Family Plan High Option Orthodontics","79597WI004",,"WIN002","WIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.909","Estimated Rate","2018-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes",,"","79597WI0040003-00","Delta Dental PPO Plus Premier Family Plan High Option Orthodontics","Standard High Off Exchange Plan","85.20%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","WI","79597","HIOS","2017-08-16 02:20:33","Individual","Yes","39-6094742","79597WI0030003","Delta Dental Individual and Family Low Plan","79597WI003",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","79597WI0030003-01","Delta Dental Individual and Family Low Plan","Standard Low On Exchange Plan","71.80%",,,,"Yes","55%","45%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group",,"$90","$90 per person","$270 per group","$90","$90 per person","$270 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/2018_DDWI_Individual_Low_Plan.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/2018_DDWI_Individual_Low_Plan.pdf"
"2018","WI","81335","HIOS","2017-06-02 02:20:22","SHOP (Small Group)","Yes","13-5581829","81335WI0120001","EHB Basic Dental Plan (Low)","81335WI012",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","81335WI0120001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460008","Prestige Bronze Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460008-00","Prestige Bronze Essential","Standard Bronze Off Exchange Plan",,"0.633442136753608","Yes","Yes","No","100%",,"$6,500","$120","$730","$60","$3,850","$850","$0","$20","$1,330","$300","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/bronzeE.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460008","Prestige Bronze Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460008-01","Prestige Bronze Essential","Standard Bronze On Exchange Plan",,"0.633442136753608","Yes","Yes","No","100%",,"$6,500","$120","$730","$60","$3,850","$850","$0","$20","$1,330","$300","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/bronzeE.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460008","Prestige Bronze Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460008-02","Prestige Bronze Essential","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://networkhealth.com/benefits/sbc/18/bronzeEna0.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460008","Prestige Bronze Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460008-03","Prestige Bronze Essential","Limited Cost Sharing Plan Variation",,"0.633442136753608","Yes","Yes","No","100%",,"$6,500","$120","$730","$60","$3,850","$850","$0","$20","$1,330","$300","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/bronzeEnalim.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470008","Prestige Bronze Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470008-00","Prestige Bronze Essential","Standard Bronze Off Exchange Plan",,"0.633442136753608","Yes","Yes","No","100%",,"$6,500","$120","$730","$60","$3,850","$850","$0","$20","$1,330","$300","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/bronzeE.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470008","Prestige Bronze Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470008-01","Prestige Bronze Essential","Standard Bronze On Exchange Plan",,"0.633442136753608","Yes","Yes","No","100%",,"$6,500","$120","$730","$60","$3,850","$850","$0","$20","$1,330","$300","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/bronzeE.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470008","Prestige Bronze Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470008-02","Prestige Bronze Essential","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://networkhealth.com/benefits/sbc/18/bronzeEna0.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470008","Prestige Bronze Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470008-03","Prestige Bronze Essential","Limited Cost Sharing Plan Variation",,"0.633442136753608","Yes","Yes","No","100%",,"$6,500","$120","$730","$60","$3,850","$850","$0","$20","$1,330","$300","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/bronzeEnalim.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460011","Prestige Silver Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460011-00","Prestige Silver Essential","Standard Silver Off Exchange Plan",,"0.709787981679662","Yes","Yes","No","100%",,"$3,500","$190","$3,220","$60","$0","$1,760","$0","$20","$970","$440","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silverE.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460011","Prestige Silver Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460011-01","Prestige Silver Essential","Standard Silver On Exchange Plan",,"0.709787981679662","Yes","Yes","No","100%",,"$3,500","$190","$3,220","$60","$0","$1,760","$0","$20","$970","$440","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silverE.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460011","Prestige Silver Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460011-02","Prestige Silver Essential","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://networkhealth.com/benefits/sbc/18/silverEna0.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460011","Prestige Silver Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460011-03","Prestige Silver Essential","Limited Cost Sharing Plan Variation",,"0.709787981679662","Yes","Yes","No","100%",,"$3,500","$190","$3,220","$60","$0","$1,760","$0","$20","$970","$440","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silverEnalim.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460011","Prestige Silver Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460011-04","Prestige Silver Essential","73% AV Level Silver Plan",,"0.732792088621379","Yes","Yes","No","100%",,"$3,200","$190","$2,460","$60","$0","$1,700","$0","$20","$970","$390","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silverE73.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460011","Prestige Silver Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460011-05","Prestige Silver Essential","87% AV Level Silver Plan",,"0.861608151885241","Yes","Yes","No","100%",,"$700","$100","$1,300","$60","$0","$1,390","$0","$20","$700","$310","$50","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silverE87.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460011","Prestige Silver Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460011-06","Prestige Silver Essential","94% AV Level Silver Plan",,"0.931127478142923","Yes","Yes","No","100%",,"$300","$100","$1,130","$60","$0","$1,000","$0","$20","$300","$370","$40","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silverE94.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470011","Prestige Silver Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470011-02","Prestige Silver Essential","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://networkhealth.com/benefits/sbc/18/silverEna0.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470011","Prestige Silver Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470011-03","Prestige Silver Essential","Limited Cost Sharing Plan Variation",,"0.709787981679662","Yes","Yes","No","100%",,"$3,500","$190","$3,220","$60","$0","$1,760","$0","$20","$970","$440","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silverEnalim.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470011","Prestige Silver Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470011-04","Prestige Silver Essential","73% AV Level Silver Plan",,"0.732792088621379","Yes","Yes","No","100%",,"$3,200","$190","$2,460","$60","$0","$1,700","$0","$20","$970","$390","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silverE73.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470011","Prestige Silver Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470011-05","Prestige Silver Essential","87% AV Level Silver Plan",,"0.861608151885241","Yes","Yes","No","100%",,"$700","$100","$1,300","$60","$0","$1,390","$0","$20","$700","$310","$50","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silverE87.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470011","Prestige Silver Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470011-06","Prestige Silver Essential","94% AV Level Silver Plan",,"0.931127478142923","Yes","Yes","No","100%",,"$300","$100","$1,130","$60","$0","$1,000","$0","$20","$300","$370","$40","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$825","$825 per person","$1650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silverE94.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460005","Prestige Bronze 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460005-00","Prestige Bronze 20 HDHP","Standard Bronze Off Exchange Plan",,"0.61176557634003","Yes","Yes","No","100%",,"$5,500","$0","$1,430","$60","$5,500","$0","$270","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/18/bronze20hdhp.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460005","Prestige Bronze 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460005-01","Prestige Bronze 20 HDHP","Standard Bronze On Exchange Plan",,"0.61176557634003","Yes","Yes","No","100%",,"$5,500","$0","$1,430","$60","$5,500","$0","$270","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/18/bronze20hdhp.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460005","Prestige Bronze 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460005-02","Prestige Bronze 20 HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://networkhealth.com/benefits/sbc/18/bronze20hdhpna0.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460005","Prestige Bronze 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460005-03","Prestige Bronze 20 HDHP","Limited Cost Sharing Plan Variation",,"0.61176557634003","Yes","Yes","No","100%",,"$5,500","$0","$1,430","$60","$5,500","$0","$270","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/bronze20hdhpnalim.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460007","Prestige Silver 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460007-00","Prestige Silver 20 HDHP","Standard Silver Off Exchange Plan",,"0.68458277862376","Yes","Yes","No","100%",,"$2,700","$0","$1,990","$60","$2,700","$0","$830","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/18/silver20hdhp.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460007","Prestige Silver 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460007-01","Prestige Silver 20 HDHP","Standard Silver On Exchange Plan",,"0.68458277862376","Yes","Yes","No","100%",,"$2,700","$0","$1,990","$60","$2,700","$0","$830","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/18/silver20hdhp.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460007","Prestige Silver 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460007-02","Prestige Silver 20 HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://networkhealth.com/benefits/sbc/18/silver20hdhpna0.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460007","Prestige Silver 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460007-03","Prestige Silver 20 HDHP","Limited Cost Sharing Plan Variation",,"0.68458277862376","Yes","Yes","No","100%",,"$2,700","$0","$1,990","$60","$2,700","$0","$830","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver20hdhpnalim.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460007","Prestige Silver 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460007-04","Prestige Silver 20 HDHP","73% AV Level Silver Plan",,"0.738684479504524","Yes","Yes","No","100%",,"$1,600","$0","$2,210","$60","$1,600","$0","$1,050","$20","$1,600","$0","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver20hdhp73.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460007","Prestige Silver 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460007-05","Prestige Silver 20 HDHP","87% AV Level Silver Plan",,"0.860625348014376","Yes","Yes","No","100%",,"$800","$0","$2,370","$60","$800","$0","$1,210","$20","$800","$0","$220","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver20hdhp87.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460007","Prestige Silver 20 HDHP","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460007-06","Prestige Silver 20 HDHP","94% AV Level Silver Plan",,"0.93112271454714","Yes","Yes","No","100%",,"$250","$0","$1,860","$60","$250","$0","$990","$20","$250","$0","$250","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver20hdhp94.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470007","Prestige Silver 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470007-00","Prestige Silver 20 HDHP","Standard Silver Off Exchange Plan",,"0.68458277862376","Yes","Yes","No","100%",,"$2,700","$0","$1,990","$60","$2,700","$0","$830","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/18/silver20hdhp.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470007","Prestige Silver 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470007-01","Prestige Silver 20 HDHP","Standard Silver On Exchange Plan",,"0.68458277862376","Yes","Yes","No","100%",,"$2,700","$0","$1,990","$60","$2,700","$0","$830","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/18/silver20hdhp.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470007","Prestige Silver 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470007-02","Prestige Silver 20 HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://networkhealth.com/benefits/sbc/18/silver20hdhpna0.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470007","Prestige Silver 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470007-03","Prestige Silver 20 HDHP","Limited Cost Sharing Plan Variation",,"0.68458277862376","Yes","Yes","No","100%",,"$2,700","$0","$1,990","$60","$2,700","$0","$830","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver20hdhpnalim.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470007","Prestige Silver 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470007-04","Prestige Silver 20 HDHP","73% AV Level Silver Plan",,"0.738684479504524","Yes","Yes","No","100%",,"$1,600","$0","$2,210","$60","$1,600","$0","$1,050","$20","$1,600","$0","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver20hdhp73.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470007","Prestige Silver 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470007-05","Prestige Silver 20 HDHP","87% AV Level Silver Plan",,"0.860625348014376","Yes","Yes","No","100%",,"$800","$0","$2,370","$60","$800","$0","$1,210","$20","$800","$0","$220","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver20hdhp87.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470007","Prestige Silver 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470007-06","Prestige Silver 20 HDHP","94% AV Level Silver Plan",,"0.93112271454714","Yes","Yes","No","100%",,"$250","$0","$1,860","$60","$250","$0","$990","$20","$250","$0","$250","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver20hdhp94.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470005","Prestige Bronze 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470005-00","Prestige Bronze 20 HDHP","Standard Bronze Off Exchange Plan",,"0.61176557634003","Yes","Yes","No","100%",,"$5,500","$0","$1,430","$60","$5,500","$0","$270","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/18/bronze20hdhp.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470005","Prestige Bronze 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470005-01","Prestige Bronze 20 HDHP","Standard Bronze On Exchange Plan",,"0.61176557634003","Yes","Yes","No","100%",,"$5,500","$0","$1,430","$60","$5,500","$0","$270","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://networkhealth.com/benefits/sbc/18/bronze20hdhp.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470005","Prestige Bronze 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470005-02","Prestige Bronze 20 HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://networkhealth.com/benefits/sbc/18/bronze20hdhpna0.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470005","Prestige Bronze 20 HDHP","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470005-03","Prestige Bronze 20 HDHP","Limited Cost Sharing Plan Variation",,"0.61176557634003","Yes","Yes","No","100%",,"$5,500","$0","$1,430","$60","$5,500","$0","$270","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/bronze20hdhpnalim.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470003-00","Prestige Silver 0","Standard Silver Off Exchange Plan",,"0.691217302584845","Yes","Yes","No","100%",,"$4,000","$40","$0","$60","$840","$1,580","$0","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver0.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470003-01","Prestige Silver 0","Standard Silver On Exchange Plan",,"0.691217302584845","Yes","Yes","No","100%",,"$4,000","$40","$0","$60","$840","$1,580","$0","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver0.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470003-02","Prestige Silver 0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://networkhealth.com/benefits/sbc/18/silver0na0.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470003-03","Prestige Silver 0","Limited Cost Sharing Plan Variation",,"0.691217302584845","Yes","Yes","No","100%",,"$4,000","$40","$0","$60","$840","$1,580","$0","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver0nalim.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470003-04","Prestige Silver 0","73% AV Level Silver Plan",,"0.723458760143133","Yes","Yes","No","100%",,"$3,450","$40","$0","$60","$840","$1,260","$0","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,450","$3450 per person","$6900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver073.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470003-06","Prestige Silver 0","94% AV Level Silver Plan",,"0.930449457003029","Yes","Yes","No","100%",,"$350","$40","$0","$60","$350","$1,260","$0","$20","$350","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$725","$725 per person","$1450 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver094.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460013","Prestige Gold Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460013-00","Prestige Gold Essential","Standard Gold Off Exchange Plan",,"0.785566750005329","Yes","Yes","No","100%",,"$1,500","$130","$2,010","$60","$0","$1,320","$0","$20","$200","$580","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/goldE.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460013","Prestige Gold Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460013-01","Prestige Gold Essential","Standard Gold On Exchange Plan",,"0.785566750005329","Yes","Yes","No","100%",,"$1,500","$130","$2,010","$60","$0","$1,320","$0","$20","$200","$580","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/goldE.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460013","Prestige Gold Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460013-02","Prestige Gold Essential","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://networkhealth.com/benefits/sbc/18/goldEna0.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460013","Prestige Gold Essential","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460013-03","Prestige Gold Essential","Limited Cost Sharing Plan Variation",,"0.785566750005329","Yes","Yes","No","100%",,"$1,500","$130","$2,010","$60","$0","$1,320","$0","$20","$200","$580","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/goldEnalim.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470013","Prestige Gold Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470013-00","Prestige Gold Essential","Standard Gold Off Exchange Plan",,"0.785566750005329","Yes","Yes","No","100%",,"$1,500","$130","$2,010","$60","$0","$1,320","$0","$20","$200","$580","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/goldE.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010001","HMO Silver 7000","86584WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010001-05","HMO Silver 400 CSR 87","87% AV Level Silver Plan","87.73%","0.870210743619985","No","Yes","No","100%",,"$400","$100","$0","$10","$100","$1,300","$0","$0","$400","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010001-05.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010001-05.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010001","HMO Silver 7000","86584WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010001-06","HMO Silver 0 CSR 94","94% AV Level Silver Plan","94.84%","0.940668773656294","No","Yes","No","100%",,"$0","$100","$0","$10","$0","$500","$0","$0","$0","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010001-06.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010001-06.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010002","HMO Silver 4500","86584WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010002-00","HMO Silver 4500","Standard Silver Off Exchange Plan","69.95%","0.693822936383651","No","Yes","No","100%",,"$4,500","$100","$1,600","$10","$100","$2,760","$0","$0","$1,300","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010002-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010002-00.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010002","HMO Silver 4500","86584WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010002-02","HMO Silver 0 CSR Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010002-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010002-02.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470013","Prestige Gold Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470013-01","Prestige Gold Essential","Standard Gold On Exchange Plan",,"0.785566750005329","Yes","Yes","No","100%",,"$1,500","$130","$2,010","$60","$0","$1,320","$0","$20","$200","$580","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/goldE.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470013","Prestige Gold Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470013-02","Prestige Gold Essential","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://networkhealth.com/benefits/sbc/18/goldEna0.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0470013","Prestige Gold Essential","81413WI047","7114920748","WIN002","WIS002","WIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0470013-03","Prestige Gold Essential","Limited Cost Sharing Plan Variation",,"0.785566750005329","Yes","Yes","No","100%",,"$1,500","$130","$2,010","$60","$0","$1,320","$0","$20","$200","$580","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/goldEnalim.pdf","http://www.networkhealth.com/plans/18individualbrochuresewi.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010002","HMO Silver 4500","86584WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010002-01","HMO Silver 4500","Standard Silver On Exchange Plan","69.95%","0.693822936383651","No","Yes","No","100%",,"$4,500","$100","$1,600","$10","$100","$2,760","$0","$0","$1,300","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010002-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010002-01.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460003-00","Prestige Silver 0","Standard Silver Off Exchange Plan",,"0.691217302584845","Yes","Yes","No","100%",,"$4,000","$40","$0","$60","$840","$1,580","$0","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver0.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460003-01","Prestige Silver 0","Standard Silver On Exchange Plan",,"0.691217302584845","Yes","Yes","No","100%",,"$4,000","$40","$0","$60","$840","$1,580","$0","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver0.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460003-02","Prestige Silver 0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://networkhealth.com/benefits/sbc/18/silver0na0.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460003-03","Prestige Silver 0","Limited Cost Sharing Plan Variation",,"0.691217302584845","Yes","Yes","No","100%",,"$4,000","$40","$0","$60","$840","$1,580","$0","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver0nalim.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460003-04","Prestige Silver 0","73% AV Level Silver Plan",,"0.723458760143133","Yes","Yes","No","100%",,"$3,450","$40","$0","$60","$840","$1,260","$0","$20","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,450","$3450 per person","$6900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver073.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460003-05","Prestige Silver 0","87% AV Level Silver Plan",,"0.860180717523562","Yes","Yes","No","100%",,"$980","$40","$0","$60","$840","$1,260","$0","$20","$980","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$975","$975 per person","$1950 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver087.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","81413","HIOS","2017-08-17 02:20:39","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","Yes","Emergency Services or Urgent Care Services When services are performed in a free standing urgent care facility or hospital based urgent care","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","https://networkhealth.com/_files/pdf/Pharmacy/2018_Pharmacy/individualdruglist6Tier.pdf","81413WI0460003-06","Prestige Silver 0","94% AV Level Silver Plan",,"0.930449457003029","Yes","Yes","No","100%",,"$350","$40","$0","$60","$350","$1,260","$0","$20","$350","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$725","$725 per person","$1450 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://networkhealth.com/benefits/sbc/18/silver094.pdf","http://www.networkhealth.com/plans/18individualbrochurenewi.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010005","HMO Bronze 7350","86584WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010005-00","HMO Bronze 7350","Standard Bronze Off Exchange Plan",,"0.58543686315904","Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$7,100","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010005-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010005-00.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010005","HMO Bronze 7350","86584WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010005-01","HMO Bronze 7350","Standard Bronze On Exchange Plan",,"0.58543686315904","Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$7,100","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010005-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010005-01.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010005","HMO Bronze 7350","86584WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010005-02","HMO Bronze 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010005-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010005-02.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010005","HMO Bronze 7350","86584WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010005-03","HMO Bronze 7350 CSR Limited","Limited Cost Sharing Plan Variation",,"0.58543686315904","Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$7,100","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010005-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010005-03.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010006","HMO Bronze 6250","86584WI001",,"WIN001","WIS001","WIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010006-00","HMO Bronze 6250","Standard Bronze Off Exchange Plan",,"0.591470578464992","Yes","Yes","No","100%",,"$6,250","$0","$700","$10","$6,250","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010006-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010006-00.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010006","HMO Bronze 6250","86584WI001",,"WIN001","WIS001","WIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010006-01","HMO Bronze 6250","Standard Bronze On Exchange Plan",,"0.591470578464992","Yes","Yes","No","100%",,"$6,250","$0","$700","$10","$6,250","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010006-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010006-01.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010006","HMO Bronze 6250","86584WI001",,"WIN001","WIS001","WIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010006-02","HMO Bronze 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010006-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010006-02.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010006","HMO Bronze 6250","86584WI001",,"WIN001","WIS001","WIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010006-03","HMO Bronze 6250 CSR Limited","Limited Cost Sharing Plan Variation",,"0.591470578464992","Yes","Yes","No","100%",,"$6,250","$0","$700","$10","$6,250","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010006-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010006-03.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010001","HMO Silver 7000","86584WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010001-00","HMO Silver 7000","Standard Silver Off Exchange Plan","69.74%","0.691690699571929","No","Yes","No","100%",,"$7,000","$100","$0","$10","$100","$2,760","$0","$0","$1,300","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010001-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010001-00.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010001","HMO Silver 7000","86584WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010001-01","HMO Silver 7000","Standard Silver On Exchange Plan","69.74%","0.691690699571929","No","Yes","No","100%",,"$7,000","$100","$0","$10","$100","$2,760","$0","$0","$1,300","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010001-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010001-01.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010001","HMO Silver 7000","86584WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010001-02","HMO Silver 0 CSR Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010001-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010001-02.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010001","HMO Silver 7000","86584WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010001-03","HMO Silver 7000 CSR Limited","Limited Cost Sharing Plan Variation","69.74%","0.691690699571929","No","Yes","No","100%",,"$7,000","$100","$0","$10","$100","$2,760","$0","$0","$1,300","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010001-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010001-03.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010001","HMO Silver 7000","86584WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010001-04","HMO Silver 3800 CSR 73","73% AV Level Silver Plan","73.97%","0.733715031277424","No","Yes","No","100%",,"$3,800","$100","$0","$10","$100","$2,760","$0","$0","$1,300","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010001-04.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010001-04.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010002","HMO Silver 4500","86584WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010002-03","HMO Silver 4500 CSR Limited","Limited Cost Sharing Plan Variation","69.95%","0.693822936383651","No","Yes","No","100%",,"$4,500","$100","$1,600","$10","$100","$2,760","$0","$0","$1,300","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010002-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010002-03.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010002","HMO Silver 4500","86584WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010002-04","HMO Silver 3800 CSR 73","73% AV Level Silver Plan","73.97%","0.733715031277424","No","Yes","No","100%",,"$3,800","$100","$0","$10","$100","$2,760","$0","$0","$1,300","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010002-04.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010002-04.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010002","HMO Silver 4500","86584WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010002-05","HMO Silver 400 CSR 87","87% AV Level Silver Plan","87.73%","0.870210743619985","No","Yes","No","100%",,"$400","$100","$0","$10","$100","$1,300","$0","$0","$400","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010002-05.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010002-05.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010002","HMO Silver 4500","86584WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010002-06","HMO Silver 0 CSR 94","94% AV Level Silver Plan","94.84%","0.940668773656294","No","Yes","No","100%",,"$0","$100","$0","$10","$0","$500","$0","$0","$0","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010002-06.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010002-06.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010007","HMO Gold 2000","86584WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010007-00","HMO Gold 2000","Standard Gold Off Exchange Plan","80.04%","0.794652629844453","No","Yes","No","100%",,"$2,000","$100","$1,500","$10","$100","$2,220","$0","$0","$1,300","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010007-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010007-00.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010007","HMO Gold 2000","86584WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010007-01","HMO Gold 2000","Standard Gold On Exchange Plan","80.04%","0.794652629844453","No","Yes","No","100%",,"$2,000","$100","$1,500","$10","$100","$2,220","$0","$0","$1,300","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010007-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010007-01.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010007","HMO Gold 2000","86584WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010007-02","HMO Gold 0 CSR Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010007-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010007-02.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010007","HMO Gold 2000","86584WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010007-03","HMO Gold 2000 CSR Limited","Limited Cost Sharing Plan Variation","80.04%","0.794652629844453","No","Yes","No","100%",,"$2,000","$100","$1,500","$10","$100","$2,220","$0","$0","$1,300","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010007-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010007-03.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020001","POS Silver 7000","86584WI002",,"WIN001","WIS001","WIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020001-00","POS Silver 7000","Standard Silver Off Exchange Plan","69.74%","0.691690699571929","No","Yes","No","100%",,"$7,000","$0","$0","$10","$100","$2,760","$0","$0","$1,300","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020001-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020001-00.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020001","POS Silver 7000","86584WI002",,"WIN001","WIS001","WIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020001-01","POS Silver 7000","Standard Silver On Exchange Plan","69.74%","0.691690699571929","No","Yes","No","100%",,"$7,000","$0","$0","$10","$100","$2,760","$0","$0","$1,300","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020001-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020001-01.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020001","POS Silver 7000","86584WI002",,"WIN001","WIS001","WIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020001-02","POS Silver 0 CSR Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020001-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020001-02.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020001","POS Silver 7000","86584WI002",,"WIN001","WIS001","WIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020001-03","POS Silver 7000 CSR Limited","Limited Cost Sharing Plan Variation","69.74%","0.691690699571929","No","Yes","No","100%",,"$7,000","$0","$0","$10","$100","$2,760","$0","$0","$1,300","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020001-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020001-03.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020001","POS Silver 7000","86584WI002",,"WIN001","WIS001","WIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020001-04","POS Silver 3800 CSR 73","73% AV Level Silver Plan","73.97%","0.733715031277424","No","Yes","No","100%",,"$3,800","$100","$0","$10","$100","$2,760","$0","$0","$1,300","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020001-04.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020001-04.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020001","POS Silver 7000","86584WI002",,"WIN001","WIS001","WIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020001-05","POS Silver 400 CSR 87","87% AV Level Silver Plan","87.73%","0.870210743619985","No","Yes","No","100%",,"$400","$100","$0","$10","$100","$1,300","$0","$0","$400","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020001-05.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020001-05.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020001","POS Silver 7000","86584WI002",,"WIN001","WIS001","WIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020001-06","POS Silver 0 CSR 94","94% AV Level Silver Plan","94.84%","0.940668773656294","No","Yes","No","100%",,"$0","$100","$400","$10","$0","$500","$0","$0","$0","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020001-06.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020001-06.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020002","POS Silver 4500","86584WI002",,"WIN001","WIS001","WIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020002-00","POS Silver 4500","Standard Silver Off Exchange Plan","69.95%","0.693822936383651","No","Yes","No","100%",,"$4,500","$100","$1,600","$10","$100","$2,760","$0","$0","$1,300","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$19,000","$19000 per person","$38000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020002-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020002-00.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020002","POS Silver 4500","86584WI002",,"WIN001","WIS001","WIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020002-01","POS Silver 4500","Standard Silver On Exchange Plan","69.95%","0.693822936383651","No","Yes","No","100%",,"$4,500","$100","$1,600","$10","$100","$2,760","$0","$0","$1,300","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$19,000","$19000 per person","$38000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020002-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020002-01.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020002","POS Silver 4500","86584WI002",,"WIN001","WIS001","WIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020002-02","POS Silver 0 CSR Zero","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020002-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020002-02.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010009","HMO HDHP Bronze 6650","86584WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010009-03","HMO HDHP Bronze 6650 CSR Limited","Limited Cost Sharing Plan Variation",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$10","$6,650","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010009-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010009-03.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010003","HMO HDHP Bronze 5500","86584WI001",,"WIN001","WIS001","WIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010003-00","HMO HDHP Bronze 5500","Standard Bronze Off Exchange Plan",,"0.610411758285305","Yes","Yes","No","100%",,"$5,500","$0","$900","$10","$5,500","$0","$300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010003-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010003-00.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010003","HMO HDHP Bronze 5500","86584WI001",,"WIN001","WIS001","WIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010003-01","HMO HDHP Bronze 5500","Standard Bronze On Exchange Plan",,"0.610411758285305","Yes","Yes","No","100%",,"$5,500","$0","$900","$10","$5,500","$0","$300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010003-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010003-01.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010003","HMO HDHP Bronze 5500","86584WI001",,"WIN001","WIS001","WIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010003-02","HMO HDHP Bronze 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010003-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010003-02.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010003","HMO HDHP Bronze 5500","86584WI001",,"WIN001","WIS001","WIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010003-03","HMO HDHP Bronze 5500 CSR Limited","Limited Cost Sharing Plan Variation",,"0.610411758285305","Yes","Yes","No","100%",,"$5,500","$0","$900","$10","$5,500","$0","$300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010003-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010003-03.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010004","HMO HDHP Silver 2700","86584WI001",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010004-00","HMO HDHP Silver 2700","Standard Silver Off Exchange Plan",,"0.686089904738914","Yes","Yes","No","100%",,"$2,700","$0","$1,400","$10","$2,700","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010004-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010004-00.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020002","POS Silver 4500","86584WI002",,"WIN001","WIS001","WIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020002-03","POS Silver 4500 CSR Limited","Limited Cost Sharing Plan Variation","69.95%","0.693822936383651","No","Yes","No","100%",,"$4,500","$100","$1,600","$10","$100","$2,760","$0","$0","$1,300","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$19,000","$19000 per person","$38000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020002-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020002-03.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020002","POS Silver 4500","86584WI002",,"WIN001","WIS001","WIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020002-04","POS Silver 3800 CSR 73","73% AV Level Silver Plan","73.97%","0.733715031277424","No","Yes","No","100%",,"$3,800","$100","$0","$10","$100","$2,760","$0","$0","$1,300","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"$19,000","$19000 per person","$38000 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020002-04.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020002-04.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020002","POS Silver 4500","86584WI002",,"WIN001","WIS001","WIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020002-05","POS Silver 400 CSR 87","87% AV Level Silver Plan","87.73%","0.870210743619985","No","Yes","No","100%",,"$400","$100","$0","$10","$100","$1,300","$0","$0","$400","$550","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$19,000","$19000 per person","$38000 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020002-05.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020002-05.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020002","POS Silver 4500","86584WI002",,"WIN001","WIS001","WIF001","Existing","POS","Silver","Not Applicable","Yes","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020002-06","POS Silver 0 CSR 94","94% AV Level Silver Plan","94.84%","0.940668773656294","No","Yes","No","100%",,"$0","$100","$0","$10","$0","$500","$0","$0","$0","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$19,000","$19000 per person","$38000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020002-06.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020002-06.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010009","HMO HDHP Bronze 6650","86584WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010009-00","HMO HDHP Bronze 6650","Standard Bronze Off Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$10","$6,650","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010009-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010009-00.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010009","HMO HDHP Bronze 6650","86584WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010009-01","HMO HDHP Bronze 6650","Standard Bronze On Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$10","$6,650","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010009-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010009-01.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010009","HMO HDHP Bronze 6650","86584WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010009-02","HMO HDHP Bronze 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010009-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010009-02.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010004","HMO HDHP Silver 2700","86584WI001",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010004-01","HMO HDHP Silver 2700","Standard Silver On Exchange Plan",,"0.686089904738914","Yes","Yes","No","100%",,"$2,700","$0","$1,400","$10","$2,700","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010004-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010004-01.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010004","HMO HDHP Silver 2700","86584WI001",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010004-02","HMO HDHP Silver 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010004-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010004-02.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010004","HMO HDHP Silver 2700","86584WI001",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010004-03","HMO HDHP Silver 2700 CSR Limited","Limited Cost Sharing Plan Variation",,"0.686089904738914","Yes","Yes","No","100%",,"$2,700","$0","$1,400","$10","$2,700","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010004-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010004-03.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010004","HMO HDHP Silver 2700","86584WI001",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010004-04","HMO HDHP Silver 2000 CSR 73","73% AV Level Silver Plan",,"0.73995484508148","Yes","Yes","No","100%",,"$2,000","$0","$200","$10","$2,000","$0","$300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010004-04.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010004-04.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010004","HMO HDHP Silver 2700","86584WI001",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010004-05","HMO HDHP Silver 1250 CSR 87","87% AV Level Silver Plan",,"0.862986557484674","Yes","Yes","No","100%",,"$1,250","$0","$0","$10","$1,250","$0","$0","$0","$1,250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010004-05.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010004-05.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010004","HMO HDHP Silver 2700","86584WI001",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010004-06","HMO HDHP Silver 450 CSR 94","94% AV Level Silver Plan",,"0.943356891821955","Yes","Yes","No","100%",,"$450","$0","$0","$10","$450","$0","$0","$0","$450","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010004-06.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010004-06.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010010","HMO HDHP Silver 4000","86584WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010010-00","HMO HDHP Silver 4000","Standard Silver Off Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$10","$4,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010010-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010010-00.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010010","HMO HDHP Silver 4000","86584WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010010-01","HMO HDHP Silver 4000","Standard Silver On Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$10","$4,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010010-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010010-01.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010010","HMO HDHP Silver 4000","86584WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010010-02","HMO HDHP Silver 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010010-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010010-02.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010010","HMO HDHP Silver 4000","86584WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010010-03","HMO HDHP Silver 4000 CSR Limited","Limited Cost Sharing Plan Variation",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$10","$4,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010010-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010010-03.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010010","HMO HDHP Silver 4000","86584WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010010-04","HMO HDHP Silver 3250 CSR 73","73% AV Level Silver Plan",,"0.734355957399132","Yes","Yes","No","100%",,"$3,250","$0","$0","$10","$3,250","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010010-04.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010010-04.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010010","HMO HDHP Silver 4000","86584WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010010-05","HMO HDHP Silver 1250 CSR 87","87% AV Level Silver Plan",,"0.862986557484674","Yes","Yes","No","100%",,"$1,250","$0","$0","$10","$1,250","$0","$0","$0","$1,250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010010-05.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010010-05.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010010","HMO HDHP Silver 4000","86584WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010010-06","HMO HDHP Silver 450 CSR 94","94% AV Level Silver Plan",,"0.943356891821955","Yes","Yes","No","100%",,"$450","$0","$0","$10","$450","$0","$0","$0","$450","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010010-06.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010010-06.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010013","HMO HDHP Silver 5000","86584WI001",,"WIN001","WIS001","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010013-00","HMO HDHP Silver 5000","Standard Silver Off Exchange Plan",,"0.662934672262727","Yes","Yes","No","100%",,"$5,000","$0","$0","$10","$5,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010013-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010013-00.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010013","HMO HDHP Silver 5000","86584WI001",,"WIN001","WIS001","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010013-01","HMO HDHP Silver 5000","Standard Silver On Exchange Plan",,"0.662934672262727","Yes","Yes","No","100%",,"$5,000","$0","$0","$10","$5,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010013-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010013-01.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010013","HMO HDHP Silver 5000","86584WI001",,"WIN001","WIS001","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010013-02","HMO HDHP Silver 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010013-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010013-02.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010013","HMO HDHP Silver 5000","86584WI001",,"WIN001","WIS001","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010013-03","HMO HDHP Silver 5000 CSR Limited","Limited Cost Sharing Plan Variation",,"0.662934672262727","Yes","Yes","No","100%",,"$5,000","$0","$0","$10","$5,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010013-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010013-03.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010013","HMO HDHP Silver 5000","86584WI001",,"WIN001","WIS001","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010013-04","HMO HDHP Silver 3250 CSR 73","73% AV Level Silver Plan",,"0.734355957399132","Yes","Yes","No","100%",,"$3,250","$0","$0","$10","$3,250","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010013-04.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010013-04.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010013","HMO HDHP Silver 5000","86584WI001",,"WIN001","WIS001","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010013-05","HMO HDHP Silver 1250 CSR 87","87% AV Level Silver Plan",,"0.862986557484674","Yes","Yes","No","100%",,"$1,250","$0","$0","$10","$1,250","$0","$0","$0","$1,250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010013-05.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010013-05.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010013","HMO HDHP Silver 5000","86584WI001",,"WIN001","WIS001","WIF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010013-06","HMO HDHP Silver 450 CSR 94","94% AV Level Silver Plan",,"0.943356891821955","Yes","Yes","No","100%",,"$450","$0","$0","$10","$450","$0","$0","$0","$450","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010013-06.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010013-06.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020003","POS HDHP Bronze 5500","86584WI002",,"WIN001","WIS001","WIF006","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020003-00","POS HDHP Bronze 5500","Standard Bronze Off Exchange Plan",,"0.610411758285305","Yes","Yes","No","100%",,"$5,500","$0","$900","$10","$5,500","$0","$300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020003-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020003-00.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020003","POS HDHP Bronze 5500","86584WI002",,"WIN001","WIS001","WIF006","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020003-01","POS HDHP Bronze 5500","Standard Bronze On Exchange Plan",,"0.610411758285305","Yes","Yes","No","100%",,"$5,500","$0","$900","$10","$5,500","$0","$300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020003-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020003-01.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020003","POS HDHP Bronze 5500","86584WI002",,"WIN001","WIS001","WIF006","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020003-02","POS HDHP Bronze 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020003-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020003-02.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020004","POS HDHP Silver 2700","86584WI002",,"WIN001","WIS001","WIF006","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020004-06","POS HDHP Silver 450 CSR 94","94% AV Level Silver Plan",,"0.943356891821955","Yes","Yes","No","100%",,"$450","$0","$0","$10","$450","$0","$0","$0","$450","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020004-06.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020004-06.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020003","POS HDHP Bronze 5500","86584WI002",,"WIN001","WIS001","WIF006","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020003-03","POS HDHP Bronze 5500 CSR Limited","Limited Cost Sharing Plan Variation",,"0.610411758285305","Yes","Yes","No","100%",,"$5,500","$0","$900","$10","$5,500","$0","$300","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020003-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020003-03.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020004","POS HDHP Silver 2700","86584WI002",,"WIN001","WIS001","WIF006","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020004-00","POS HDHP Silver 2700","Standard Silver Off Exchange Plan",,"0.686089904738914","Yes","Yes","No","100%",,"$2,700","$0","$1,400","$10","$2,700","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020004-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020004-00.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020004","POS HDHP Silver 2700","86584WI002",,"WIN001","WIS001","WIF006","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020004-01","POS HDHP Silver 2700","Standard Silver On Exchange Plan",,"0.686089904738914","Yes","Yes","No","100%",,"$2,700","$0","$1,400","$10","$2,700","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020004-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020004-01.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020004","POS HDHP Silver 2700","86584WI002",,"WIN001","WIS001","WIF006","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020004-02","POS HDHP Silver 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020004-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020004-02.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020004","POS HDHP Silver 2700","86584WI002",,"WIN001","WIS001","WIF006","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020004-03","POS HDHP Silver 2700 CSR Limited","Limited Cost Sharing Plan Variation",,"0.686089904738914","Yes","Yes","No","100%",,"$2,700","$0","$1,400","$10","$2,700","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020004-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020004-03.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020004","POS HDHP Silver 2700","86584WI002",,"WIN001","WIS001","WIF006","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020004-04","POS HDHP Silver 2000 CSR 73","73% AV Level Silver Plan",,"0.73995484508148","Yes","Yes","No","100%",,"$2,000","$0","$1,600","$10","$2,000","$0","$1,000","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020004-04.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020004-04.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0020004","POS HDHP Silver 2700","86584WI002",,"WIN001","WIS001","WIF006","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","Tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0020004-05","POS HDHP Silver 1250 CSR 87","87% AV Level Silver Plan",,"0.862986557484674","Yes","Yes","No","100%",,"$1,250","$0","$0","$10","$1,250","$0","$0","$0","$1,250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0020004-05.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0020004-05.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010008","HMO Catastrophic 7350","86584WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010008-00","HMO Catastrophic 7350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$7,100","$0","$0","$0","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010008-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010008-00.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010008","HMO Catastrophic 7350","86584WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010008-01","HMO Catastrophic 7350","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$7,100","$0","$0","$0","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010008-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010008-01.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010011","Simple Choice HMO Bronze 6650","86584WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010011-00","Simple Choice HMO Bronze 6650","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,550","$200","$600","$10","$100","$2,140","$0","$0","$1,500","$290","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010011-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010011-00.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010011","Simple Choice HMO Bronze 6650","86584WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010011-01","Simple Choice HMO Bronze 6650","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,550","$200","$600","$10","$100","$2,140","$0","$0","$1,500","$290","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010011-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010011-01.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010011","Simple Choice HMO Bronze 6650","86584WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010011-02","Simple Choice HMO Bronze 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010011-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010011-02.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010011","Simple Choice HMO Bronze 6650","86584WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010011-03","Simple Choice HMO Bronze 6650 CSR Limited","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,550","$200","$600","$10","$100","$2,140","$0","$0","$1,500","$290","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010011-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010011-03.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010014","Simple Choice HMO HDHP Bronze 6000","86584WI001",,"WIN001","WIS001","WIF005","New","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010014-00","Simple Choice HMO HDHP Bronze 6000","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010014-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010014-00.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010014","Simple Choice HMO HDHP Bronze 6000","86584WI001",,"WIN001","WIS001","WIF005","New","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010014-01","Simple Choice HMO HDHP Bronze 6000","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010014-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010014-01.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010014","Simple Choice HMO HDHP Bronze 6000","86584WI001",,"WIN001","WIS001","WIF005","New","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010014-02","Simple Choice HMO HDHP Bronze 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010014-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010014-02.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010014","Simple Choice HMO HDHP Bronze 6000","86584WI001",,"WIN001","WIS001","WIF005","New","HMO","Expanded Bronze","Design 2","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010014-03","Simple Choice HMO HDHP Bronze 6000 CSR Limited","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$6,000","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010014-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010014-03.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010012","Simple Choice HMO Silver 3500","86584WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010012-00","Simple Choice HMO Silver 3500","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$1,200","$10","$100","$2,490","$0","$0","$1,500","$250","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010012-00.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010012-00.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010012","Simple Choice HMO Silver 3500","86584WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010012-01","Simple Choice HMO Silver 3500","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$1,200","$10","$100","$2,490","$0","$0","$1,500","$250","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010012-01.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010012-01.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010012","Simple Choice HMO Silver 3500","86584WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010012-02","Simple Choice HMO Silver 0 CSR Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010012-02.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010012-02.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010012","Simple Choice HMO Silver 3500","86584WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010012-03","Simple Choice HMO Silver 3500 CSR Limited","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$1,200","$10","$100","$2,490","$0","$0","$1,500","$250","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010012-03.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010012-03.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010012","Simple Choice HMO Silver 3500","86584WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010012-04","Simple Choice HMO Silver 3000 CSR 73","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$100","$1,300","$10","$100","$2,440","$0","$0","$1,500","$250","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010012-04.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010012-04.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010012","Simple Choice HMO Silver 3500","86584WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010012-05","Simple Choice HMO Silver 700 CSR 87","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,700","$10","$100","$1,270","$0","$0","$700","$90","$370","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010012-05.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010012-05.pdf"
"2018","WI","86584","HIOS","2017-08-05 02:21:19","Individual","No","36-4832569","86584WI0010012","Simple Choice HMO Silver 3500","86584WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Non-participating specialists and tertiary care specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,"2018-01-01","2018-12-31","No","Limited to emergency care only","No","Limited to emergency care only","No","https://pay.aspirusarise.com","https://www.aspirusarise.com/wps/portal/whi/aspirus-arise/resources/drug-formulary/","86584WI0010012-06","Simple Choice HMO Silver 250 CSR 94","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$0","$500","$10","$100","$450","$0","$0","$250","$40","$150","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.AspirusArise.com/files/AspirusArise/sbc/2018/86584WI0010012-06.pdf","https://www.AspirusArise.com/files/AspirusArise/brochure/2018/86584WI0010012-06.pdf"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030020","Envision Aurora Bellin - Gold 2000/80","87416WI003",,"WIN002","WIS001","WIF009","New","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030020-00","Envision Aurora Bellin - Gold 2000/80","Standard Gold Off Exchange Plan",,"0.76012735245907","Yes","Yes","No","100%",,"$2,000","$120","$2,480","$60","$2,000","$2,050","$372","$55","$1,305","$180","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Gold2000-80.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Gold2000-80"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020015","Envision Aurora Bellin PPO - Gold 600/80","87416WI002",,"WIN002","WIS001","WIF012","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020015-00","Envision Aurora Bellin PPO - Gold 600/80","Standard Gold Off Exchange Plan",,"0.810289260738324","Yes","Yes","No","100%",,"$600","$110","$2,480","$60","$600","$1,685","$372","$55","$600","$180","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20.00%",,,,,"$1,200","$1200 per person","$2400 per group","$1,800","$1800 per person","$3600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Gold600-80Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Gold600-80Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020015","Envision Aurora Bellin PPO - Gold 600/80","87416WI002",,"WIN002","WIS001","WIF012","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020015-01","Envision Aurora Bellin PPO - Gold 600/80","Standard Gold On Exchange Plan",,"0.810289260738324","Yes","Yes","No","100%",,"$600","$110","$2,480","$60","$600","$1,685","$372","$55","$600","$180","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20.00%",,,,,"$1,200","$1200 per person","$2400 per group","$1,800","$1800 per person","$3600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Gold600-80Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Gold600-80Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030020","Envision Aurora Bellin - Gold 2000/80","87416WI003",,"WIN002","WIS001","WIF009","New","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030020-01","Envision Aurora Bellin - Gold 2000/80","Standard Gold On Exchange Plan",,"0.76012735245907","Yes","Yes","No","100%",,"$2,000","$120","$2,480","$60","$2,000","$2,050","$372","$55","$1,305","$180","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Gold2000-80.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Gold2000-80"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030020","Envision Aurora Bellin - Gold 2000/80","87416WI003",,"WIN002","WIS001","WIF009","New","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030020-02","Envision Aurora Bellin - Gold 2000/80 NCS","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Gold2000-80NCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Gold2000-80NCS"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020016","Envision Aurora Bellin PPO - Gold 1000/80","87416WI002",,"WIN002","WIS001","WIF012","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020016-00","Envision Aurora Bellin PPO - Gold 1000/80","Standard Gold Off Exchange Plan",,"0.793916349177203","Yes","Yes","No","100%",,"$1,000","$110","$2,480","$60","$1,000","$1,685","$372","$55","$1,000","$180","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Gold1000-80Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Gold1000-80Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020016","Envision Aurora Bellin PPO - Gold 1000/80","87416WI002",,"WIN002","WIS001","WIF012","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020016-01","Envision Aurora Bellin PPO - Gold 1000/80","Standard Gold On Exchange Plan",,"0.793916349177203","Yes","Yes","No","100%",,"$1,000","$110","$2,480","$60","$1,000","$1,685","$372","$55","$1,000","$180","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Gold1000-80Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Gold1000-80Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030020","Envision Aurora Bellin - Gold 2000/80","87416WI003",,"WIN002","WIS001","WIF009","New","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030020-03","Envision Aurora Bellin - Gold 2000/80 LCS","Limited Cost Sharing Plan Variation",,"0.76012735245907","Yes","Yes","No","100%",,"$2,000","$120","$2,480","$60","$2,000","$2,050","$372","$55","$1,305","$180","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Gold2000-80LCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Gold2000-80LCS"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030021","Envision Aurora Bellin - Silver 4000/75","87416WI003",,"WIN002","WIS001","WIF008","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030021-00","Envision Aurora Bellin - Silver 4000/75","Standard Silver Off Exchange Plan",,"0.664831422039107","Yes","Yes","No","100%",,"$4,000","$180","$2,480","$60","$4,000","$1,180","$1,089","$55","$1,305","$240","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver4000-75.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver4000-75"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020053","Envision Aurora Bellin PPO - Silver 3600/80","87416WI002",,"WIN002","WIS001","WIF006","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020053-00","Envision Aurora Bellin PPO - Silver 3600/80","Standard Silver Off Exchange Plan",,"0.71569069903842","Yes","Yes","No","100%",,"$3,600","$180","$2,480","$60","$1,489","$2,230","$372","$55","$1,305","$240","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","20.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver3600-80Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver3600-80Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020053","Envision Aurora Bellin PPO - Silver 3600/80","87416WI002",,"WIN002","WIS001","WIF006","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020053-01","Envision Aurora Bellin PPO - Silver 3600/80","Standard Silver On Exchange Plan",,"0.71569069903842","Yes","Yes","No","100%",,"$3,600","$180","$2,480","$60","$1,489","$2,230","$372","$55","$1,305","$240","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","20.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver3600-80Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver3600-80Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030021","Envision Aurora Bellin - Silver 4000/75","87416WI003",,"WIN002","WIS001","WIF008","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030021-01","Envision Aurora Bellin - Silver 4000/75","Standard Silver On Exchange Plan",,"0.664831422039107","Yes","Yes","No","100%",,"$4,000","$180","$2,480","$60","$4,000","$1,180","$1,089","$55","$1,305","$240","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver4000-75.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver4000-75"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030021","Envision Aurora Bellin - Silver 4000/75","87416WI003",,"WIN002","WIS001","WIF008","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030021-02","Envision Aurora Bellin - Silver 4000/75 NCS","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver4000-75NCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver4000-75NCS"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020017","Envision Aurora Bellin PPO - Silver 3000/80/Copay35","87416WI002",,"WIN002","WIS001","WIF007","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020017-00","Envision Aurora Bellin PPO - Silver 3000/80/Copay35","Standard Silver Off Exchange Plan",,"0.716168369653782","Yes","Yes","No","100%",,"$3,000","$170","$2,480","$60","$3,000","$1,205","$1,089","$55","$1,305","$225","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver3000-80-Copay35Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver3000-80-Copay35Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020017","Envision Aurora Bellin PPO - Silver 3000/80/Copay35","87416WI002",,"WIN002","WIS001","WIF007","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020017-01","Envision Aurora Bellin PPO - Silver 3000/80/Copay35","Standard Silver On Exchange Plan",,"0.716168369653782","Yes","Yes","No","100%",,"$3,000","$170","$2,480","$60","$3,000","$1,205","$1,089","$55","$1,305","$225","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver3000-80-Copay35Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver3000-80-Copay35Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030021","Envision Aurora Bellin - Silver 4000/75","87416WI003",,"WIN002","WIS001","WIF008","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030021-03","Envision Aurora Bellin - Silver 4000/75 LCS","Limited Cost Sharing Plan Variation",,"0.664831422039107","Yes","Yes","No","100%",,"$4,000","$180","$2,480","$60","$4,000","$1,180","$1,089","$55","$1,305","$240","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver4000-75LCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver4000-75LCS"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030021","Envision Aurora Bellin - Silver 4000/75","87416WI003",,"WIN002","WIS001","WIF008","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030021-04","Envision Aurora Bellin - Silver 2850 CSR","73% AV Level Silver Plan",,"0.736438458875153","Yes","Yes","No","100%",,"$2,850","$110","$2,480","$60","$2,850","$730","$1,089","$55","$1,305","$210","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver2850CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver2850CSR"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020008","Empower PPO - Gold 600/80","87416WI002",,"WIN001","WIS001","WIF012","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020008-00","Empower PPO - Gold 600/80","Standard Gold Off Exchange Plan",,"0.810289260738324","Yes","Yes","No","100%",,"$600","$110","$2,480","$60","$600","$1,685","$372","$55","$600","$180","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20.00%",,,,,"$1,200","$1200 per person","$2400 per group","$1,800","$1800 per person","$3600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Gold600-80Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Gold600-80Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020008","Empower PPO - Gold 600/80","87416WI002",,"WIN001","WIS001","WIF012","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020008-01","Empower PPO - Gold 600/80","Standard Gold On Exchange Plan",,"0.810289260738324","Yes","Yes","No","100%",,"$600","$110","$2,480","$60","$600","$1,685","$372","$55","$600","$180","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20.00%",,,,,"$1,200","$1200 per person","$2400 per group","$1,800","$1800 per person","$3600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Gold600-80Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Gold600-80Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030021","Envision Aurora Bellin - Silver 4000/75","87416WI003",,"WIN002","WIS001","WIF008","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030021-05","Envision Aurora Bellin - Silver 150 CSR","87% AV Level Silver Plan",,"0.872601311802599","Yes","Yes","No","100%",,"$150","$0","$2,300","$60","$150","$610","$1,089","$55","$150","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver150CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver150CSR"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030021","Envision Aurora Bellin - Silver 4000/75","87416WI003",,"WIN002","WIS001","WIF008","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030021-06","Envision Aurora Bellin - Silver 50/0 PCP CSR","94% AV Level Silver Plan",,"0.946406872358336","Yes","Yes","No","100%",,"$50","$0","$950","$60","$50","$40","$910","$55","$50","$60","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver50-0PCPCSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver50-0PCPCSR"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020009","Empower PPO - Gold 1000/80","87416WI002",,"WIN001","WIS001","WIF012","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020009-00","Empower PPO - Gold 1000/80","Standard Gold Off Exchange Plan",,"0.793916349177203","Yes","Yes","No","100%",,"$1,000","$110","$2,480","$60","$1,000","$1,685","$372","$55","$1,000","$180","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Gold1000-80Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Gold1000-80Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020009","Empower PPO - Gold 1000/80","87416WI002",,"WIN001","WIS001","WIF012","Existing","PPO","Gold","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020009-01","Empower PPO - Gold 1000/80","Standard Gold On Exchange Plan",,"0.793916349177203","Yes","Yes","No","100%",,"$1,000","$110","$2,480","$60","$1,000","$1,685","$372","$55","$1,000","$180","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Gold1000-80Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Gold1000-80Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030022","Envision Aurora Bellin - Silver 3000/75/Copay40","87416WI003",,"WIN002","WIS001","WIF005","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030022-00","Envision Aurora Bellin - Silver 3000/75/Copay40","Standard Silver Off Exchange Plan",,"0.682196193054658","Yes","Yes","No","100%",,"$3,000","$180","$2,480","$60","$3,000","$1,255","$1,089","$55","$1,305","$240","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver3000-75-Copay40.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver3000-75-Copay40"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030022","Envision Aurora Bellin - Silver 3000/75/Copay40","87416WI003",,"WIN002","WIS001","WIF005","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030022-01","Envision Aurora Bellin - Silver 3000/75/Copay40","Standard Silver On Exchange Plan",,"0.682196193054658","Yes","Yes","No","100%",,"$3,000","$180","$2,480","$60","$3,000","$1,255","$1,089","$55","$1,305","$240","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver3000-75-Copay40.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver3000-75-Copay40"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020033","Empower PPO - Silver 3600/80","87416WI002",,"WIN001","WIS001","WIF006","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020033-00","Empower PPO - Silver 3600/80","Standard Silver Off Exchange Plan",,"0.71569069903842","Yes","Yes","No","100%",,"$3,600","$180","$2,480","$60","$1,489","$2,230","$372","$55","$1,305","$240","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","20.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver3600-80Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver3600-80Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020033","Empower PPO - Silver 3600/80","87416WI002",,"WIN001","WIS001","WIF006","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020033-01","Empower PPO - Silver 3600/80","Standard Silver On Exchange Plan",,"0.71569069903842","Yes","Yes","No","100%",,"$3,600","$180","$2,480","$60","$1,489","$2,230","$372","$55","$1,305","$240","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","20.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver3600-80Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver3600-80Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030022","Envision Aurora Bellin - Silver 3000/75/Copay40","87416WI003",,"WIN002","WIS001","WIF005","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030022-02","Envision Aurora Bellin - Silver 3000/75/Copay40 NCS","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver3000-75-Copay40NCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver3000-75-Copay40NCS"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030022","Envision Aurora Bellin - Silver 3000/75/Copay40","87416WI003",,"WIN002","WIS001","WIF005","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030022-03","Envision Aurora Bellin - Silver 3000/75/Copay40 LCS","Limited Cost Sharing Plan Variation",,"0.682196193054658","Yes","Yes","No","100%",,"$3,000","$180","$2,480","$60","$3,000","$1,255","$1,089","$55","$1,305","$240","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver3000-75-Copay40LCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver3000-75-Copay40LCS"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020010","Empower PPO - Silver 3000/80/Copay35","87416WI002",,"WIN001","WIS001","WIF007","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020010-00","Empower PPO - Silver 3000/80/Copay35","Standard Silver Off Exchange Plan",,"0.716168369653782","Yes","Yes","No","100%",,"$3,000","$170","$2,480","$60","$3,000","$1,205","$1,089","$55","$1,305","$225","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver3000-80-Copay35Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver3000-80-Copay35Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020010","Empower PPO - Silver 3000/80/Copay35","87416WI002",,"WIN001","WIS001","WIF007","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020010-01","Empower PPO - Silver 3000/80/Copay35","Standard Silver On Exchange Plan",,"0.716168369653782","Yes","Yes","No","100%",,"$3,000","$170","$2,480","$60","$3,000","$1,205","$1,089","$55","$1,305","$225","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver3000-80-Copay35Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver3000-80-Copay35Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030022","Envision Aurora Bellin - Silver 3000/75/Copay40","87416WI003",,"WIN002","WIS001","WIF005","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030022-04","Envision Aurora Bellin - Silver 2750 CSR","73% AV Level Silver Plan",,"0.73835858607972","Yes","Yes","No","100%",,"$2,750","$110","$2,480","$60","$2,750","$730","$1,089","$55","$1,305","$210","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver2750CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver2750CSR"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030022","Envision Aurora Bellin - Silver 3000/75/Copay40","87416WI003",,"WIN002","WIS001","WIF005","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030022-05","Envision Aurora Bellin - Silver 100 CSR","87% AV Level Silver Plan",,"0.874694597134391","Yes","Yes","No","100%",,"$100","$0","$2,350","$60","$100","$610","$1,089","$55","$100","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver100CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver100CSR"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030022","Envision Aurora Bellin - Silver 3000/75/Copay40","87416WI003",,"WIN002","WIS001","WIF005","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030022-06","Envision Aurora Bellin - Silver 25 CSR","94% AV Level Silver Plan",,"0.947925551570429","Yes","Yes","No","100%",,"$25","$0","$975","$60","$25","$40","$935","$55","$25","$60","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$50 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver25CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver25CSR"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030047","Envision Aurora Bellin - Silver 5500/80","87416WI003",,"WIN002","WIS001","WIF010","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030047-00","Envision Aurora Bellin - Silver 5500/80","Standard Silver Off Exchange Plan","66.07%","0.66065760930932","No","Yes","No","100%",,"$4,870","$0","$2,480","$60","$4,355","$990","$1,089","$55","$1,305","$300","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver5500-80.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver5500-80"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030047","Envision Aurora Bellin - Silver 5500/80","87416WI003",,"WIN002","WIS001","WIF010","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030047-01","Envision Aurora Bellin - Silver 5500/80","Standard Silver On Exchange Plan","66.07%","0.66065760930932","No","Yes","No","100%",,"$4,870","$0","$2,480","$60","$4,355","$990","$1,089","$55","$1,305","$300","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver5500-80.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver5500-80"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030047","Envision Aurora Bellin - Silver 5500/80","87416WI003",,"WIN002","WIS001","WIF010","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030047-02","Envision Aurora Bellin - Silver 5500/80 NCS","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver5500-80NCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver5500-80NCS"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030047","Envision Aurora Bellin - Silver 5500/80","87416WI003",,"WIN002","WIS001","WIF010","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030047-03","Envision Aurora Bellin - Silver 5500/80 LCS","Limited Cost Sharing Plan Variation","66.07%","0.66065760930932","No","Yes","No","100%",,"$4,870","$0","$2,480","$60","$4,355","$990","$1,089","$55","$1,305","$300","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver5500-80LCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver5500-80LCS"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030047","Envision Aurora Bellin - Silver 5500/80","87416WI003",,"WIN002","WIS001","WIF010","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030047-04","Envision Aurora Bellin - Silver 2700 CSR","73% AV Level Silver Plan","73.94%","0.751455938185672","No","Yes","No","100%",,"$2,700","$110","$2,480","$60","$2,700","$730","$1,089","$55","$1,305","$210","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver2700CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver2700CSR"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030047","Envision Aurora Bellin - Silver 5500/80","87416WI003",,"WIN002","WIS001","WIF010","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030047-05","Envision Aurora Bellin - Silver 50/25 PCP CSR","87% AV Level Silver Plan","87.73%","0.87843690691713","No","Yes","No","100%",,"$50","$0","$2,400","$60","$50","$610","$1,089","$55","$50","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver50-25PCPCSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver50-25PCPCSR"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030047","Envision Aurora Bellin - Silver 5500/80","87416WI003",,"WIN002","WIS001","WIF010","New","EPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030047-06","Envision Aurora Bellin - Silver 0 CSR","94% AV Level Silver Plan","94.97%","0.949706713176759","No","Yes","No","100%",,"$0","$0","$1,000","$60","$0","$40","$960","$55","$0","$60","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver0CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver0CSR"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030030","Envision Aurora Bellin - HSA Silver 3200/75","87416WI003",,"WIN002","WIS001","WIF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030030-00","Envision Aurora Bellin - HSA Silver 3200/75","Standard Silver Off Exchange Plan",,"0.662622042058757","Yes","Yes","No","100%",,"$3,200","$0","$2,527","$60","$3,200","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSASilver3200-75.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSASilver3200-75"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020035","Envision Aurora Bellin PPO - HSA Silver 3600/100","87416WI002",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020035-00","Envision Aurora Bellin PPO - HSA Silver 3600/100","Standard Silver Off Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,600","$0","$0","$60","$3,600","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$14,400","$14400 per person","$28800 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSASilver3600-100Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSASilver3600-100Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020035","Envision Aurora Bellin PPO - HSA Silver 3600/100","87416WI002",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020035-01","Envision Aurora Bellin PPO - HSA Silver 3600/100","Standard Silver On Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,600","$0","$0","$60","$3,600","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$14,400","$14400 per person","$28800 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSASilver3600-100Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSASilver3600-100Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030030","Envision Aurora Bellin - HSA Silver 3200/75","87416WI003",,"WIN002","WIS001","WIF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030030-01","Envision Aurora Bellin - HSA Silver 3200/75","Standard Silver On Exchange Plan",,"0.662622042058757","Yes","Yes","No","100%",,"$3,200","$0","$2,527","$60","$3,200","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSASilver3200-75.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSASilver3200-75"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030030","Envision Aurora Bellin - HSA Silver 3200/75","87416WI003",,"WIN002","WIS001","WIF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030030-02","Envision Aurora Bellin - Silver 3200/75 NCS","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSASilver3200-75NCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSASilver3200-75NCS"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020018","Envision Aurora Bellin PPO - Silver 2600/80","87416WI002",,"WIN002","WIS001","WIF011","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020018-00","Envision Aurora Bellin PPO - Silver 2600/80","Standard Silver Off Exchange Plan",,"0.699240521070574","Yes","Yes","No","100%",,"$2,600","$40","$2,520","$60","$2,600","$310","$1,302","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$5,200","$5200 per person","$10400 per group","$7,800","$7800 per person","$15600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver2600-80Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver2600-80Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020018","Envision Aurora Bellin PPO - Silver 2600/80","87416WI002",,"WIN002","WIS001","WIF011","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020018-01","Envision Aurora Bellin PPO - Silver 2600/80","Standard Silver On Exchange Plan",,"0.699240521070574","Yes","Yes","No","100%",,"$2,600","$40","$2,520","$60","$2,600","$310","$1,302","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$5,200","$5200 per person","$10400 per group","$7,800","$7800 per person","$15600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver2600-80Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver2600-80Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030030","Envision Aurora Bellin - HSA Silver 3200/75","87416WI003",,"WIN002","WIS001","WIF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030030-03","Envision Aurora Bellin - HSA Silver 3200/75 LCS","Limited Cost Sharing Plan Variation",,"0.662622042058757","Yes","Yes","No","100%",,"$3,200","$0","$2,527","$60","$3,200","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSASilver3200-75LCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSASilver3200-75LCS"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030030","Envision Aurora Bellin - HSA Silver 3200/75","87416WI003",,"WIN002","WIS001","WIF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030030-04","Envision Aurora Bellin - Silver 2000 CSR","73% AV Level Silver Plan",,"0.721397214492182","Yes","Yes","No","100%",,"$2,000","$0","$2,527","$60","$2,000","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver2000CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSASilver2000CSR"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020019","Envision Aurora Bellin PPO - Silver 2000/80","87416WI002",,"WIN002","WIS001","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020019-00","Envision Aurora Bellin PPO - Silver 2000/80","Standard Silver Off Exchange Plan",,"0.716562170301212","Yes","Yes","No","100%",,"$2,000","$0","$2,527","$60","$2,000","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,200","$19200 per person","$38400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver2000-80Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver2000-80Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020019","Envision Aurora Bellin PPO - Silver 2000/80","87416WI002",,"WIN002","WIS001","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020019-01","Envision Aurora Bellin PPO - Silver 2000/80","Standard Silver On Exchange Plan",,"0.716562170301212","Yes","Yes","No","100%",,"$2,000","$0","$2,527","$60","$2,000","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,200","$19200 per person","$38400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver2000-80Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver2000-80Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030030","Envision Aurora Bellin - HSA Silver 3200/75","87416WI003",,"WIN002","WIS001","WIF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030030-05","Envision Aurora Bellin - Silver 200 CSR","87% AV Level Silver Plan",,"0.879122580820258","Yes","Yes","No","100%",,"$200","$0","$2,250","$60","$200","$0","$1,437","$55","$200","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver200CSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSASilver200CSR"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030030","Envision Aurora Bellin - HSA Silver 3200/75","87416WI003",,"WIN002","WIS001","WIF004","New","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030030-06","Envision Aurora Bellin - Silver 50 HSA CSR","94% AV Level Silver Plan",,"0.930885507251954","Yes","Yes","No","100%",,"$50","$0","$950","$60","$50","$0","$950","$55","$50","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver50HSACSR.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSASilver50CSR"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020051","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI002",,"WIN002","WIS001","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020051-00","Envision Aurora Bellin PPO - HSA Silver 3000/80","Standard Silver Off Exchange Plan",,"0.703454114021115","Yes","Yes","No","100%",,"$2,752","$0","$1,748","$60","$3,000","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSASilver3000-80Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSASilver3000-80Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020051","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI002",,"WIN002","WIS001","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020051-01","Envision Aurora Bellin PPO - HSA Silver 3000/80","Standard Silver On Exchange Plan",,"0.703454114021115","Yes","Yes","No","100%",,"$2,752","$0","$1,748","$60","$3,000","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSASilver3000-80Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSASilver3000-80Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030031","Envision Aurora Bellin - HSA Bronze 6650/100","87416WI003",,"WIN002","WIS002","WIF001","New","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030031-00","Envision Aurora Bellin - HSA Bronze 6650/100","Standard Bronze Off Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSABronze6650-100.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSABronze6650-100"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030031","Envision Aurora Bellin - HSA Bronze 6650/100","87416WI003",,"WIN002","WIS002","WIF001","New","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030031-01","Envision Aurora Bellin - HSA Bronze 6650/100","Standard Bronze On Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSABronze6650-100.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSABronze6650-100"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020052","Envision Aurora Bellin PPO - HSA Bronze 5800/90","87416WI002",,"WIN002","WIS001","WIF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020052-00","Envision Aurora Bellin PPO - HSA Bronze 5800/90","Standard Bronze Off Exchange Plan",,"0.611728272568227","Yes","Yes","No","100%",,"$5,260","$0","$1,240","$60","$5,800","$0","$700","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","10.00%",,,,,"$11,600","$11600 per person","$23200 per group","$17,400","$17400 per person","$34800 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSABronze5800-90Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSABronze5800-90Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020052","Envision Aurora Bellin PPO - HSA Bronze 5800/90","87416WI002",,"WIN002","WIS001","WIF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020052-01","Envision Aurora Bellin PPO - HSA Bronze 5800/90","Standard Bronze On Exchange Plan",,"0.611728272568227","Yes","Yes","No","100%",,"$5,260","$0","$1,240","$60","$5,800","$0","$700","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","10.00%",,,,,"$11,600","$11600 per person","$23200 per group","$17,400","$17400 per person","$34800 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSABronze5800-90Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSABronze5800-90Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030031","Envision Aurora Bellin - HSA Bronze 6650/100","87416WI003",,"WIN002","WIS002","WIF001","New","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030031-02","Envision Aurora Bellin - HSA Bronze 6650/100 NCS","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSABronze6650-100NCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSABronze6650-100NCS"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030031","Envision Aurora Bellin - HSA Bronze 6650/100","87416WI003",,"WIN002","WIS002","WIF001","New","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030031-03","Envision Aurora Bellin - HSA Bronze 6650/100 LCS","Limited Cost Sharing Plan Variation",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSABronze6650-100LCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSABronze6650-100LCS"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020036","Envision Aurora Bellin PPO - HSA Bronze 6400/100","87416WI002",,"WIN002","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020036-00","Envision Aurora Bellin PPO - HSA Bronze 6400/100","Standard Bronze Off Exchange Plan",,"0.608957768456605","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$25,600","$25600 per person","$51200 per group","$32,000","$32000 per person","$64000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"$12,800","$12800 per person","$25600 per group","$19,200","$19200 per person","$38400 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSABronze6400-100Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSABronze6400-100Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020032","Empower PPO - HSA Bronze 5800/90","87416WI002",,"WIN001","WIS001","WIF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020032-00","Empower PPO - HSA Bronze 5800/90","Standard Bronze Off Exchange Plan",,"0.611728272568227","Yes","Yes","No","100%",,"$5,260","$0","$1,240","$60","$5,800","$0","$700","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","10.00%",,,,,"$11,600","$11600 per person","$23200 per group","$17,400","$17400 per person","$34800 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSABronze5800-90Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSABronze5800-90Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020036","Envision Aurora Bellin PPO - HSA Bronze 6400/100","87416WI002",,"WIN002","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020036-01","Envision Aurora Bellin PPO - HSA Bronze 6400/100","Standard Bronze On Exchange Plan",,"0.608957768456605","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$25,600","$25600 per person","$51200 per group","$32,000","$32000 per person","$64000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"$12,800","$12800 per person","$25600 per group","$19,200","$19200 per person","$38400 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSABronze6400-100Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSABronze6400-100Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020038","Empower PPO - HSA Silver 3600/100","87416WI002",,"WIN001","WIS001","WIF001","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020038-00","Empower PPO - HSA Silver 3600/100","Standard Silver Off Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,600","$0","$0","$60","$3,600","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$14,400","$14400 per person","$28800 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSASilver3600-100Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSASilver3600-100Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020038","Empower PPO - HSA Silver 3600/100","87416WI002",,"WIN001","WIS001","WIF001","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020038-01","Empower PPO - HSA Silver 3600/100","Standard Silver On Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,600","$0","$0","$60","$3,600","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$14,400","$14400 per person","$28800 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSASilver3600-100Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSASilver3600-100Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020011","Empower PPO - Silver 2600/80","87416WI002",,"WIN001","WIS001","WIF011","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020011-00","Empower PPO - Silver 2600/80","Standard Silver Off Exchange Plan",,"0.699240521070574","Yes","Yes","No","100%",,"$2,600","$40","$2,520","$60","$2,600","$310","$1,302","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$5,200","$5200 per person","$10400 per group","$7,800","$7800 per person","$15600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver2600-80Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver2600-80Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020011","Empower PPO - Silver 2600/80","87416WI002",,"WIN001","WIS001","WIF011","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020011-01","Empower PPO - Silver 2600/80","Standard Silver On Exchange Plan",,"0.699240521070574","Yes","Yes","No","100%",,"$2,600","$40","$2,520","$60","$2,600","$310","$1,302","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$5,200","$5200 per person","$10400 per group","$7,800","$7800 per person","$15600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver2600-80Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver2600-80Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020012","Empower PPO - Silver 2000/80","87416WI002",,"WIN001","WIS001","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020012-00","Empower PPO - Silver 2000/80","Standard Silver Off Exchange Plan",,"0.716562170301212","Yes","Yes","No","100%",,"$2,000","$0","$2,527","$60","$2,000","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,200","$19200 per person","$38400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver2000-80Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver2000-80Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020012","Empower PPO - Silver 2000/80","87416WI002",,"WIN001","WIS001","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020012-01","Empower PPO - Silver 2000/80","Standard Silver On Exchange Plan",,"0.716562170301212","Yes","Yes","No","100%",,"$2,000","$0","$2,527","$60","$2,000","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,200","$19200 per person","$38400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Silver2000-80Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Silver2000-80Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020031","Empower PPO - HSA Silver 3000/80","87416WI002",,"WIN001","WIS001","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020031-00","Empower PPO - HSA Silver 3000/80","Standard Silver Off Exchange Plan",,"0.703454114021115","Yes","Yes","No","100%",,"$2,752","$0","$1,748","$60","$3,000","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSASilver3000-80Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSASilver3000-80Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020031","Empower PPO - HSA Silver 3000/80","87416WI002",,"WIN001","WIS001","WIF003","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020031-01","Empower PPO - HSA Silver 3000/80","Standard Silver On Exchange Plan",,"0.703454114021115","Yes","Yes","No","100%",,"$2,752","$0","$1,748","$60","$3,000","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSASilver3000-80Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSASilver3000-80Empower"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220028","Select Gold 1000 Ded/4000 MOOP","94529WI022",,"WIN002","WIS004","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220028-00","Select Gold 1000 Ded/4000 MOOP","Standard Gold Off Exchange Plan",,"0.815735953864402","No","Yes","No","100%",,"$1,000","$1,390","$160","$10","$110","$250","$1,310","$20","$360","$50","$370","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1842207","https://planfinder.ghcscw.com/marketplace/1842207"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240050","Silver Simple Choice Plan","94529WI024",,"WIN001","WIS001","WIF009","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240050-01","Silver Simple Choice Plan","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$0","$120","$10","$610","$250","$1,300","$20","$910","$50","$130","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811343","https://planfinder.ghcscw.com/marketplace/1811343"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus","11269WY007","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-06","BlueSelect Silver HealthPlus","94% AV Level Silver Plan","93.26%","0.930959482841167","Yes","Yes","No","100%",,"$100","$10","$800","$60","$100","$400","$400","$60","$100","$0","$500","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","25.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,100","$20100 per person","$40200 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus94DentalforIndividuals18","https://www.bcbswy.com/docs/coverage/2018/Subsidy_Silver94.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver Value","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-04","BlueSelect Silver Value","73% AV Level Silver Plan",,"0.728815474287251","No","Yes","No","100%",,"$3,000","$20","$1,900","$60","$2,500","$900","$0","$60","$1,900","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,000","$23000 per person","$46000 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValue73DentalforIndividuals18","https://www.bcbswy.com/docs/coverage/2018/Subsidy_Silver73.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver Value","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-05","BlueSelect Silver Value","87% AV Level Silver Plan",,"0.86122731889987","No","Yes","No","100%",,"$600","$20","$1,800","$60","$600","$600","$400","$60","$600","$0","$300","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,600","$20600 per person","$41200 per group","$150","$150 per person","$300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValue87DentalforIndividuals18","https://www.bcbswy.com/docs/coverage/2018/Subsidy_Silver87.pdf"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020032","Empower PPO - HSA Bronze 5800/90","87416WI002",,"WIN001","WIS001","WIF002","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020032-01","Empower PPO - HSA Bronze 5800/90","Standard Bronze On Exchange Plan",,"0.611728272568227","Yes","Yes","No","100%",,"$5,260","$0","$1,240","$60","$5,800","$0","$700","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","10.00%",,,,,"$11,600","$11600 per person","$23200 per group","$17,400","$17400 per person","$34800 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSABronze5800-90Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSABronze5800-90Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020039","Empower PPO - HSA Bronze 6400/100","87416WI002",,"WIN001","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020039-00","Empower PPO - HSA Bronze 6400/100","Standard Bronze Off Exchange Plan",,"0.608957768456605","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$25,600","$25600 per person","$51200 per group","$32,000","$32000 per person","$64000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"$12,800","$12800 per person","$25600 per group","$19,200","$19200 per person","$38400 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSABronze6400-100Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSABronze6400-100Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020039","Empower PPO - HSA Bronze 6400/100","87416WI002",,"WIN001","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020039-01","Empower PPO - HSA Bronze 6400/100","Standard Bronze On Exchange Plan",,"0.608957768456605","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$25,600","$25600 per person","$51200 per group","$32,000","$32000 per person","$64000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"$12,800","$12800 per person","$25600 per group","$19,200","$19200 per person","$38400 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/HSABronze6400-100Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018HSABronze6400-100Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020021","Envision Aurora Bellin PPO - Bronze 7000/100","87416WI002",,"WIN002","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020021-00","Envision Aurora Bellin PPO - Bronze 7000/100","Standard Bronze Off Exchange Plan",,"0.615010574673005","Yes","Yes","No","100%",,"$7,000","$0","$0","$60","$7,000","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Bronze7000-100Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Bronze7000-100Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030026","Envision Aurora Bellin - Catastrophic 7350/100","87416WI003",,"WIN002","WIS001","WIF001","New","EPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030026-00","Envision Aurora Bellin - Catastrophic 7350/100","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Catastrophic7350-100.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Catastrophic7350-100"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030026","Envision Aurora Bellin - Catastrophic 7350/100","87416WI003",,"WIN002","WIS001","WIF001","New","EPO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030026-01","Envision Aurora Bellin - Catastrophic 7350/100","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Catastrophic7350-100.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Catastrophic7350-100"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020021","Envision Aurora Bellin PPO - Bronze 7000/100","87416WI002",,"WIN002","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020021-01","Envision Aurora Bellin PPO - Bronze 7000/100","Standard Bronze On Exchange Plan",,"0.615010574673005","Yes","Yes","No","100%",,"$7,000","$0","$0","$60","$7,000","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Bronze7000-100Envision.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Bronze7000-100Envision"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020014","Empower PPO - Bronze 7000/100","87416WI002",,"WIN001","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020014-00","Empower PPO - Bronze 7000/100","Standard Bronze Off Exchange Plan",,"0.615010574673005","Yes","Yes","No","100%",,"$7,000","$0","$0","$60","$7,000","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Bronze7000-100Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Bronze7000-100Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030027","Envision Aurora Bellin - Bronze 7350/100","87416WI003",,"WIN002","WIS002","WIF001","New","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030027-00","Envision Aurora Bellin - Bronze 7350/100","Standard Bronze Off Exchange Plan",,"0.606545787781847","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Bronze7350-100.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Bronze7350-100"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030027","Envision Aurora Bellin - Bronze 7350/100","87416WI003",,"WIN002","WIS002","WIF001","New","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030027-01","Envision Aurora Bellin - Bronze 7350/100","Standard Bronze On Exchange Plan",,"0.606545787781847","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Bronze7350-100.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Bronze7350-100"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","SHOP (Small Group)","No","45-3309488","87416WI0020014","Empower PPO - Bronze 7000/100","87416WI002",,"WIN001","WIS001","WIF001","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9995",,,"2018-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0020014-01","Empower PPO - Bronze 7000/100","Standard Bronze On Exchange Plan",,"0.615010574673005","Yes","Yes","No","100%",,"$7,000","$0","$0","$60","$7,000","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$28,000","$28000 per person","$56000 per group","$35,000","$35000 per person","$70000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","0.00%",,,,,"$14,000","$14000 per person","$28000 per group","$21,000","$21000 per person","$42000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Bronze7000-100Empower.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Bronze7000-100Empower"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030027","Envision Aurora Bellin - Bronze 7350/100","87416WI003",,"WIN002","WIS002","WIF001","New","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030027-02","Envision Aurora Bellin - Bronze 7350/100 NCS","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Bronze7350-100NCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Bronze7350-100NCS"
"2018","WI","87416","HIOS","2017-09-06 02:20:26","Individual","No","45-3309488","87416WI0030027","Envision Aurora Bellin - Bronze 7350/100","87416WI003",,"WIN002","WIS002","WIF001","New","EPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No","Emergency Services Only","No","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/Formulary.pdf","87416WI0030027-03","Envision Aurora Bellin - Bronze 7350/100 LCS","Limited Cost Sharing Plan Variation",,"0.606545787781847","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2018/SBC/Bronze7350-100LCS.pdf","http://www.commongroundhealthcare.org/our-plans/individuals-families/2018Bronze7350-100LCS"
"2018","WI","90028","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","39-0138065","90028WI0450003","Anthem Family Dental","90028WI045",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","90028WI0450003-00","Anthem Family Dental","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/wi/f0/s0/t0/pw_e215732.pdf",
"2018","WI","90028","HIOS","2017-08-15 02:20:31","Individual","Yes","39-0138065","90028WI0420005","Anthem Dental Family Value","90028WI042",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","90028WI0420005-01","Anthem Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/wi/f0/s0/t0/pw_e215734.pdf",
"2018","WI","90028","HIOS","2017-08-15 02:20:31","Individual","Yes","39-0138065","90028WI0480005","Anthem Dental Family Value","90028WI048",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","90028WI0480005-00","Anthem Dental Family Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/wi/f0/s0/t0/pw_e215734.pdf",
"2018","WI","90028","HIOS","2017-08-15 02:20:31","Individual","Yes","39-0138065","90028WI0420003","Anthem Dental Family","90028WI042",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","90028WI0420003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/wi/f0/s0/t0/pw_e215732.pdf",
"2018","WI","90028","HIOS","2017-08-15 02:20:31","SHOP (Small Group)","Yes","39-0138065","90028WI0450004","Anthem Dental Family","90028WI045",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.863","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","90028WI0450004-00","Anthem Dental Family","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/wi/f0/s0/t0/pw_e215733.pdf",
"2018","WI","90028","HIOS","2017-08-15 02:20:31","Individual","Yes","39-0138065","90028WI0480003","Anthem Dental Family","90028WI048",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","90028WI0480003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/wi/f0/s0/t0/pw_e215732.pdf",
"2018","WI","90028","HIOS","2017-08-15 02:20:31","Individual","Yes","39-0138065","90028WI0420004","Anthem Dental Family Enhanced","90028WI042",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.863","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","90028WI0420004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/wi/f0/s0/t0/pw_e215733.pdf",
"2018","WI","90028","HIOS","2017-08-15 02:20:31","Individual","Yes","39-0138065","90028WI0480004","Anthem Dental Family Enhanced","90028WI048",,"WIN001","WIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.863","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","90028WI0480004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/wi/f0/s0/t0/pw_e215733.pdf",
"2018","WI","91604","HIOS","2017-08-08 02:20:26","Individual","Yes","39-1263473","91604WI0490001","Humana Dental Smart Choice","91604WI049",,"WIN001","WIS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9875","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","91604WI0490001-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","68.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110484"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210017","Platinum 500 Ded/1000 MOOP","94529WI021",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210017-00","Platinum 500 Ded/1000 MOOP","Standard Platinum Off Exchange Plan",,"0.917784667524214","No","Yes","No","100%",,"$500","$460","$40","$10","$100","$250","$610","$20","$360","$50","$180","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1831110","https://planfinder.ghcscw.com/marketplace/1831110"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220016","Platinum 500 Ded/1000 MOOP","94529WI022",,"WIN001","WIS003","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220016-00","Platinum 500 Ded/1000 MOOP","Standard Platinum Off Exchange Plan",,"0.917784667524214","No","Yes","No","100%",,"$500","$460","$40","$10","$100","$250","$610","$20","$360","$50","$180","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1841110","https://planfinder.ghcscw.com/marketplace/1841110"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220016","Platinum 500 Ded/1000 MOOP","94529WI022",,"WIN001","WIS003","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220016-01","Platinum 500 Ded/1000 MOOP","Standard Platinum On Exchange Plan",,"0.917784667524214","No","Yes","No","100%",,"$500","$460","$40","$10","$100","$250","$610","$20","$360","$50","$180","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1821110","https://planfinder.ghcscw.com/marketplace/1821110"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210017","Platinum 500 Ded/1000 MOOP","94529WI021",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210017-01","Platinum 500 Ded/1000 MOOP","Standard Platinum On Exchange Plan",,"0.917784667524214","No","Yes","No","100%",,"$500","$460","$40","$10","$100","$250","$610","$20","$360","$50","$180","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811110","https://planfinder.ghcscw.com/marketplace/1811110"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210017","Platinum 500 Ded/1000 MOOP","94529WI021",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210017-02","Platinum 500 Ded/1000 MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811112","https://planfinder.ghcscw.com/marketplace/1811112"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210017","Platinum 500 Ded/1000 MOOP","94529WI021",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210017-03","Platinum 500 Ded/1000 MOOP Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.917784667524214","No","Yes","No","100%",,"$500","$460","$40","$10","$100","$250","$610","$20","$360","$50","$180","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811111","https://planfinder.ghcscw.com/marketplace/1811111"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220018","Gold 1000 Ded/4000 MOOP","94529WI022",,"WIN001","WIS003","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220018-00","Gold 1000 Ded/4000 MOOP","Standard Gold Off Exchange Plan",,"0.815735953864402","No","Yes","No","100%",,"$1,000","$1,390","$160","$10","$110","$250","$1,310","$20","$360","$50","$370","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1841207","https://planfinder.ghcscw.com/marketplace/1841207"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220018","Gold 1000 Ded/4000 MOOP","94529WI022",,"WIN001","WIS003","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220018-01","Gold 1000 Ded/4000 MOOP","Standard Gold On Exchange Plan",,"0.815735953864402","No","Yes","No","100%",,"$1,000","$1,390","$160","$10","$110","$250","$1,310","$20","$360","$50","$370","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1821207","https://planfinder.ghcscw.com/marketplace/1821207"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220041","Gold 2500 Ded/6500 MOOP","94529WI022",,"WIN001","WIS003","WIF002","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220041-00","Gold 2500 Ded/6500 MOOP","Standard Gold Off Exchange Plan",,"0.760404300018516","No","Yes","No","100%",,"$2,500","$0","$160","$10","$110","$250","$1,310","$20","$360","$50","$420","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1841213","https://planfinder.ghcscw.com/marketplace/1841213"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220038","Bronze 6550 Ded/6550 MOOP HSA","94529WI022",,"WIN001","WIS003","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220038-01","Bronze 6550 Ded/6550 MOOP HSA","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$5,430","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1821404","https://planfinder.ghcscw.com/marketplace/1821404"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220030","Select Gold 2000 Ded/2000 MOOP HSA","94529WI022",,"WIN002","WIS004","WIF007","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220030-00","Select Gold 2000 Ded/2000 MOOP HSA","Standard Gold Off Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$10","$1,900","$100","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1842210","https://planfinder.ghcscw.com/marketplace/1842210"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210044","Bronze 6550 Ded/6550 MOOP HSA","94529WI021",,"WIN001","WIS001","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210044-02","Bronze 6550 Ded/6550 MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1811406","https://planfinder.ghcscw.com/marketplace/1811406"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0230002","Silver 2000 Ded/6000 MOOP POS","94529WI023",,"WIN001","WIS006","WIF003","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0230002-01","Silver 2000 Ded/6000 MOOP POS","Standard Silver On Exchange Plan",,"0.709247258237053","No","Yes","No","100%",,"$2,000","$90","$240","$10","$710","$250","$1,740","$20","$1,100","$50","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1824325","https://planfinder.ghcscw.com/marketplace/1824325"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250014","Select Silver 4000 Ded/7350X MOOP","94529WI025",,"WIN002","WIS004","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250014-01","Select Silver 4000 Ded/7350X MOOP","Standard Silver On Exchange Plan",,"0.7084281936391","No","No","No","100%",,"$4,000","$0","$400","$10","$110","$50","$2,160","$20","$360","$50","$600","$0",,"0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1822301","https://planfinder.ghcscw.com/marketplace/1822301"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic","11269WY007","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-04","BlueSelect Silver Classic","73% AV Level Silver Plan",,"0.724522731677367","Yes","Yes","No","100%",,"$2,500","$20","$3,300","$60","$2,500","$800","$0","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"$20,000","$20000 per person","$40000 per group","$22,500","$22500 per person","$45000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic73DentalforIndividuals18","https://www.bcbswy.com/docs/coverage/2018/Subsidy_Silver73.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic","11269WY007","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-05","BlueSelect Silver Classic","87% AV Level Silver Plan",,"0.861440453169831","Yes","Yes","No","100%",,"$300","$10","$2,100","$60","$300","$300","$900","$60","$300","$0","$700","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","40.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,300","$20300 per person","$40600 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic87DentalforIndividuals18","https://www.bcbswy.com/docs/coverage/2018/Subsidy_Silver87.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070004","BlueSelect Bronze Core","11269WY007","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070004-00","BlueSelect Bronze Core","Standard Bronze Off Exchange Plan",,"0.612246328779518","Yes","Yes","No","100%",,"$4,500","$0","$2,100","$60","$4,500","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","50.00%",,,,,"$20,000","per person not applicable","$40000 per group","$24,500","per person not applicable","$49000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeCoreIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220041","Gold 2500 Ded/6500 MOOP","94529WI022",,"WIN001","WIS003","WIF002","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220041-01","Gold 2500 Ded/6500 MOOP","Standard Gold On Exchange Plan",,"0.760404300018516","No","Yes","No","100%",,"$2,500","$0","$160","$10","$110","$250","$1,310","$20","$360","$50","$420","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1821213","https://planfinder.ghcscw.com/marketplace/1821213"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210019","Gold 1000 Ded/4000 MOOP","94529WI021",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210019-00","Gold 1000 Ded/4000 MOOP","Standard Gold Off Exchange Plan",,"0.815735953864402","No","Yes","No","100%",,"$1,000","$1,390","$160","$10","$110","$250","$1,310","$20","$360","$50","$370","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1831207","https://planfinder.ghcscw.com/marketplace/1831207"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220021","Silver 3000 Ded/7350 MOOP","94529WI022",,"WIN001","WIS003","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220021-00","Silver 3000 Ded/7350 MOOP","Standard Silver Off Exchange Plan",,"0.717463936236314","No","Yes","No","100%",,"$3,000","$0","$240","$10","$110","$250","$1,990","$20","$360","$50","$550","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1841319","https://planfinder.ghcscw.com/marketplace/1841319"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220021","Silver 3000 Ded/7350 MOOP","94529WI022",,"WIN001","WIS003","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220021-01","Silver 3000 Ded/7350 MOOP","Standard Silver On Exchange Plan",,"0.717463936236314","No","Yes","No","100%",,"$3,000","$0","$240","$10","$110","$250","$1,990","$20","$360","$50","$550","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1821319","https://planfinder.ghcscw.com/marketplace/1821319"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210019","Gold 1000 Ded/4000 MOOP","94529WI021",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210019-01","Gold 1000 Ded/4000 MOOP","Standard Gold On Exchange Plan",,"0.815735953864402","No","Yes","No","100%",,"$1,000","$1,390","$160","$10","$110","$250","$1,310","$20","$360","$50","$370","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811207","https://planfinder.ghcscw.com/marketplace/1811207"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210019","Gold 1000 Ded/4000 MOOP","94529WI021",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210019-02","Gold 1000 Ded/4000 MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811209","https://planfinder.ghcscw.com/marketplace/1811209"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220022","Silver 2000 Ded/6000 MOOP","94529WI022",,"WIN001","WIS003","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220022-00","Silver 2000 Ded/6000 MOOP","Standard Silver Off Exchange Plan",,"0.709247258237053","No","Yes","No","100%",,"$2,000","$90","$240","$10","$710","$250","$1,740","$20","$1,100","$50","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1841325","https://planfinder.ghcscw.com/marketplace/1841325"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220022","Silver 2000 Ded/6000 MOOP","94529WI022",,"WIN001","WIS003","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220022-01","Silver 2000 Ded/6000 MOOP","Standard Silver On Exchange Plan",,"0.709247258237053","No","Yes","No","100%",,"$2,000","$90","$240","$10","$710","$250","$1,740","$20","$1,100","$50","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1821325","https://planfinder.ghcscw.com/marketplace/1821325"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210019","Gold 1000 Ded/4000 MOOP","94529WI021",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210019-03","Gold 1000 Ded/4000 MOOP Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.815735953864402","No","Yes","No","100%",,"$1,000","$1,390","$160","$10","$110","$250","$1,310","$20","$360","$50","$370","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811208","https://planfinder.ghcscw.com/marketplace/1811208"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210047","Gold 2500 Ded/6500 MOOP","94529WI021",,"WIN001","WIS001","WIF002","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210047-00","Gold 2500 Ded/6500 MOOP","Standard Gold Off Exchange Plan",,"0.760404300018516","No","Yes","No","100%",,"$2,500","$0","$160","$10","$110","$250","$1,310","$20","$360","$50","$420","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1831216","https://planfinder.ghcscw.com/marketplace/1831216"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220036","Silver 4500 Ded/7350 MOOP","94529WI022",,"WIN001","WIS003","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220036-00","Silver 4500 Ded/7350 MOOP","Standard Silver Off Exchange Plan",,"0.71910831926917","No","Yes","No","100%",,"$4,500","$0","$240","$10","$110","$250","$1,890","$20","$360","$50","$470","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1841337","https://planfinder.ghcscw.com/marketplace/1841337"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220036","Silver 4500 Ded/7350 MOOP","94529WI022",,"WIN001","WIS003","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220036-01","Silver 4500 Ded/7350 MOOP","Standard Silver On Exchange Plan",,"0.71910831926917","No","Yes","No","100%",,"$4,500","$0","$240","$10","$110","$250","$1,890","$20","$360","$50","$470","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1821337","https://planfinder.ghcscw.com/marketplace/1821337"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210047","Gold 2500 Ded/6500 MOOP","94529WI021",,"WIN001","WIS001","WIF002","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210047-01","Gold 2500 Ded/6500 MOOP","Standard Gold On Exchange Plan",,"0.760404300018516","No","Yes","No","100%",,"$2,500","$0","$160","$10","$110","$250","$1,310","$20","$360","$50","$420","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811216","https://planfinder.ghcscw.com/marketplace/1811216"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210047","Gold 2500 Ded/6500 MOOP","94529WI021",,"WIN001","WIS001","WIF002","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210047-02","Gold 2500 Ded/6500 MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811218","https://planfinder.ghcscw.com/marketplace/1811218"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220042","Silver 5500 Ded/7350 MOOP","94529WI022",,"WIN001","WIS003","WIF005","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220042-00","Silver 5500 Ded/7350 MOOP","Standard Silver Off Exchange Plan",,"0.664517756643812","No","Yes","No","100%",,"$5,500","$0","$400","$10","$110","$250","$3,980","$20","$360","$50","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1841343","https://planfinder.ghcscw.com/marketplace/1841343"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220042","Silver 5500 Ded/7350 MOOP","94529WI022",,"WIN001","WIS003","WIF005","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220042-01","Silver 5500 Ded/7350 MOOP","Standard Silver On Exchange Plan",,"0.664517756643812","No","Yes","No","100%",,"$5,500","$0","$400","$10","$110","$250","$3,980","$20","$360","$50","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1821343","https://planfinder.ghcscw.com/marketplace/1821343"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210047","Gold 2500 Ded/6500 MOOP","94529WI021",,"WIN001","WIS001","WIF002","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210047-03","Gold 2500 Ded/6500 MOOP Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.760404300018516","No","Yes","No","100%",,"$2,500","$0","$160","$10","$110","$250","$1,310","$20","$360","$50","$420","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811217","https://planfinder.ghcscw.com/marketplace/1811217"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210028","Select Platinum 500 Ded/1000 MOOP","94529WI021",,"WIN002","WIS002","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210028-00","Select Platinum 500 Ded/1000 MOOP","Standard Platinum Off Exchange Plan",,"0.917784667524214","No","Yes","No","100%",,"$500","$460","$40","$10","$100","$250","$610","$20","$360","$50","$180","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1832110","https://planfinder.ghcscw.com/marketplace/1832110"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220024","Bronze 4000 Ded/7350 MOOP","94529WI022",,"WIN001","WIS003","WIF005","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220024-00","Bronze 4000 Ded/7350 MOOP","Standard Bronze Off Exchange Plan",,"0.645018519452696","No","Yes","No","100%",,"$4,000","$0","$400","$10","$110","$250","$4,230","$20","$360","$50","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1841401","https://planfinder.ghcscw.com/marketplace/1841401"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220024","Bronze 4000 Ded/7350 MOOP","94529WI022",,"WIN001","WIS003","WIF005","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220024-01","Bronze 4000 Ded/7350 MOOP","Standard Bronze On Exchange Plan",,"0.645018519452696","No","Yes","No","100%",,"$4,000","$0","$400","$10","$110","$250","$4,230","$20","$360","$50","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1821401","https://planfinder.ghcscw.com/marketplace/1821401"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210028","Select Platinum 500 Ded/1000 MOOP","94529WI021",,"WIN002","WIS002","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210028-01","Select Platinum 500 Ded/1000 MOOP","Standard Platinum On Exchange Plan",,"0.917784667524214","No","Yes","No","100%",,"$500","$460","$40","$10","$100","$250","$610","$20","$360","$50","$180","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812110","https://planfinder.ghcscw.com/marketplace/1812110"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210028","Select Platinum 500 Ded/1000 MOOP","94529WI021",,"WIN002","WIS002","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210028-02","Select Platinum 500 Ded/1000 MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812112","https://planfinder.ghcscw.com/marketplace/1812112"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210028","Select Platinum 500 Ded/1000 MOOP","94529WI021",,"WIN002","WIS002","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210028-03","Select Platinum 500 Ded/1000 MOOP Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.917784667524214","No","Yes","No","100%",,"$500","$460","$40","$10","$100","$250","$610","$20","$360","$50","$180","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812111","https://planfinder.ghcscw.com/marketplace/1812111"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220026","Select Platinum 500 Ded/1000 MOOP","94529WI022",,"WIN002","WIS004","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220026-00","Select Platinum 500 Ded/1000 MOOP","Standard Platinum Off Exchange Plan",,"0.917784667524214","No","Yes","No","100%",,"$500","$460","$40","$10","$100","$250","$610","$20","$360","$50","$180","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1842110","https://planfinder.ghcscw.com/marketplace/1842110"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220026","Select Platinum 500 Ded/1000 MOOP","94529WI022",,"WIN002","WIS004","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220026-01","Select Platinum 500 Ded/1000 MOOP","Standard Platinum On Exchange Plan",,"0.917784667524214","No","Yes","No","100%",,"$500","$460","$40","$10","$100","$250","$610","$20","$360","$50","$180","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1822110","https://planfinder.ghcscw.com/marketplace/1822110"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210030","Select Gold 1000 Ded/4000 MOOP","94529WI021",,"WIN002","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210030-00","Select Gold 1000 Ded/4000 MOOP","Standard Gold Off Exchange Plan",,"0.815735953864402","No","Yes","No","100%",,"$1,000","$1,390","$160","$10","$110","$250","$1,310","$20","$360","$50","$370","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1832207","https://planfinder.ghcscw.com/marketplace/1832207"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220028","Select Gold 1000 Ded/4000 MOOP","94529WI022",,"WIN002","WIS004","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220028-01","Select Gold 1000 Ded/4000 MOOP","Standard Gold On Exchange Plan",,"0.815735953864402","No","Yes","No","100%",,"$1,000","$1,390","$160","$10","$110","$250","$1,310","$20","$360","$50","$370","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1822207","https://planfinder.ghcscw.com/marketplace/1822207"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210030","Select Gold 1000 Ded/4000 MOOP","94529WI021",,"WIN002","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210030-01","Select Gold 1000 Ded/4000 MOOP","Standard Gold On Exchange Plan",,"0.815735953864402","No","Yes","No","100%",,"$1,000","$1,390","$160","$10","$110","$250","$1,310","$20","$360","$50","$370","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812207","https://planfinder.ghcscw.com/marketplace/1812207"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210030","Select Gold 1000 Ded/4000 MOOP","94529WI021",,"WIN002","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210030-02","Select Gold 1000 Ded/4000 MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812209","https://planfinder.ghcscw.com/marketplace/1812209"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220045","Select Gold 2500 Ded/6500 MOOP","94529WI022",,"WIN002","WIS004","WIF002","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220045-00","Select Gold 2500 Ded/6500 MOOP","Standard Gold Off Exchange Plan",,"0.760404300018516","No","Yes","No","100%",,"$2,500","$0","$160","$10","$110","$250","$1,310","$20","$360","$50","$420","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1842213","https://planfinder.ghcscw.com/marketplace/1842213"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220045","Select Gold 2500 Ded/6500 MOOP","94529WI022",,"WIN002","WIS004","WIF002","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220045-01","Select Gold 2500 Ded/6500 MOOP","Standard Gold On Exchange Plan",,"0.760404300018516","No","Yes","No","100%",,"$2,500","$0","$160","$10","$110","$250","$1,310","$20","$360","$50","$420","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1822213","https://planfinder.ghcscw.com/marketplace/1822213"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210030","Select Gold 1000 Ded/4000 MOOP","94529WI021",,"WIN002","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210030-03","Select Gold 1000 Ded/4000 MOOP Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.815735953864402","No","Yes","No","100%",,"$1,000","$1,390","$160","$10","$110","$250","$1,310","$20","$360","$50","$370","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812208","https://planfinder.ghcscw.com/marketplace/1812208"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210051","Select Gold 2500 Ded/6500 MOOP","94529WI021",,"WIN002","WIS002","WIF002","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210051-00","Select Gold 2500 Ded/6500 MOOP","Standard Gold Off Exchange Plan",,"0.760404300018516","No","Yes","No","100%",,"$2,500","$0","$160","$10","$110","$250","$1,310","$20","$360","$50","$420","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1832216","https://planfinder.ghcscw.com/marketplace/1832216"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220031","Select Silver 3000 Ded/7350 MOOP","94529WI022",,"WIN002","WIS004","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220031-00","Select Silver 3000 Ded/7350 MOOP","Standard Silver Off Exchange Plan",,"0.717463936236314","No","Yes","No","100%",,"$3,000","$0","$240","$10","$110","$250","$1,990","$20","$360","$50","$550","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1842319","https://planfinder.ghcscw.com/marketplace/1842319"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220031","Select Silver 3000 Ded/7350 MOOP","94529WI022",,"WIN002","WIS004","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220031-01","Select Silver 3000 Ded/7350 MOOP","Standard Silver On Exchange Plan",,"0.717463936236314","No","Yes","No","100%",,"$3,000","$0","$240","$10","$110","$250","$1,990","$20","$360","$50","$550","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1822319","https://planfinder.ghcscw.com/marketplace/1822319"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210051","Select Gold 2500 Ded/6500 MOOP","94529WI021",,"WIN002","WIS002","WIF002","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210051-01","Select Gold 2500 Ded/6500 MOOP","Standard Gold On Exchange Plan",,"0.760404300018516","No","Yes","No","100%",,"$2,500","$0","$160","$10","$110","$250","$1,310","$20","$360","$50","$420","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812216","https://planfinder.ghcscw.com/marketplace/1812216"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210051","Select Gold 2500 Ded/6500 MOOP","94529WI021",,"WIN002","WIS002","WIF002","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210051-02","Select Gold 2500 Ded/6500 MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812218","https://planfinder.ghcscw.com/marketplace/1812218"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220032","Select Silver 2000 Ded/6000 MOOP","94529WI022",,"WIN002","WIS004","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220032-00","Select Silver 2000 Ded/6000 MOOP","Standard Silver Off Exchange Plan",,"0.709247258237053","No","Yes","No","100%",,"$2,000","$90","$240","$10","$710","$250","$1,740","$20","$1,100","$50","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1842325","https://planfinder.ghcscw.com/marketplace/1842325"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220032","Select Silver 2000 Ded/6000 MOOP","94529WI022",,"WIN002","WIS004","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220032-01","Select Silver 2000 Ded/6000 MOOP","Standard Silver On Exchange Plan",,"0.709247258237053","No","Yes","No","100%",,"$2,000","$90","$240","$10","$710","$250","$1,740","$20","$1,100","$50","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1822325","https://planfinder.ghcscw.com/marketplace/1822325"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210051","Select Gold 2500 Ded/6500 MOOP","94529WI021",,"WIN002","WIS002","WIF002","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210051-03","Select Gold 2500 Ded/6500 MOOP Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.760404300018516","No","Yes","No","100%",,"$2,500","$0","$160","$10","$110","$250","$1,310","$20","$360","$50","$420","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812217","https://planfinder.ghcscw.com/marketplace/1812217"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220037","Select Silver 4500 Ded/7350 MOOP","94529WI022",,"WIN002","WIS004","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220037-00","Select Silver 4500 Ded/7350 MOOP","Standard Silver Off Exchange Plan",,"0.71910831926917","No","Yes","No","100%",,"$4,500","$0","$240","$10","$110","$250","$1,890","$20","$360","$50","$470","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1842337","https://planfinder.ghcscw.com/marketplace/1842337"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220037","Select Silver 4500 Ded/7350 MOOP","94529WI022",,"WIN002","WIS004","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220037-01","Select Silver 4500 Ded/7350 MOOP","Standard Silver On Exchange Plan",,"0.71910831926917","No","Yes","No","100%",,"$4,500","$0","$240","$10","$110","$250","$1,890","$20","$360","$50","$470","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1822337","https://planfinder.ghcscw.com/marketplace/1822337"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220046","Select Silver 5500 Ded/7350 MOOP","94529WI022",,"WIN002","WIS004","WIF005","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220046-00","Select Silver 5500 Ded/7350 MOOP","Standard Silver Off Exchange Plan",,"0.664517756643812","No","Yes","No","100%",,"$5,500","$0","$400","$10","$110","$250","$3,980","$20","$360","$50","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1842343","https://planfinder.ghcscw.com/marketplace/1842343"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220046","Select Silver 5500 Ded/7350 MOOP","94529WI022",,"WIN002","WIS004","WIF005","New","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220046-01","Select Silver 5500 Ded/7350 MOOP","Standard Silver On Exchange Plan",,"0.664517756643812","No","Yes","No","100%",,"$5,500","$0","$400","$10","$110","$250","$3,980","$20","$360","$50","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1822343","https://planfinder.ghcscw.com/marketplace/1822343"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220034","Select Bronze 4000 Ded/7350 MOOP","94529WI022",,"WIN002","WIS004","WIF005","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220034-00","Select Bronze 4000 Ded/7350 MOOP","Standard Bronze Off Exchange Plan",,"0.645018519452696","No","Yes","No","100%",,"$4,000","$0","$400","$10","$110","$250","$4,230","$20","$360","$50","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1842401","https://planfinder.ghcscw.com/marketplace/1842401"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220034","Select Bronze 4000 Ded/7350 MOOP","94529WI022",,"WIN002","WIS004","WIF005","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220034-01","Select Bronze 4000 Ded/7350 MOOP","Standard Bronze On Exchange Plan",,"0.645018519452696","No","Yes","No","100%",,"$4,000","$0","$400","$10","$110","$250","$4,230","$20","$360","$50","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1822401","https://planfinder.ghcscw.com/marketplace/1822401"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220020","Gold 2000 Ded/2000 MOOP HSA","94529WI022",,"WIN001","WIS003","WIF007","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220020-00","Gold 2000 Ded/2000 MOOP HSA","Standard Gold Off Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$10","$1,900","$100","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1841210","https://planfinder.ghcscw.com/marketplace/1841210"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210021","Gold 2000 Ded/2000 MOOP HSA","94529WI021",,"WIN001","WIS001","WIF007","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210021-00","Gold 2000 Ded/2000 MOOP HSA","Standard Gold Off Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$10","$1,900","$100","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1831210","https://planfinder.ghcscw.com/marketplace/1831210"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210021","Gold 2000 Ded/2000 MOOP HSA","94529WI021",,"WIN001","WIS001","WIF007","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210021-01","Gold 2000 Ded/2000 MOOP HSA","Standard Gold On Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$10","$1,900","$100","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1811210","https://planfinder.ghcscw.com/marketplace/1811210"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220020","Gold 2000 Ded/2000 MOOP HSA","94529WI022",,"WIN001","WIS003","WIF007","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220020-01","Gold 2000 Ded/2000 MOOP HSA","Standard Gold On Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$10","$1,900","$100","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1821210","https://planfinder.ghcscw.com/marketplace/1821210"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220023","Silver 4000 Ded/4000 MOOP HSA","94529WI022",,"WIN001","WIS003","WIF007","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220023-00","Silver 4000 Ded/4000 MOOP HSA","Standard Silver Off Exchange Plan",,"0.700980885295207","Yes","Yes","No","100%",,"$4,000","$0","$0","$10","$3,780","$220","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1841331","https://planfinder.ghcscw.com/marketplace/1841331"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210021","Gold 2000 Ded/2000 MOOP HSA","94529WI021",,"WIN001","WIS001","WIF007","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210021-02","Gold 2000 Ded/2000 MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1811212","https://planfinder.ghcscw.com/marketplace/1811212"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210021","Gold 2000 Ded/2000 MOOP HSA","94529WI021",,"WIN001","WIS001","WIF007","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210021-03","Gold 2000 Ded/2000 MOOP HSA Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$10","$1,900","$100","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1811211","https://planfinder.ghcscw.com/marketplace/1811211"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220023","Silver 4000 Ded/4000 MOOP HSA","94529WI022",,"WIN001","WIS003","WIF007","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220023-01","Silver 4000 Ded/4000 MOOP HSA","Standard Silver On Exchange Plan",,"0.700980885295207","Yes","Yes","No","100%",,"$4,000","$0","$0","$10","$3,780","$220","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1821331","https://planfinder.ghcscw.com/marketplace/1821331"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220038","Bronze 6550 Ded/6550 MOOP HSA","94529WI022",,"WIN001","WIS003","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220038-00","Bronze 6550 Ded/6550 MOOP HSA","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$5,430","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1841404","https://planfinder.ghcscw.com/marketplace/1841404"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210044","Bronze 6550 Ded/6550 MOOP HSA","94529WI021",,"WIN001","WIS001","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210044-00","Bronze 6550 Ded/6550 MOOP HSA","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$5,430","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1831404","https://planfinder.ghcscw.com/marketplace/1831404"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210044","Bronze 6550 Ded/6550 MOOP HSA","94529WI021",,"WIN001","WIS001","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210044-01","Bronze 6550 Ded/6550 MOOP HSA","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$5,430","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1811404","https://planfinder.ghcscw.com/marketplace/1811404"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210044","Bronze 6550 Ded/6550 MOOP HSA","94529WI021",,"WIN001","WIS001","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210044-03","Bronze 6550 Ded/6550 MOOP HSA Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$5,430","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1811405","https://planfinder.ghcscw.com/marketplace/1811405"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220030","Select Gold 2000 Ded/2000 MOOP HSA","94529WI022",,"WIN002","WIS004","WIF007","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220030-01","Select Gold 2000 Ded/2000 MOOP HSA","Standard Gold On Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$10","$1,900","$100","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1822210","https://planfinder.ghcscw.com/marketplace/1822210"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220033","Select Silver 4000 Ded/4000 MOOP HSA","94529WI022",,"WIN002","WIS004","WIF007","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220033-00","Select Silver 4000 Ded/4000 MOOP HSA","Standard Silver Off Exchange Plan",,"0.700980885295207","Yes","Yes","No","100%",,"$4,000","$0","$0","$10","$3,780","$220","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1842331","https://planfinder.ghcscw.com/marketplace/1842331"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210032","Select Gold 2000 Ded/2000 MOOP HSA","94529WI021",,"WIN002","WIS002","WIF007","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210032-00","Select Gold 2000 Ded/2000 MOOP HSA","Standard Gold Off Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$10","$1,900","$100","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1832210","https://planfinder.ghcscw.com/marketplace/1832210"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210032","Select Gold 2000 Ded/2000 MOOP HSA","94529WI021",,"WIN002","WIS002","WIF007","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210032-01","Select Gold 2000 Ded/2000 MOOP HSA","Standard Gold On Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$10","$1,900","$100","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1812210","https://planfinder.ghcscw.com/marketplace/1812210"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220033","Select Silver 4000 Ded/4000 MOOP HSA","94529WI022",,"WIN002","WIS004","WIF007","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220033-01","Select Silver 4000 Ded/4000 MOOP HSA","Standard Silver On Exchange Plan",,"0.700980885295207","Yes","Yes","No","100%",,"$4,000","$0","$0","$10","$3,780","$220","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1822331","https://planfinder.ghcscw.com/marketplace/1822331"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220039","Select Bronze 6550 Ded/6550 MOOP HSA","94529WI022",,"WIN002","WIS004","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220039-00","Select Bronze 6550 Ded/6550 MOOP HSA","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$5,430","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1842404","https://planfinder.ghcscw.com/marketplace/1842404"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210032","Select Gold 2000 Ded/2000 MOOP HSA","94529WI021",,"WIN002","WIS002","WIF007","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210032-02","Select Gold 2000 Deductible Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1812212","https://planfinder.ghcscw.com/marketplace/1812212"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210032","Select Gold 2000 Ded/2000 MOOP HSA","94529WI021",,"WIN002","WIS002","WIF007","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210032-03","Select Gold 2000 Ded/2000 MOOP HSA Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$10","$1,900","$100","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1812211","https://planfinder.ghcscw.com/marketplace/1812211"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0220039","Select Bronze 6550 Ded/6550 MOOP HSA","94529WI022",,"WIN002","WIS004","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0220039-01","Select Bronze 6550 Ded/6550 MOOP HSA","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$5,430","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://planfinder.ghcscw.com/sbc/1822404","https://planfinder.ghcscw.com/marketplace/1822404"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210045","Select Bronze 6550 Ded/6550 MOOP HSA","94529WI021",,"WIN002","WIS002","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210045-00","Select Bronze 6550 Ded/6550 MOOP HSA","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$5,430","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1832404","https://planfinder.ghcscw.com/marketplace/1832404"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210045","Select Bronze 6550 Ded/6550 MOOP HSA","94529WI021",,"WIN002","WIS002","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210045-01","Select Bronze 6550 Ded/6550 MOOP HSA","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$5,430","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1812404","https://planfinder.ghcscw.com/marketplace/1812404"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210045","Select Bronze 6550 Ded/6550 MOOP HSA","94529WI021",,"WIN002","WIS002","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210045-02","Select Bronze 6550 Ded/6550 MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1812406","https://planfinder.ghcscw.com/marketplace/1812406"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210045","Select Bronze 6550 Ded/6550 MOOP HSA","94529WI021",,"WIN002","WIS002","WIF007","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210045-03","Select Bronze 6550 Ded/6550 MOOP HSA Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$10","$5,430","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1812405","https://planfinder.ghcscw.com/marketplace/1812405"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210025","Bronze 4000 Ded/7350 MOOP","94529WI021",,"WIN001","WIS001","WIF005","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210025-00","Bronze 4000 Ded/7350 MOOP","Standard Bronze Off Exchange Plan",,"0.645018519452696","No","Yes","No","100%",,"$4,000","$0","$400","$10","$110","$250","$4,230","$20","$360","$50","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1831401","https://planfinder.ghcscw.com/marketplace/1831401"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0230001","Gold 1000 Ded/4000 MOOP POS","94529WI023",,"WIN001","WIS006","WIF002","Existing","POS","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0230001-00","Gold 1000 Ded/4000 MOOP POS","Standard Gold Off Exchange Plan",,"0.815735953864402","No","Yes","No","100%",,"$1,000","$1,390","$160","$10","$110","$250","$1,310","$20","$360","$50","$370","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1844207","https://planfinder.ghcscw.com/marketplace/1844207"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0230001","Gold 1000 Ded/4000 MOOP POS","94529WI023",,"WIN001","WIS006","WIF002","Existing","POS","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0230001-01","Gold 1000 Ded/4000 MOOP POS","Standard Gold On Exchange Plan",,"0.815735953864402","No","Yes","No","100%",,"$1,000","$1,390","$160","$10","$110","$250","$1,310","$20","$360","$50","$370","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1824207","https://planfinder.ghcscw.com/marketplace/1824207"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210025","Bronze 4000 Ded/7350 MOOP","94529WI021",,"WIN001","WIS001","WIF005","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210025-01","Bronze 4000 Ded/7350 MOOP","Standard Bronze On Exchange Plan",,"0.645018519452696","No","Yes","No","100%",,"$4,000","$0","$400","$10","$110","$250","$4,230","$20","$360","$50","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811401","https://planfinder.ghcscw.com/marketplace/1811401"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210025","Bronze 4000 Ded/7350 MOOP","94529WI021",,"WIN001","WIS001","WIF005","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210025-02","Bronze 4000 Ded/7350 MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811403","https://planfinder.ghcscw.com/marketplace/1811403"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0230002","Silver 2000 Ded/6000 MOOP POS","94529WI023",,"WIN001","WIS006","WIF003","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0230002-00","Silver 2000 Ded/6000 MOOP POS","Standard Silver Off Exchange Plan",,"0.709247258237053","No","Yes","No","100%",,"$2,000","$90","$240","$10","$710","$250","$1,740","$20","$1,100","$50","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1844325","https://planfinder.ghcscw.com/marketplace/1844325"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210025","Bronze 4000 Ded/7350 MOOP","94529WI021",,"WIN001","WIS001","WIF005","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210025-03","Bronze 4000 Ded/7350 MOOP Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.645018519452696","No","Yes","No","100%",,"$4,000","$0","$400","$10","$110","$250","$4,230","$20","$360","$50","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811402","https://planfinder.ghcscw.com/marketplace/1811402"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210036","Select Bronze 4000 Ded/7350 MOOP","94529WI021",,"WIN002","WIS002","WIF005","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210036-00","Select Bronze 4000 Ded/7350 MOOP","Standard Bronze Off Exchange Plan",,"0.645018519452696","No","Yes","No","100%",,"$4,000","$0","$400","$10","$110","$250","$4,230","$20","$360","$50","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1832401","https://planfinder.ghcscw.com/marketplace/1832401"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210036","Select Bronze 4000 Ded/7350 MOOP","94529WI021",,"WIN002","WIS002","WIF005","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210036-01","Select Bronze 4000 Ded/7350 MOOP","Standard Bronze On Exchange Plan",,"0.645018519452696","No","Yes","No","100%",,"$4,000","$0","$400","$10","$110","$250","$4,230","$20","$360","$50","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812401","https://planfinder.ghcscw.com/marketplace/1812401"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210036","Select Bronze 4000 Ded/7350 MOOP","94529WI021",,"WIN002","WIS002","WIF005","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210036-02","Select Bronze 4000 Ded/7350 MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812403","https://planfinder.ghcscw.com/marketplace/1812403"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210036","Select Bronze 4000 Ded/7350 MOOP","94529WI021",,"WIN002","WIS002","WIF005","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210036-03","Select Bronze 4000 Ded/7350 MOOP Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.645018519452696","No","Yes","No","100%",,"$4,000","$0","$400","$10","$110","$250","$4,230","$20","$360","$50","$900","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812402","https://planfinder.ghcscw.com/marketplace/1812402"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240001","Platinum No Ded/3000X MOOP","94529WI024",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240001-00","Platinum No Ded/3000X MOOP","Standard Platinum Off Exchange Plan",,"0.91687090514424","No","No","No","100%",,"$0","$1,000","$80","$10","$0","$80","$720","$20","$0","$120","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1831101","https://planfinder.ghcscw.com/marketplace/1831101"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240001","Platinum No Ded/3000X MOOP","94529WI024",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240001-01","Platinum No Ded/3000X MOOP","Standard Platinum On Exchange Plan",,"0.91687090514424","No","No","No","100%",,"$0","$1,000","$80","$10","$0","$80","$720","$20","$0","$120","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811101","https://planfinder.ghcscw.com/marketplace/1811101"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240001","Platinum No Ded/3000X MOOP","94529WI024",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240001-02","Platinum No Ded/3000X MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811103","https://planfinder.ghcscw.com/marketplace/1811103"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240001","Platinum No Ded/3000X MOOP","94529WI024",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240001-03","Platinum No Ded/3000X MOOP  Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.91687090514424","No","No","No","100%",,"$0","$1,000","$80","$10","$0","$80","$720","$20","$0","$120","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811102","https://planfinder.ghcscw.com/marketplace/1811102"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240002","Platinum 500 Ded/3000X MOOP","94529WI024",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240002-00","Platinum 500 Ded/3000X MOOP","Standard Platinum Off Exchange Plan",,"0.896056685906042","No","No","No","100%",,"$500","$500","$80","$10","$110","$60","$720","$20","$360","$50","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1831104","https://planfinder.ghcscw.com/marketplace/1831104"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240002","Platinum 500 Ded/3000X MOOP","94529WI024",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240002-01","Platinum 500 Ded/3000X MOOP","Standard Platinum On Exchange Plan",,"0.896056685906042","No","No","No","100%",,"$500","$500","$80","$10","$110","$60","$720","$20","$360","$50","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811104","https://planfinder.ghcscw.com/marketplace/1811104"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240002","Platinum 500 Ded/3000X MOOP","94529WI024",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240002-02","Platinum 500 Ded/3000X MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811106","https://planfinder.ghcscw.com/marketplace/1811106"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240002","Platinum 500 Ded/3000X MOOP","94529WI024",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240002-03","Platinum 500 Ded/3000X MOOP  Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.896056685906042","No","No","No","100%",,"$500","$500","$80","$10","$110","$60","$720","$20","$360","$50","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811105","https://planfinder.ghcscw.com/marketplace/1811105"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240004","Gold 1500 Ded/5200X MOOP","94529WI024",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240004-00","Gold 1500 Ded/5200X MOOP","Standard Gold Off Exchange Plan",,"0.819954810749618","No","No","No","100%",,"$1,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$320","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1831201","https://planfinder.ghcscw.com/marketplace/1831201"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240004","Gold 1500 Ded/5200X MOOP","94529WI024",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240004-01","Gold 1500 Ded/5200X MOOP","Standard Gold On Exchange Plan",,"0.819954810749618","No","No","No","100%",,"$1,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$320","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811201","https://planfinder.ghcscw.com/marketplace/1811201"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240004","Gold 1500 Ded/5200X MOOP","94529WI024",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240004-02","Gold 1500 Ded/5200X MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811203","https://planfinder.ghcscw.com/marketplace/1811203"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240004","Gold 1500 Ded/5200X MOOP","94529WI024",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240004-03","Gold 1500 Ded/5200X MOOP Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.819954810749618","No","No","No","100%",,"$1,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$320","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811202","https://planfinder.ghcscw.com/marketplace/1811202"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240005","Gold 2500 Ded/7000X MOOP","94529WI024",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240005-00","Gold 2500 Ded/7000X MOOP","Standard Gold Off Exchange Plan",,"0.794305332377655","No","No","No","100%",,"$2,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$300","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1831204","https://planfinder.ghcscw.com/marketplace/1831204"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240005","Gold 2500 Ded/7000X MOOP","94529WI024",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240005-01","Gold 2500 Ded/7000X MOOP","Standard Gold On Exchange Plan",,"0.794305332377655","No","No","No","100%",,"$2,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$300","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811204","https://planfinder.ghcscw.com/marketplace/1811204"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240005","Gold 2500 Ded/7000X MOOP","94529WI024",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240005-02","Gold 2500 Ded/7000X MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811206","https://planfinder.ghcscw.com/marketplace/1811206"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240005","Gold 2500 Ded/7000X MOOP","94529WI024",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240005-03","Gold 2500 Ded/7000X MOOP Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.794305332377655","No","No","No","100%",,"$2,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$300","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811205","https://planfinder.ghcscw.com/marketplace/1811205"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240009","Select Platinum No Ded/3000X MOOP","94529WI024",,"WIN002","WIS002","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240009-00","Select Platinum No Ded/3000X MOOP","Standard Platinum Off Exchange Plan",,"0.91687090514424","No","No","No","100%",,"$0","$1,000","$80","$10","$0","$80","$720","$20","$0","$120","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1832101","https://planfinder.ghcscw.com/marketplace/1832101"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240009","Select Platinum No Ded/3000X MOOP","94529WI024",,"WIN002","WIS002","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240009-01","Select Platinum No Ded/3000X MOOP","Standard Platinum On Exchange Plan",,"0.91687090514424","No","No","No","100%",,"$0","$1,000","$80","$10","$0","$80","$720","$20","$0","$120","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812101","https://planfinder.ghcscw.com/marketplace/1812101"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240009","Select Platinum No Ded/3000X MOOP","94529WI024",,"WIN002","WIS002","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240009-02","Select Platinum No Ded/3000X MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812103","https://planfinder.ghcscw.com/marketplace/1812103"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240009","Select Platinum No Ded/3000X MOOP","94529WI024",,"WIN002","WIS002","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240009-03","Select Platinum No Ded/3000X MOOP  Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.91687090514424","No","No","No","100%",,"$0","$1,000","$80","$10","$0","$80","$720","$20","$0","$120","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812102","https://planfinder.ghcscw.com/marketplace/1812102"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240010","Select Platinum 500 Ded/3000X MOOP","94529WI024",,"WIN002","WIS002","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240010-00","Select Platinum 500 Ded/3000X MOOP","Standard Platinum Off Exchange Plan",,"0.896056685906042","No","No","No","100%",,"$500","$500","$80","$10","$110","$60","$720","$20","$360","$50","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1832104","https://planfinder.ghcscw.com/marketplace/1832104"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240010","Select Platinum 500 Ded/3000X MOOP","94529WI024",,"WIN002","WIS002","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240010-01","Select Platinum 500 Ded/3000X MOOP","Standard Platinum On Exchange Plan",,"0.896056685906042","No","No","No","100%",,"$500","$500","$80","$10","$110","$60","$720","$20","$360","$50","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812104","https://planfinder.ghcscw.com/marketplace/1812104"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240010","Select Platinum 500 Ded/3000X MOOP","94529WI024",,"WIN002","WIS002","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240010-02","Select Platinum 500 Ded/3000X MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812106","https://planfinder.ghcscw.com/marketplace/1812106"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240010","Select Platinum 500 Ded/3000X MOOP","94529WI024",,"WIN002","WIS002","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240010-03","Select Platinum 500 Ded/3000X MOOP  Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.896056685906042","No","No","No","100%",,"$500","$500","$80","$10","$110","$60","$720","$20","$360","$50","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812105","https://planfinder.ghcscw.com/marketplace/1812105"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240012","Select Gold 1500 Ded/5200X MOOP","94529WI024",,"WIN002","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240012-00","Select Gold 1500 Ded/5200X MOOP","Standard Gold Off Exchange Plan",,"0.819954810749618","No","No","No","100%",,"$1,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$320","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1832201","https://planfinder.ghcscw.com/marketplace/1832201"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240012","Select Gold 1500 Ded/5200X MOOP","94529WI024",,"WIN002","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240012-01","Select Gold 1500 Ded/5200X MOOP","Standard Gold On Exchange Plan",,"0.819954810749618","No","No","No","100%",,"$1,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$320","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812201","https://planfinder.ghcscw.com/marketplace/1812201"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240012","Select Gold 1500 Ded/5200X MOOP","94529WI024",,"WIN002","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240012-02","Select Gold 1500 Ded/5200X MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812203","https://planfinder.ghcscw.com/marketplace/1812203"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240012","Select Gold 1500 Ded/5200X MOOP","94529WI024",,"WIN002","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240012-03","Select Gold 1500 Ded/5200X MOOP Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.819954810749618","No","No","No","100%",,"$1,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$320","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812202","https://planfinder.ghcscw.com/marketplace/1812202"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240013","Select Gold 2500 Ded/7000X MOOP","94529WI024",,"WIN002","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240013-00","Select Gold 2500 Ded/7000X MOOP","Standard Gold Off Exchange Plan",,"0.794305332377655","No","No","No","100%",,"$2,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$300","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1832204","https://planfinder.ghcscw.com/marketplace/1832204"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240013","Select Gold 2500 Ded/7000X MOOP","94529WI024",,"WIN002","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240013-01","Select Gold 2500 Ded/7000X MOOP","Standard Gold On Exchange Plan",,"0.794305332377655","No","No","No","100%",,"$2,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$300","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812204","https://planfinder.ghcscw.com/marketplace/1812204"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240013","Select Gold 2500 Ded/7000X MOOP","94529WI024",,"WIN002","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240013-02","Select Gold 2500 Ded/7000X MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812206","https://planfinder.ghcscw.com/marketplace/1812206"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240013","Select Gold 2500 Ded/7000X MOOP","94529WI024",,"WIN002","WIS002","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240013-03","Select Gold 2500 Ded/7000X MOOP Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.794305332377655","No","No","No","100%",,"$2,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$300","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812205","https://planfinder.ghcscw.com/marketplace/1812205"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240020","Catastrophic 7350 Ded/7350 MOOP","94529WI024",,"WIN001","WIS001","WIF007","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240020-00","Catastrophic 7350 Ded/7350 MOOP","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$5,430","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1831001","https://planfinder.ghcscw.com/marketplace/1831001"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250001","Platinum No Ded/3000X MOOP","94529WI025",,"WIN001","WIS003","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250001-00","Platinum No Ded/3000X MOOP","Standard Platinum Off Exchange Plan",,"0.91687090514424","No","No","No","100%",,"$0","$1,000","$80","$10","$0","$80","$720","$20","$0","$120","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1841101","https://planfinder.ghcscw.com/marketplace/1841101"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250001","Platinum No Ded/3000X MOOP","94529WI025",,"WIN001","WIS003","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250001-01","Platinum No Ded/3000X MOOP","Standard Platinum On Exchange Plan",,"0.91687090514424","No","No","No","100%",,"$0","$1,000","$80","$10","$0","$80","$720","$20","$0","$120","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1821101","https://planfinder.ghcscw.com/marketplace/1821101"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240020","Catastrophic 7350 Ded/7350 MOOP","94529WI024",,"WIN001","WIS001","WIF007","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240020-01","Catastrophic 7350 Ded/7350 MOOP","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$5,430","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1811001","https://planfinder.ghcscw.com/marketplace/1811001"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240021","Select Catastrophic 7350 Ded/7350 MOOP","94529WI024",,"WIN002","WIS002","WIF007","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240021-00","Select Catastrophic 7350 Ded/7350 MOOP","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$5,430","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1832001","https://planfinder.ghcscw.com/marketplace/1832001"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250002","Platinum 500 Ded/3000X MOOP","94529WI025",,"WIN001","WIS003","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250002-00","Platinum 500 Ded/3000X MOOP","Standard Platinum Off Exchange Plan",,"0.896056685906042","No","No","No","100%",,"$500","$500","$80","$10","$110","$60","$720","$20","$360","$50","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1841104","https://planfinder.ghcscw.com/marketplace/1841104"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250002","Platinum 500 Ded/3000X MOOP","94529WI025",,"WIN001","WIS003","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250002-01","Platinum 500 Ded/3000X MOOP","Standard Platinum On Exchange Plan",,"0.896056685906042","No","No","No","100%",,"$500","$500","$80","$10","$110","$60","$720","$20","$360","$50","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1821104","https://planfinder.ghcscw.com/marketplace/1821104"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240021","Select Catastrophic 7350 Ded/7350 MOOP","94529WI024",,"WIN002","WIS002","WIF007","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240021-01","Select Catastrophic 7350 Ded/7350 MOOP","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$5,430","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1812001","https://planfinder.ghcscw.com/marketplace/1812001"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250004","Gold 1500 Ded/5200X MOOP","94529WI025",,"WIN001","WIS003","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250004-00","Gold 1500 Ded/5200X MOOP","Standard Gold Off Exchange Plan",,"0.819954810749618","No","No","No","100%",,"$1,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$320","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1841201","https://planfinder.ghcscw.com/marketplace/1841201"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250004","Gold 1500 Ded/5200X MOOP","94529WI025",,"WIN001","WIS003","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250004-01","Gold 1500 Ded/5200X MOOP","Standard Gold On Exchange Plan",,"0.819954810749618","No","No","No","100%",,"$1,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$320","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1821201","https://planfinder.ghcscw.com/marketplace/1821201"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250005","Gold 2500 Ded/7000X MOOP","94529WI025",,"WIN001","WIS003","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250005-00","Gold 2500 Ded/7000X MOOP","Standard Gold Off Exchange Plan",,"0.794305332377655","No","No","No","100%",,"$2,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$300","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1841204","https://planfinder.ghcscw.com/marketplace/1841204"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250005","Gold 2500 Ded/7000X MOOP","94529WI025",,"WIN001","WIS003","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250005-01","Gold 2500 Ded/7000X MOOP","Standard Gold On Exchange Plan",,"0.794305332377655","No","No","No","100%",,"$2,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$300","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1821204","https://planfinder.ghcscw.com/marketplace/1821204"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250006","Silver 4000 Ded/7350X MOOP","94529WI025",,"WIN001","WIS003","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250006-00","Silver 4000 Ded/7350X MOOP","Standard Silver Off Exchange Plan",,"0.7084281936391","No","No","No","100%",,"$4,000","$0","$400","$10","$110","$50","$2,160","$20","$360","$50","$600","$0",,"0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1841301","https://planfinder.ghcscw.com/marketplace/1841301"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250006","Silver 4000 Ded/7350X MOOP","94529WI025",,"WIN001","WIS003","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250006-01","Silver 4000 Ded/7350X MOOP","Standard Silver On Exchange Plan",,"0.7084281936391","No","No","No","100%",,"$4,000","$0","$400","$10","$110","$50","$2,160","$20","$360","$50","$600","$0",,"0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1821301","https://planfinder.ghcscw.com/marketplace/1821301"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250008","Silver 5000 Ded/7350X MOOP","94529WI025",,"WIN001","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250008-00","Silver 5000 Ded/7350X MOOP","Standard Silver Off Exchange Plan",,"0.716902197502333","No","No","No","100%",,"$5,000","$0","$320","$10","$110","$50","$1,170","$20","$360","$50","$700","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1841313","https://planfinder.ghcscw.com/marketplace/1841313"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250008","Silver 5000 Ded/7350X MOOP","94529WI025",,"WIN001","WIS003","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250008-01","Silver 5000 Ded/7350X MOOP","Standard Silver On Exchange Plan",,"0.716902197502333","No","No","No","100%",,"$5,000","$0","$320","$10","$110","$50","$1,170","$20","$360","$50","$700","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1821313","https://planfinder.ghcscw.com/marketplace/1821313"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250009","Select Platinum No Ded/3000X MOOP","94529WI025",,"WIN002","WIS004","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250009-00","Select Platinum No Ded/3000X MOOP","Standard Platinum Off Exchange Plan",,"0.91687090514424","No","No","No","100%",,"$0","$1,000","$80","$10","$0","$80","$720","$20","$0","$120","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1842101","https://planfinder.ghcscw.com/marketplace/1842101"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250009","Select Platinum No Ded/3000X MOOP","94529WI025",,"WIN002","WIS004","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250009-01","Select Platinum No Ded/3000X MOOP","Standard Platinum On Exchange Plan",,"0.91687090514424","No","No","No","100%",,"$0","$1,000","$80","$10","$0","$80","$720","$20","$0","$120","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1822101","https://planfinder.ghcscw.com/marketplace/1822101"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250010","Select Platinum 500 Ded/3000X MOOP","94529WI025",,"WIN002","WIS004","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250010-00","Select Platinum 500 Ded/3000X MOOP","Standard Platinum Off Exchange Plan",,"0.896056685906042","No","No","No","100%",,"$500","$500","$80","$10","$110","$60","$720","$20","$360","$50","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1842104","https://planfinder.ghcscw.com/marketplace/1842104"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250010","Select Platinum 500 Ded/3000X MOOP","94529WI025",,"WIN002","WIS004","WIF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250010-01","Select Platinum 500 Ded/3000X MOOP","Standard Platinum On Exchange Plan",,"0.896056685906042","No","No","No","100%",,"$500","$500","$80","$10","$110","$60","$720","$20","$360","$50","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1822104","https://planfinder.ghcscw.com/marketplace/1822104"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250012","Select Gold 1500 Ded/5200X MOOP","94529WI025",,"WIN002","WIS004","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250012-00","Select Gold 1500 Ded/5200X MOOP","Standard Gold Off Exchange Plan",,"0.819954810749618","No","No","No","100%",,"$1,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$320","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1842201","https://planfinder.ghcscw.com/marketplace/1842201"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250012","Select Gold 1500 Ded/5200X MOOP","94529WI025",,"WIN002","WIS004","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250012-01","Select Gold 1500 Ded/5200X MOOP","Standard Gold On Exchange Plan",,"0.819954810749618","No","No","No","100%",,"$1,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$320","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1822201","https://planfinder.ghcscw.com/marketplace/1822201"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250013","Select Gold 2500 Ded/7000X MOOP","94529WI025",,"WIN002","WIS004","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250013-00","Select Gold 2500 Ded/7000X MOOP","Standard Gold Off Exchange Plan",,"0.794305332377655","No","No","No","100%",,"$2,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$300","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1842204","https://planfinder.ghcscw.com/marketplace/1842204"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250013","Select Gold 2500 Ded/7000X MOOP","94529WI025",,"WIN002","WIS004","WIF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250013-01","Select Gold 2500 Ded/7000X MOOP","Standard Gold On Exchange Plan",,"0.794305332377655","No","No","No","100%",,"$2,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$300","$0","$300","0","0","0","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1822204","https://planfinder.ghcscw.com/marketplace/1822204"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250014","Select Silver 4000 Ded/7350X MOOP","94529WI025",,"WIN002","WIS004","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250014-00","Select Silver 4000 Ded/7350X MOOP","Standard Silver Off Exchange Plan",,"0.7084281936391","No","No","No","100%",,"$4,000","$0","$400","$10","$110","$50","$2,160","$20","$360","$50","$600","$0",,"0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1842301","https://planfinder.ghcscw.com/marketplace/1842301"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250016","Select Silver 5000 Ded/7350X MOOP","94529WI025",,"WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250016-00","Select Silver 5000 Ded/7350X MOOP","Standard Silver Off Exchange Plan",,"0.716902197502333","No","No","No","100%",,"$5,000","$0","$320","$10","$110","$50","$1,170","$20","$360","$50","$700","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1842313","https://planfinder.ghcscw.com/marketplace/1842313"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0250016","Select Silver 5000 Ded/7350X MOOP","94529WI025",,"WIN002","WIS004","WIF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0250016-01","Select Silver 5000 Ded/7350X MOOP","Standard Silver On Exchange Plan",,"0.716902197502333","No","No","No","100%",,"$5,000","$0","$320","$10","$110","$50","$1,170","$20","$360","$50","$700","$0","$300","0","0","0","$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1822313","https://planfinder.ghcscw.com/marketplace/1822313"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240049","Gold Simple Choice Plan","94529WI024",,"WIN001","WIS001","WIF008","New","HMO","Gold","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240049-00","Gold Simple Choice Plan","Standard Gold Off Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$110","$80","$10","$110","$250","$960","$20","$910","$50","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1831213","https://planfinder.ghcscw.com/marketplace/1831213"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0270001","Platinum 500 Ded/3000X MOOP POS","94529WI027",,"WIN001","WIS006","WIF001","Existing","POS","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0270001-00","Platinum 500 Ded/3000X MOOP POS","Standard Platinum Off Exchange Plan",,"0.896056685906042","No","No","No","100%",,"$500","$500","$80","$10","$110","$60","$720","$20","$360","$50","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1844104","https://planfinder.ghcscw.com/marketplace/1844104"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0270001","Platinum 500 Ded/3000X MOOP POS","94529WI027",,"WIN001","WIS006","WIF001","Existing","POS","Platinum","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0270001-01","Platinum 500 Ded/3000X MOOP POS","Standard Platinum On Exchange Plan",,"0.896056685906042","No","No","No","100%",,"$500","$500","$80","$10","$110","$60","$720","$20","$360","$50","$250","$0","$300","0","0","0","$1,000","$1000 per person","$2000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1824104","https://planfinder.ghcscw.com/marketplace/1824104"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240049","Gold Simple Choice Plan","94529WI024",,"WIN001","WIS001","WIF008","New","HMO","Gold","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240049-01","Gold Simple Choice Plan","Standard Gold On Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$110","$80","$10","$110","$250","$960","$20","$910","$50","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811213","https://planfinder.ghcscw.com/marketplace/1811213"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240049","Gold Simple Choice Plan","94529WI024",,"WIN001","WIS001","WIF008","New","HMO","Gold","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240049-02","Gold Simple Choice Plan Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811215","https://planfinder.ghcscw.com/marketplace/1811215"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0270002","Gold 1500 Ded/5200X MOOP POS","94529WI027",,"WIN001","WIS006","WIF002","Existing","POS","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0270002-00","Gold 1500 Ded/5200X MOOP POS","Standard Gold Off Exchange Plan",,"0.819954810749618","No","No","No","100%",,"$1,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$320","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1844201","https://planfinder.ghcscw.com/marketplace/1844201"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0270002","Gold 1500 Ded/5200X MOOP POS","94529WI027",,"WIN001","WIS006","WIF002","Existing","POS","Gold","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0270002-01","Gold 1500 Ded/5200X MOOP POS","Standard Gold On Exchange Plan",,"0.819954810749618","No","No","No","100%",,"$1,500","$0","$160","$10","$110","$50","$1,160","$20","$360","$50","$320","$0","$300","0","0","0","$2,200","$2200 per person","$4400 per group",,,,"$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1824201","https://planfinder.ghcscw.com/marketplace/1824201"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240049","Gold Simple Choice Plan","94529WI024",,"WIN001","WIS001","WIF008","New","HMO","Gold","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240049-03","Gold Simple Choice Plan Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$110","$80","$10","$110","$250","$960","$20","$910","$50","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811214","https://planfinder.ghcscw.com/marketplace/1811214"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240051","Bronze Simple Choice Plan","94529WI024",,"WIN001","WIS001","WIF010","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240051-00","Bronze Simple Choice Plan","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$140","$10","$3,940","$250","$1,230","$20","$910","$50","$150","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1831407","https://planfinder.ghcscw.com/marketplace/1831407"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0270003","Silver 4000 Ded/7350X MOOP POS","94529WI027",,"WIN001","WIS006","WIF004","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0270003-00","Silver 4000 Ded/7350X MOOP POS","Standard Silver Off Exchange Plan",,"0.718999489961355","No","No","No","100%",,"$4,000","$0","$320","$10","$110","$50","$2,040","$20","$360","$50","$600","$0","$300","0","0","0","$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1844301","https://planfinder.ghcscw.com/marketplace/1844301"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","SHOP (Small Group)","No","39-1199466","94529WI0270003","Silver 4000 Ded/7350X MOOP POS","94529WI027",,"WIN001","WIS006","WIF004","Existing","POS","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0270003-01","Silver 4000 Ded/7350X MOOP POS","Standard Silver On Exchange Plan",,"0.718999489961355","No","No","No","100%",,"$4,000","$0","$320","$10","$110","$50","$2,040","$20","$360","$50","$600","$0","$300","0","0","0","$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://planfinder.ghcscw.com/sbc/1824301","https://planfinder.ghcscw.com/marketplace/1824301"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240051","Bronze Simple Choice Plan","94529WI024",,"WIN001","WIS001","WIF010","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240051-01","Bronze Simple Choice Plan","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$140","$10","$3,940","$250","$1,230","$20","$910","$50","$150","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1811407","https://planfinder.ghcscw.com/marketplace/1811407"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240051","Bronze Simple Choice Plan","94529WI024",,"WIN001","WIS001","WIF010","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240051-02","Bronze Simple Choice Plan Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1811409","https://planfinder.ghcscw.com/marketplace/1811409"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240051","Bronze Simple Choice Plan","94529WI024",,"WIN001","WIS001","WIF010","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240051-03","Bronze Simple Choice Plan Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$140","$10","$3,940","$250","$1,230","$20","$910","$50","$150","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1811408","https://planfinder.ghcscw.com/marketplace/1811408"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240017","Select Gold Simple Choice Plan","94529WI024",,"WIN002","WIS002","WIF008","Existing","HMO","Gold","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240017-00","Select Gold Simple Choice Plan","Standard Gold Off Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$110","$80","$10","$110","$250","$960","$20","$910","$50","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1832213","https://planfinder.ghcscw.com/marketplace/1832213"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240017","Select Gold Simple Choice Plan","94529WI024",,"WIN002","WIS002","WIF008","Existing","HMO","Gold","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240017-01","Select Gold Simple Choice Plan","Standard Gold On Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$110","$80","$10","$110","$250","$960","$20","$910","$50","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812213","https://planfinder.ghcscw.com/marketplace/1812213"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240017","Select Gold Simple Choice Plan","94529WI024",,"WIN002","WIS002","WIF008","Existing","HMO","Gold","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240017-02","Select Gold Simple Choice Plan Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812215","https://planfinder.ghcscw.com/marketplace/1812215"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240017","Select Gold Simple Choice Plan","94529WI024",,"WIN002","WIS002","WIF008","Existing","HMO","Gold","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240017-03","Select Gold Simple Choice Plan Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$110","$80","$10","$110","$250","$960","$20","$910","$50","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812214","https://planfinder.ghcscw.com/marketplace/1812214"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240019","Select Bronze Simple Choice Plan","94529WI024",,"WIN002","WIS002","WIF010","Existing","HMO","Expanded Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240019-00","Select Bronze Simple Choice Plan","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$140","$10","$3,940","$250","$1,230","$20","$910","$50","$150","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1832407","https://planfinder.ghcscw.com/marketplace/1832407"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240019","Select Bronze Simple Choice Plan","94529WI024",,"WIN002","WIS002","WIF010","Existing","HMO","Expanded Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240019-01","Select Bronze Simple Choice Plan","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$140","$10","$3,940","$250","$1,230","$20","$910","$50","$150","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1812407","https://planfinder.ghcscw.com/marketplace/1812407"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240019","Select Bronze Simple Choice Plan","94529WI024",,"WIN002","WIS002","WIF010","Existing","HMO","Expanded Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240019-02","Select Bronze Simple Choice Plan Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1812409","https://planfinder.ghcscw.com/marketplace/1812409"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240019","Select Bronze Simple Choice Plan","94529WI024",,"WIN002","WIS002","WIF010","Existing","HMO","Expanded Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240019-03","Select Bronze Simple Choice Plan Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$140","$10","$3,940","$250","$1,230","$20","$910","$50","$150","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1812408","https://planfinder.ghcscw.com/marketplace/1812408"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240052","Bronze Simple Choice Plan HSA","94529WI024",,"WIN001","WIS001","WIF007","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240052-00","Bronze Simple Choice Plan HSA","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$5,580","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1831413","https://planfinder.ghcscw.com/marketplace/1831413"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240052","Bronze Simple Choice Plan HSA","94529WI024",,"WIN001","WIS001","WIF007","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240052-01","Bronze Simple Choice Plan HSA","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$5,580","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1811413","https://planfinder.ghcscw.com/marketplace/1811413"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240052","Bronze Simple Choice Plan HSA","94529WI024",,"WIN001","WIS001","WIF007","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240052-02","Bronze Simple Choice Plan Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1811414","https://planfinder.ghcscw.com/marketplace/1811414"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240052","Bronze Simple Choice Plan HSA","94529WI024",,"WIN001","WIS001","WIF007","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240052-03","Bronze Simple Choice Plan HSA Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$5,580","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1811415","https://planfinder.ghcscw.com/marketplace/1811415"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240048","Select Bronze Simple Choice Plan HSA","94529WI024",,"WIN002","WIS002","WIF007","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240048-00","Select Bronze Simple Choice Plan HSA","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$5,580","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1832413","https://planfinder.ghcscw.com/marketplace/1832413"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240048","Select Bronze Simple Choice Plan HSA","94529WI024",,"WIN002","WIS002","WIF007","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240048-01","Select Bronze Simple Choice Plan HSA","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$5,580","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1812413","https://planfinder.ghcscw.com/marketplace/1812413"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240048","Select Bronze Simple Choice Plan HSA","94529WI024",,"WIN002","WIS002","WIF007","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240048-02","Select Bronze Simple Choice Plan Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://planfinder.ghcscw.com/sbc/1812414","https://planfinder.ghcscw.com/marketplace/1812414"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240048","Select Bronze Simple Choice Plan HSA","94529WI024",,"WIN002","WIS002","WIF007","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240048-03","Select Bronze Simple Choice Plan HSA Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$10","$5,580","$250","$0","$20","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://planfinder.ghcscw.com/sbc/1812415","https://planfinder.ghcscw.com/marketplace/1812415"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210023","Silver 2000 Ded/6000 MOOP","94529WI021",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210023-00","Silver 2000 Ded/6000 MOOP","Standard Silver Off Exchange Plan",,"0.709247258237053","No","Yes","No","100%",,"$2,000","$90","$240","$10","$710","$250","$1,740","$20","$1,100","$50","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1831325","https://planfinder.ghcscw.com/marketplace/1831325"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210023","Silver 2000 Ded/6000 MOOP","94529WI021",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210023-01","Silver 2000 Ded/6000 MOOP","Standard Silver On Exchange Plan",,"0.709247258237053","No","Yes","No","100%",,"$2,000","$90","$240","$10","$710","$250","$1,740","$20","$1,100","$50","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811325","https://planfinder.ghcscw.com/marketplace/1811325"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210023","Silver 2000 Ded/6000 MOOP","94529WI021",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210023-02","Silver 2000 Ded/6000 MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811330","https://planfinder.ghcscw.com/marketplace/1811330"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210023","Silver 2000 Ded/6000 MOOP","94529WI021",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210023-03","Silver 2000 Ded/6000 MOOP Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.709247258237053","No","Yes","No","100%",,"$2,000","$90","$240","$10","$710","$250","$1,740","$20","$1,100","$50","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811329","https://planfinder.ghcscw.com/marketplace/1811329"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210023","Silver 2000 Ded/6000 MOOP","94529WI021",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210023-04","Silver 2000 Ded/6000 MOOP 73%","73% AV Level Silver Plan",,"0.738190802627798","No","Yes","No","100%",,"$1,750","$410","$240","$10","$710","$250","$1,740","$20","$1,100","$50","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811326","https://planfinder.ghcscw.com/marketplace/1811326"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210023","Silver 2000 Ded/6000 MOOP","94529WI021",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210023-05","Silver 2000 Ded/6000 MOOP 87%","87% AV Level Silver Plan",,"0.866654816333575","No","Yes","No","100%",,"$500","$880","$120","$10","$450","$180","$870","$20","$500","$170","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811327","https://planfinder.ghcscw.com/marketplace/1811327"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210023","Silver 2000 Ded/6000 MOOP","94529WI021",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210023-06","Silver 2000 Ded/6000 MOOP 94%","94% AV Level Silver Plan",,"0.942325207985741","No","Yes","No","100%",,"$250","$130","$120","$10","$240","$50","$210","$20","$250","$130","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811328","https://planfinder.ghcscw.com/marketplace/1811328"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Ded/6000 MOOP","94529WI021",,"WIN002","WIS002","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210034-00","Select Silver 2000 Ded/6000 MOOP","Standard Silver Off Exchange Plan",,"0.709247258237053","No","Yes","No","100%",,"$2,000","$90","$240","$10","$710","$250","$1,740","$20","$1,100","$50","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1832325","https://planfinder.ghcscw.com/marketplace/1832325"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Ded/6000 MOOP","94529WI021",,"WIN002","WIS002","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210034-01","Select Silver 2000 Ded/6000 MOOP","Standard Silver On Exchange Plan",,"0.709247258237053","No","Yes","No","100%",,"$2,000","$90","$240","$10","$710","$250","$1,740","$20","$1,100","$50","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812325","https://planfinder.ghcscw.com/marketplace/1812325"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Ded/6000 MOOP","94529WI021",,"WIN002","WIS002","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210034-02","Select Silver 2000 Ded/6000 MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812330","https://planfinder.ghcscw.com/marketplace/1812330"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Ded/6000 MOOP","94529WI021",,"WIN002","WIS002","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210034-03","Select Silver 2000 Ded/6000 MOOP Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.709247258237053","No","Yes","No","100%",,"$2,000","$90","$240","$10","$710","$250","$1,740","$20","$1,100","$50","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812329","https://planfinder.ghcscw.com/marketplace/1812329"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Ded/6000 MOOP","94529WI021",,"WIN002","WIS002","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210034-04","Select Silver 2000 Ded/6000 MOOP 73%","73% AV Level Silver Plan",,"0.738190802627798","No","Yes","No","100%",,"$1,750","$410","$240","$10","$710","$250","$1,740","$20","$1,100","$50","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812326","https://planfinder.ghcscw.com/marketplace/1812326"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Ded/6000 MOOP","94529WI021",,"WIN002","WIS002","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210034-05","Select Silver 2000 Ded/6000 MOOP 87%","87% AV Level Silver Plan",,"0.866654816333575","No","Yes","No","100%",,"$500","$880","$120","$10","$450","$180","$870","$20","$500","$170","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812327","https://planfinder.ghcscw.com/marketplace/1812327"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Ded/6000 MOOP","94529WI021",,"WIN002","WIS002","WIF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0210034-06","Select Silver 2000 Ded/6000 MOOP 94%","94% AV Level Silver Plan",,"0.942325207985741","No","Yes","No","100%",,"$250","$130","$120","$10","$240","$50","$210","$20","$250","$130","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812328","https://planfinder.ghcscw.com/marketplace/1812328"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240006","Silver 4000 Ded/7350X MOOP","94529WI024",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240006-00","Silver 4000 Ded/7350X MOOP","Standard Silver Off Exchange Plan",,"0.7084281936391","No","No","No","100%",,"$4,000","$0","$400","$10","$110","$50","$2,160","$20","$360","$50","$600","$0",,"0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1831301","https://planfinder.ghcscw.com/marketplace/1831301"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240006","Silver 4000 Ded/7350X MOOP","94529WI024",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240006-01","Silver 4000 Ded/7350X MOOP","Standard Silver On Exchange Plan",,"0.7084281936391","No","No","No","100%",,"$4,000","$0","$400","$10","$110","$50","$2,160","$20","$360","$50","$600","$0",,"0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811301","https://planfinder.ghcscw.com/marketplace/1811301"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240006","Silver 4000 Ded/7350X MOOP","94529WI024",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240006-02","Silver 4000 Ded/7350X MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811306","https://planfinder.ghcscw.com/marketplace/1811306"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240006","Silver 4000 Ded/7350X MOOP","94529WI024",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240006-03","Silver 4000 Ded/7350X MOOP Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.7084281936391","No","No","No","100%",,"$4,000","$0","$400","$10","$110","$50","$2,160","$20","$360","$50","$600","$0",,"0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811305","https://planfinder.ghcscw.com/marketplace/1811305"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240006","Silver 4000 Ded/7350X MOOP","94529WI024",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240006-04","Silver 4000 Ded/7350X MOOP 73%","73% AV Level Silver Plan",,"0.735617558864075","No","No","No","100%",,"$4,000","$0","$400","$10","$110","$50","$1,560","$20","$360","$50","$600","$0",,"0","0","0","$4,150","$4150 per person","$8300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811302","https://planfinder.ghcscw.com/marketplace/1811302"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240006","Silver 4000 Ded/7350X MOOP","94529WI024",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240006-05","Silver 4000 Ded/7350X MOOP 87%","87% AV Level Silver Plan",,"0.864168788198971","No","No","No","100%",,"$500","$500","$400","$10","$110","$50","$900","$20","$360","$50","$600","$0",,"0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811303","https://planfinder.ghcscw.com/marketplace/1811303"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240006","Silver 4000 Ded/7350X MOOP","94529WI024",,"WIN001","WIS001","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240006-06","Silver 4000 Ded/7350X MOOP 94%","94% AV Level Silver Plan",,"0.94181605460055","No","No","No","100%",,"$0","$250","$400","$10","$0","$70","$450","$20","$0","$0","$250","$0",,"0","0","0","$250","$250 per person","$500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811304","https://planfinder.ghcscw.com/marketplace/1811304"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240014","Select Silver 4000 Ded/7350X MOOP","94529WI024",,"WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240014-00","Select Silver 4000 Ded/7350X MOOP","Standard Silver Off Exchange Plan",,"0.7084281936391","No","No","No","100%",,"$4,000","$0","$400","$10","$110","$50","$2,160","$20","$360","$50","$600","$0",,"0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1832301","https://planfinder.ghcscw.com/marketplace/1832301"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240014","Select Silver 4000 Ded/7350X MOOP","94529WI024",,"WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240014-01","Select Silver 4000 Ded/7350X MOOP","Standard Silver On Exchange Plan",,"0.7084281936391","No","No","No","100%",,"$4,000","$0","$400","$10","$110","$50","$2,160","$20","$360","$50","$600","$0",,"0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812301","https://planfinder.ghcscw.com/marketplace/1812301"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240014","Select Silver 4000 Ded/7350X MOOP","94529WI024",,"WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240014-02","Select Silver 4000 Ded/7350X MOOP Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812306","https://planfinder.ghcscw.com/marketplace/1812306"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240014","Select Silver 4000 Ded/7350X MOOP","94529WI024",,"WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240014-03","Select Silver 4000 Ded/7350X MOOP Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.7084281936391","No","No","No","100%",,"$4,000","$0","$400","$10","$110","$50","$2,160","$20","$360","$50","$600","$0",,"0","0","0","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812305","https://planfinder.ghcscw.com/marketplace/1812305"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240014","Select Silver 4000 Ded/7350X MOOP","94529WI024",,"WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240014-04","Select Silver 4000 Ded/7350X MOOP 73%","73% AV Level Silver Plan",,"0.735617558864075","No","No","No","100%",,"$4,000","$0","$400","$10","$110","$50","$1,560","$20","$360","$50","$600","$0",,"0","0","0","$4,150","$4150 per person","$8300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812302","https://planfinder.ghcscw.com/marketplace/1812302"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240014","Select Silver 4000 Ded/7350X MOOP","94529WI024",,"WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240014-05","Select Silver 4000 Ded/7350X MOOP 87%","87% AV Level Silver Plan",,"0.864168788198971","No","No","No","100%",,"$500","$500","$400","$10","$110","$50","$900","$20","$360","$50","$600","$0",,"0","0","0","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812303","https://planfinder.ghcscw.com/marketplace/1812303"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240014","Select Silver 4000 Ded/7350X MOOP","94529WI024",,"WIN002","WIS002","WIF005","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240014-06","Select Silver 4000 Ded/7350X MOOP 94%","94% AV Level Silver Plan",,"0.94181605460055","No","No","No","100%",,"$0","$250","$400","$10","$0","$70","$450","$20","$0","$0","$250","$0",,"0","0","0","$250","$250 per person","$500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812304","https://planfinder.ghcscw.com/marketplace/1812304"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240050","Silver Simple Choice Plan","94529WI024",,"WIN001","WIS001","WIF009","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240050-00","Silver Simple Choice Plan","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$0","$120","$10","$610","$250","$1,300","$20","$910","$50","$130","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1831343","https://planfinder.ghcscw.com/marketplace/1831343"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240050","Silver Simple Choice Plan","94529WI024",,"WIN001","WIS001","WIF009","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240050-02","Silver Simple Choice Plan Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811348","https://planfinder.ghcscw.com/marketplace/1811348"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240050","Silver Simple Choice Plan","94529WI024",,"WIN001","WIS001","WIF009","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240050-03","Silver Simple Choice Plan Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$0","$120","$10","$610","$250","$1,300","$20","$910","$50","$130","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811347","https://planfinder.ghcscw.com/marketplace/1811347"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240050","Silver Simple Choice Plan","94529WI024",,"WIN001","WIS001","WIF009","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240050-04","Silver Simple Choice Plan 73%","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$0","$120","$10","$310","$250","$1,300","$20","$910","$50","$130","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811344","https://planfinder.ghcscw.com/marketplace/1811344"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240050","Silver Simple Choice Plan","94529WI024",,"WIN001","WIS001","WIF009","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240050-05","Silver Simple Choice Plan 87%","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$950","$40","$10","$110","$250","$550","$20","$700","$90","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811345","https://planfinder.ghcscw.com/marketplace/1811345"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240050","Silver Simple Choice Plan","94529WI024",,"WIN001","WIS001","WIF009","New","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240050-06","Silver Simple Choice Plan 94%","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$190","$20","$10","$110","$250","$190","$20","$250","$80","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1811346","https://planfinder.ghcscw.com/marketplace/1811346"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240018","Select Silver Simple Choice Plan","94529WI024",,"WIN002","WIS002","WIF009","Existing","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240018-00","Select Silver Simple Choice Plan","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$0","$120","$10","$610","$250","$1,300","$20","$910","$50","$130","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1832343","https://planfinder.ghcscw.com/marketplace/1832343"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240018","Select Silver Simple Choice Plan","94529WI024",,"WIN002","WIS002","WIF009","Existing","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240018-01","Select Silver Simple Choice Plan","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$0","$120","$10","$610","$250","$1,300","$20","$910","$50","$130","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812343","https://planfinder.ghcscw.com/marketplace/1812343"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240018","Select Silver Simple Choice Plan","94529WI024",,"WIN002","WIS002","WIF009","Existing","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240018-02","Select Silver Simple Choice Plan Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$20","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812348","https://planfinder.ghcscw.com/marketplace/1812348"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240018","Select Silver Simple Choice Plan","94529WI024",,"WIN002","WIS002","WIF009","Existing","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240018-03","Select Silver Simple Choice Plan Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$0","$120","$10","$610","$250","$1,300","$20","$910","$50","$130","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812347","https://planfinder.ghcscw.com/marketplace/1812347"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240018","Select Silver Simple Choice Plan","94529WI024",,"WIN002","WIS002","WIF009","Existing","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240018-04","Select Silver Simple Choice Plan 73%","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$0","$120","$10","$310","$250","$1,300","$20","$910","$50","$130","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812344","https://planfinder.ghcscw.com/marketplace/1812344"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240018","Select Silver Simple Choice Plan","94529WI024",,"WIN002","WIS002","WIF009","Existing","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240018-05","Select Silver Simple Choice Plan 87%","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$950","$40","$10","$110","$250","$550","$20","$700","$90","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812345","https://planfinder.ghcscw.com/marketplace/1812345"
"2018","WI","94529","HIOS","2017-11-01 02:20:20","Individual","No","39-1199466","94529WI0240018","Select Silver Simple Choice Plan","94529WI024",,"WIN002","WIS002","WIF009","Existing","HMO","Silver","Design 1","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://ghcscw.com/welcome","https://www.ghcscw.com/health-insurance/understanding-pharmacy-benefits","94529WI0240018-06","Select Silver Simple Choice Plan 94%","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$190","$20","$10","$110","$250","$190","$20","$250","$80","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://planfinder.ghcscw.com/sbc/1812346","https://planfinder.ghcscw.com/marketplace/1812346"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070013","BlueSelect Gold HealthPlus","11269WY007","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070013-00","BlueSelect Gold HealthPlus","Standard Gold Off Exchange Plan","80.78%","0.803247248009522","Yes","Yes","No","100%",,"$1,000","$20","$2,300","$60","$1,000","$500","$300","$60","$1,000","$0","$200","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,000","$21000 per person","$42000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlusIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070013","BlueSelect Gold HealthPlus","11269WY007","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070013-01","BlueSelect Gold HealthPlus","Standard Gold On Exchange Plan","80.78%","0.803247248009522","Yes","Yes","No","100%",,"$1,000","$20","$2,300","$60","$1,000","$500","$300","$60","$1,000","$0","$200","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,000","$21000 per person","$42000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlusIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070013","BlueSelect Gold HealthPlus","11269WY007","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070013-02","BlueSelect Gold HealthPlus","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlus100forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070013","BlueSelect Gold HealthPlus","11269WY007","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070013-03","BlueSelect Gold HealthPlus","Limited Cost Sharing Plan Variation","80.78%","0.803247248009522","Yes","Yes","No","100%",,"$1,000","$20","$2,300","$60","$1,000","$500","$300","$60","$1,000","$0","$200","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$21,000","$21000 per person","$42000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlus300forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus","11269WY007","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-00","BlueSelect Silver HealthPlus","Standard Silver Off Exchange Plan","70.72%","0.700301888228176","Yes","Yes","No","100%",,"$3,500","$20","$2,200","$60","$2,500","$1,000","$0","$60","$1,900","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","25.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,500","$23500 per person","$47000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlusIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus","11269WY007","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-01","BlueSelect Silver HealthPlus","Standard Silver On Exchange Plan","70.72%","0.700301888228176","Yes","Yes","No","100%",,"$3,500","$20","$2,200","$60","$2,500","$1,000","$0","$60","$1,900","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","25.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,500","$23500 per person","$47000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlusIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus","11269WY007","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-02","BlueSelect Silver HealthPlus","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus100forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus","11269WY007","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-03","BlueSelect Silver HealthPlus","Limited Cost Sharing Plan Variation","70.72%","0.700301888228176","Yes","Yes","No","100%",,"$3,500","$20","$2,200","$60","$2,500","$1,000","$0","$60","$1,900","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","25.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,500","$23500 per person","$47000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus300forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus","11269WY007","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-04","BlueSelect Silver HealthPlus","73% AV Level Silver Plan","72.78%","0.721568124844647","Yes","Yes","No","100%",,"$3,500","$20","$2,200","$60","$2,500","$900","$0","$60","$1,900","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","25.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,500","$23500 per person","$47000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus73DentalforIndividuals18","https://www.bcbswy.com/docs/coverage/2018/Subsidy_Silver73.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus","11269WY007","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-05","BlueSelect Silver HealthPlus","87% AV Level Silver Plan","86.25%","0.858394145035291","Yes","Yes","No","100%",,"$650","$10","$1,700","$60","$650","$600","$500","$60","$650","$0","$300","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","25.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,650","$20650 per person","$41300 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus87DentalforIndividuals18","https://www.bcbswy.com/docs/coverage/2018/Subsidy_Silver87.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070011","BlueSelect Gold Classic","11269WY007","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070011-00","BlueSelect Gold Classic","Standard Gold Off Exchange Plan",,"0.815178121606631","Yes","Yes","No","100%",,"$750","$20","$2,300","$60","$750","$500","$300","$60","$750","$0","$200","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,750","$20750 per person","$41500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassicIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070011","BlueSelect Gold Classic","11269WY007","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070011-01","BlueSelect Gold Classic","Standard Gold On Exchange Plan",,"0.815178121606631","Yes","Yes","No","100%",,"$750","$20","$2,300","$60","$750","$500","$300","$60","$750","$0","$200","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,750","$20750 per person","$41500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassicIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070011","BlueSelect Gold Classic","11269WY007","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070011-02","BlueSelect Gold Classic","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassic100forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070011","BlueSelect Gold Classic","11269WY007","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070011-03","BlueSelect Gold Classic","Limited Cost Sharing Plan Variation",,"0.815178121606631","Yes","Yes","No","100%",,"$750","$20","$2,300","$60","$750","$500","$300","$60","$750","$0","$200","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,750","$20750 per person","$41500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassic300forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic","11269WY007","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-00","BlueSelect Silver Classic","Standard Silver Off Exchange Plan",,"0.70107544955652","Yes","Yes","No","100%",,"$2,500","$20","$4,000","$60","$2,500","$1,000","$0","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"$20,000","$20000 per person","$40000 per group","$22,500","$22500 per person","$45000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassicIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic","11269WY007","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-01","BlueSelect Silver Classic","Standard Silver On Exchange Plan",,"0.70107544955652","Yes","Yes","No","100%",,"$2,500","$20","$4,000","$60","$2,500","$1,000","$0","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"$20,000","$20000 per person","$40000 per group","$22,500","$22500 per person","$45000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassicIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic","11269WY007","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-02","BlueSelect Silver Classic","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic100forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic","11269WY007","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-03","BlueSelect Silver Classic","Limited Cost Sharing Plan Variation",,"0.70107544955652","Yes","Yes","No","100%",,"$2,500","$20","$4,000","$60","$2,500","$1,000","$0","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"$20,000","$20000 per person","$40000 per group","$22,500","$22500 per person","$45000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic300forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic","11269WY007","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-06","BlueSelect Silver Classic","94% AV Level Silver Plan",,"0.931423140382649","Yes","Yes","No","100%",,"$50","$0","$800","$60","$50","$200","$500","$60","$50","$0","$800","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","40.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,050","$20050 per person","$40100 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic94DentalforIndividuals18","https://www.bcbswy.com/docs/coverage/2018/Subsidy_Silver94.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070019","BlueSelect Bronze Value","11269WY007","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070019-00","BlueSelect Bronze Value","Standard Bronze Off Exchange Plan",,"0.596947317996425","No","Yes","No","100%",,"$6,000","$30","$1,300","$60","$2,900","$2,200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$26,000","$26000 per person","$52000 per group","$1,500","$1500 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValueIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070019","BlueSelect Bronze Value","11269WY007","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070019-01","BlueSelect Bronze Value","Standard Bronze On Exchange Plan",,"0.596947317996425","No","Yes","No","100%",,"$6,000","$30","$1,300","$60","$2,900","$2,200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$26,000","$26000 per person","$52000 per group","$1,500","$1500 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValueIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070019","BlueSelect Bronze Value","11269WY007","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070019-02","BlueSelect Bronze Value","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValue100forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070019","BlueSelect Bronze Value","11269WY007","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070019-03","BlueSelect Bronze Value","Limited Cost Sharing Plan Variation",,"0.596947317996425","No","Yes","No","100%",,"$6,000","$30","$1,300","$60","$2,900","$2,200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$26,000","$26000 per person","$52000 per group","$1,500","$1500 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValue300forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver Value","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-00","BlueSelect Silver Value","Standard Silver Off Exchange Plan",,"0.708655397836238","No","Yes","No","100%",,"$3,000","$20","$1,900","$60","$2,500","$1,000","$0","$60","$1,900","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,000","$23000 per person","$46000 per group","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver Value","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-01","BlueSelect Silver Value","Standard Silver On Exchange Plan",,"0.708655397836238","No","Yes","No","100%",,"$3,000","$20","$1,900","$60","$2,500","$1,000","$0","$60","$1,900","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,000","$23000 per person","$46000 per group","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver Value","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-02","BlueSelect Silver Value","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValue100forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver Value","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-03","BlueSelect Silver Value","Limited Cost Sharing Plan Variation",,"0.708655397836238","No","Yes","No","100%",,"$3,000","$20","$1,900","$60","$2,500","$1,000","$0","$60","$1,900","$0","$0","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,000","$23000 per person","$46000 per group","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValue300forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver Value","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-06","BlueSelect Silver Value","94% AV Level Silver Plan",,"0.93032667706431","No","Yes","No","100%",,"$150","$10","$800","$60","$150","$400","$400","$60","$150","$0","$400","$0",,"0","0","6",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,150","$20150 per person","$40300 per group","$50","$50 per person","$100 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValue94DentalforIndividuals18","https://www.bcbswy.com/docs/coverage/2018/Subsidy_Silver94.pdf"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","47731WY0020003","BESTOne Advantage Gold","47731WY002",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47731WY0010007","BESTDental Premium","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010007-00","BESTDental Premium","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTDental_Premium_Plan.pdf"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47731WY0010007","BESTDental Premium","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010007-01","BESTDental Premium","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTDental_Premium_Plan.pdf"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","47731WY0020003","BESTOne Advantage Gold","47731WY002",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","47731WY0020004","BESTOne Plus Gold","47731WY002",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47731WY0010008","BESTDental Standard - H","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTDental_Standard-H_Plan.pdf"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47731WY0010008","BESTDental Standard - H","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTDental_Standard-H_Plan.pdf"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","47731WY0020004","BESTOne Plus Gold","47731WY002",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47731WY0010010","BESTDental Choice - H","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTDental_Choice-H_Plan.pdf"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47731WY0010010","BESTDental Choice - H","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTDental_Choice-H_Plan.pdf"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47731WY0010009","BESTDental Standard - L","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTDental_Premium_Plan.pdf"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","47731WY0020005","BESTOne Plus Silver","47731WY002",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070024","BlueSelect Gold Balance","11269WY007","7154324389","WYN001","WYS001","WYF002","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070024-00","BlueSelect Gold Balance","Standard Gold Off Exchange Plan","76.24%","0.727271639026048","Yes","Yes","No","100%",,"$2,000","$80","$3,600","$60","$500","$900","$400","$60","$500","$500","$200","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$22,000","$22000 per person","$44000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBalanceIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070024","BlueSelect Gold Balance","11269WY007","7154324389","WYN001","WYS001","WYF002","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070024-01","BlueSelect Gold Balance","Standard Gold On Exchange Plan","76.24%","0.727271639026048","Yes","Yes","No","100%",,"$2,000","$80","$3,600","$60","$500","$900","$400","$60","$500","$500","$200","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$22,000","$22000 per person","$44000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBalanceIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070024","BlueSelect Gold Balance","11269WY007","7154324389","WYN001","WYS001","WYF002","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070024-02","BlueSelect Gold Balance","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBalance100forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070024","BlueSelect Gold Balance","11269WY007","7154324389","WYN001","WYS001","WYF002","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070024-03","BlueSelect Gold Balance","Limited Cost Sharing Plan Variation","76.24%","0.727271639026048","Yes","Yes","No","100%",,"$2,000","$80","$3,600","$60","$500","$900","$400","$60","$500","$500","$200","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$20,000","$20000 per person","$40000 per group","$22,000","$22000 per person","$44000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBalance300forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070023","BlueSelect Silver Balance","11269WY007","7154324389","WYN001","WYS001","WYF005","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070023-00","BlueSelect Silver Balance","Standard Silver Off Exchange Plan","67.65%","0.643498660588646","Yes","Yes","No","100%",,"$6,000","$100","$1,200","$60","$1,500","$1,600","$300","$60","$1,400","$500","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","25.00%",,,,,"$20,000","$20000 per person","$40000 per group","$26,000","$26000 per person","$52000 per group","No",,,"http://wyomingbluesbc.com.com/marketplace/BlueSelectSilverBalanceIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070023","BlueSelect Silver Balance","11269WY007","7154324389","WYN001","WYS001","WYF005","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070023-01","BlueSelect Silver Balance","Standard Silver On Exchange Plan","67.65%","0.643498660588646","Yes","Yes","No","100%",,"$6,000","$100","$1,200","$60","$1,500","$1,600","$300","$60","$1,400","$500","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","25.00%",,,,,"$20,000","$20000 per person","$40000 per group","$26,000","$26000 per person","$52000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBalanceIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070023","BlueSelect Silver Balance","11269WY007","7154324389","WYN001","WYS001","WYF005","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070023-02","BlueSelect Silver Balance","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBalance100forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070023","BlueSelect Silver Balance","11269WY007","7154324389","WYN001","WYS001","WYF005","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070023-03","BlueSelect Silver Balance","Limited Cost Sharing Plan Variation","67.65%","0.643498660588646","Yes","Yes","No","100%",,"$6,000","$100","$1,200","$60","$1,500","$1,600","$300","$60","$1,400","$500","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","25.00%",,,,,"$20,000","$20000 per person","$40000 per group","$26,000","$26000 per person","$52000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBalance300forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070023","BlueSelect Silver Balance","11269WY007","7154324389","WYN001","WYS001","WYF005","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070023-04","BlueSelect Silver Balance","73% AV Level Silver Plan","72.15%","0.689852407681515","Yes","Yes","No","100%",,"$4,000","$60","$3,300","$60","$1,000","$1,600","$400","$60","$1,000","$500","$100","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","25.00%",,,,,"$20,000","$20000 per person","$40000 per group","$24,000","$24000 per person","$48000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBalance73DentalforIndividuals18","https://www.bcbswy.com/docs/coverage/2018/Subsidy_Silver73.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070023","BlueSelect Silver Balance","11269WY007","7154324389","WYN001","WYS001","WYF005","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070023-05","BlueSelect Silver Balance","87% AV Level Silver Plan","86.35%","0.851759592183304","Yes","Yes","No","100%",,"$600","$0","$1,800","$60","$150","$1,200","$400","$60","$150","$500","$200","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","15.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,600","$20600 per person","$41200 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBalance87DentalforIndividuals18","https://www.bcbswy.com/docs/coverage/2018/Subsidy_Silver87.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070023","BlueSelect Silver Balance","11269WY007","7154324389","WYN001","WYS001","WYF005","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070023-06","BlueSelect Silver Balance","94% AV Level Silver Plan","93.03%","0.927479776378468","Yes","Yes","No","100%",,"$200","$0","$900","$60","$50","$300","$300","$60","$200","$300","$200","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%",,,,,"$20,000","$20000 per person","$40000 per group","$20,200","$20200 per person","$40400 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBalance94DentalforIndividuals18","https://www.bcbswy.com/docs/coverage/2018/Subsidy_Silver94.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070022","BlueSelect Bronze Balance","11269WY007","7154324389","WYN001","WYS001","WYF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070022-00","BlueSelectBronze Balance","Standard Bronze Off Exchange Plan","58.50%","0","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$3,500","$0","$1,100","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$30,500","$30500 per person","$61000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBalanceIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070022","BlueSelect Bronze Balance","11269WY007","7154324389","WYN001","WYS001","WYF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070022-01","BlueSelectBronze Balance","Standard Bronze On Exchange Plan","58.50%","0","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$3,500","$0","$1,100","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$30,500","$30500 per person","$61000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBalanceIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070022","BlueSelect Bronze Balance","11269WY007","7154324389","WYN001","WYS001","WYF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070022-02","BlueSelectBronze Balance","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBalance100forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070022","BlueSelect Bronze Balance","11269WY007","7154324389","WYN001","WYS001","WYF008","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070022-03","BlueSelectBronze Balance","Limited Cost Sharing Plan Variation","58.50%","0","Yes","Yes","No","100%",,"$7,400","$0","$0","$60","$3,500","$0","$1,100","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$30,500","$30500 per person","$61000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBalance300forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070004","BlueSelect Bronze Core","11269WY007","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070004-01","BlueSelect Bronze Core","Standard Bronze On Exchange Plan",,"0.612246328779518","Yes","Yes","No","100%",,"$4,500","$0","$2,100","$60","$4,500","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","50.00%",,,,,"$20,000","per person not applicable","$40000 per group","$24,500","per person not applicable","$49000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeCoreIXD18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070004","BlueSelect Bronze Core","11269WY007","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070004-02","BlueSelect Bronze Core","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeCore100forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","WY","11269","HIOS","2017-11-01 02:20:20","Individual","No","83-0231011","11269WY0070004","BlueSelect Bronze Core","11269WY007","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,"2018-01-01",,"Yes","Blue Cross Blue Shield Global Core – Have access to doctors and hospitals in more than 200 countries and territories around the world.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbsglobalcore.com.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070004-03","BlueSelect Bronze Core","Limited Cost Sharing Plan Variation",,"0.612246328779518","Yes","Yes","No","100%",,"$4,500","$0","$2,100","$60","$4,500","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","50.00%",,,,,"$20,000","per person not applicable","$40000 per group","$24,500","per person not applicable","$49000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeCore300forTribalMembersDental18","https://www.bcbswy.com/docs/coverage/2018/BCBSWY_BlueSelect_IndFam_BRO.pdf"
"2018","AR","75293","OPM","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1210002","Silver Plan AWM1","75293AR121","7427051652","ARN201","ARS201","ARF103","Existing","PPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list\exchange\metallicdruglist.aspx?yr=2018","75293AR1210002-04","Silver Plan AWM1","73% AV Level Silver Plan",,"0.739948349209459","No","Yes","No","100%",,"$2,000","$90","$1,600","$90","$200","$2,400","$0","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","15.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32028&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","OPM","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1210002","Silver Plan AWM1","75293AR121","7427051652","ARN201","ARS201","ARF103","Existing","PPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list\exchange\metallicdruglist.aspx?yr=2018","75293AR1210002-05","Silver Plan AWM1","87% AV Level Silver Plan",,"0.879934658582781","No","Yes","No","100%",,"$600","$90","$800","$90","$200","$1,500","$0","$60","$600","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32029&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","OPM","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1210002","Silver Plan AWM1","75293AR121","7427051652","ARN201","ARS201","ARF103","Existing","PPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list\exchange\metallicdruglist.aspx?yr=2018","75293AR1210002-06","Silver Plan AWM1","94% AV Level Silver Plan",,"0.948966831257585","No","Yes","No","100%",,"$600","$20","$0","$90","$600","$500","$4,600","$60","$600","$60","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$790","$790 per person","$1580 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$550","$550 per person","$1100 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32030&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","OPM","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1210004","Silver Plan AWM1A","75293AR121","7427051652","ARN201","ARS201","ARF107","Existing","PPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list\exchange\metallicdruglist.aspx?yr=2018","75293AR1210004-01","Silver Plan AWM1A","Standard Silver On Exchange Plan",,"0.660106454725073","No","Yes","No","100%",,"$5,100","$0","$6,500","$90","$5,000","$200","$200","$60","$1,900","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$5,100","$5100 per person","$10200 per group","30.00%",,,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34046&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","OPM","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1210004","Silver Plan AWM1A","75293AR121","7427051652","ARN201","ARS201","ARF107","Existing","PPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list\exchange\metallicdruglist.aspx?yr=2018","75293AR1210004-02","Silver Plan AWM1A","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$90","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34047&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","OPM","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1210004","Silver Plan AWM1A","75293AR121","7427051652","ARN201","ARS201","ARF107","Existing","PPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list\exchange\metallicdruglist.aspx?yr=2018","75293AR1210004-03","Silver Plan AWM1A","Limited Cost Sharing Plan Variation",,"0.660106454725073","No","Yes","No","100%",,"$5,100","$90","$2,300","$90","$5,100","$1,400","$0","$60","$1,000","$700","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$5,100","$5100 per person","$10200 per group","30.00%",,,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34048&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","47731WY0020005","BESTOne Plus Silver","47731WY002",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47731WY0010009","BESTDental Standard - L","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTDental_Premium_Plan.pdf"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47731WY0010011","BESTDental Choice - L","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTDental_Standard-H_Plan.pdf"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","47731WY0020006","BESTOne Basic Silver","47731WY002",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","Individual","Yes","95-6042390","47731WY0020006","BESTOne Basic Silver","47731WY002",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47731WY0010011","BESTDental Choice - L","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTDental_Standard-H_Plan.pdf"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47731WY0010012","BESTDental Value","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTDental_Choice-H_Plan.pdf"
"2018","WY","47731","HIOS","2017-08-08 02:20:26","SHOP (Small Group)","Yes","95-6042390","47731WY0010012","BESTDental Value","47731WY001",,"WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/wy/current/WY_BESTDental_Choice-H_Plan.pdf"
"2018","AR","75293","OPM","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1210004","Silver Plan AWM1A","75293AR121","7427051652","ARN201","ARS201","ARF107","Existing","PPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list\exchange\metallicdruglist.aspx?yr=2018","75293AR1210004-06","Silver Plan AWM1A","94% AV Level Silver Plan",,"0.949864395211681","No","Yes","No","100%",,"$300","$40","$600","$90","$300","$500","$500","$60","$1,300","$90","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","5.00%",,,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable","$70","$70 per person","$140 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34051&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","26904","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","26904AR0020003","BESTOne Advantage Gold","26904AR002",,"ARN001","ARS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full Covreage","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/current/AR_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","AR","26904","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","26904AR0020003","BESTOne Advantage Gold","26904AR002",,"ARN001","ARS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full Covreage","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/current/AR_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","AR","26904","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","26904AR0020004","BESTOne Plus Gold","26904AR002",,"ARN001","ARS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full Coverage","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/current/AR_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","AR","26904","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","26904AR0020004","BESTOne Plus Gold","26904AR002",,"ARN001","ARS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full Coverage","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/current/AR_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","AR","26904","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","26904AR0020005","BESTOne Plus Silver","26904AR002",,"ARN001","ARS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/current/AR_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","AR","26904","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","26904AR0020005","BESTOne Plus Silver","26904AR002",,"ARN001","ARS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/current/AR_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","WY","80132","HIOS","2017-05-26 02:20:19","Individual","Yes","47-0397286","80132WY0020001","Renaissance Individual Dental PPO, EHB Certified","80132WY002",,"WYN001","WYS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","80132WY0020001-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","WY","80132","HIOS","2017-05-26 02:20:19","Individual","Yes","47-0397286","80132WY0020002","Renaissance Individual Dental PPO, EHB Certified","80132WY002",,"WYN001","WYS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","80132WY0020002-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","WY","80132","HIOS","2017-05-26 02:20:19","Individual","Yes","47-0397286","80132WY0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","80132WY004",,"WYN001","WYS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132","","80132WY0040001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WY_EHB_High_2018","http://www.renaissancedental.com/WY_EHB_High_2018"
"2018","WY","80132","HIOS","2017-05-26 02:20:19","Individual","Yes","47-0397286","80132WY0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","80132WY004",,"WYN001","WYS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132","","80132WY0040002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WY_EHB_Low_2018","http://www.renaissancedental.com/WY_EHB_Low_2018"
"2018","WY","80132","HIOS","2017-05-26 02:20:19","Individual","Yes","47-0397286","80132WY0050001","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","80132WY005",,"WYN001","WYS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132","","80132WY0050001-01","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WY_Ped_High_2018","http://www.renaissancedental.com/WY_Ped_High_2018"
"2018","WY","80132","HIOS","2017-05-26 02:20:19","Individual","Yes","47-0397286","80132WY0050002","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","80132WY005",,"WYN001","WYS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132","","80132WY0050002-01","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WY_Ped_Low_2018","http://www.renaissancedental.com/WY_Ped_Low_2018"
"2018","WY","80132","HIOS","2017-05-26 02:20:19","Individual","Yes","47-0397286","80132WY0060001","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","80132WY006",,"WYN001","WYS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","80132WY0060001-00","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","WY","80132","HIOS","2017-05-26 02:20:19","Individual","Yes","47-0397286","80132WY0060002","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","80132WY006",,"WYN001","WYS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","80132WY0060002-00","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","WY","83964","HIOS","2017-06-22 02:20:27","Individual","Yes","83-0209667","83964WY0010003","Delta Dental Individual & Family Low Plan","83964WY001","7609879839","WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,"EHB coverage is not available for anyone over the age of 18.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-03","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.   Through the Delta Dental Plan Association there is a nationwide Premier network presence","Yes","https://secure.deltadentalwy.org/wyffm/default.aspx","","83964WY0010003-00","Delta Dental Individual & Family Low Plan","Standard Low Off Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwy.org/Subscribers/SubscribersDocuments/d140224.aspx",
"2018","WY","83964","HIOS","2017-06-22 02:20:27","SHOP (Small Group)","Yes","83-0209667","83964WY0020003","Delta Dental Small Group Low Plan","83964WY002","7609879839","WYN001","WYS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,"EHB coverage is not available for anyone over the age of 18.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-03","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.   Through the Delta Dental Plan Association there is a nationwide Premier network presence","Yes","https://secure.deltadentalwy.org/wyffm/default.aspx","","83964WY0020003-00","Delta Dental Small Group Low Plan","Standard Low Off Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwy.org/Subscribers/SubscribersDocuments/d140227.aspx",
"2018","WY","83964","HIOS","2017-06-22 02:20:27","SHOP (Small Group)","Yes","83-0209667","83964WY0020004","Delta Dental Small Group High Plan","83964WY002","7609879839","WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,"EHB pediatric coverage is not available for anyone over the age of 18.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence","Yes","https://secure.deltadentalwy.org/wyffm/default.aspx","","83964WY0020004-00","Delta Dental Small Group High Plan","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwy.org/Subscribers/SubscribersDocuments/d140226.aspx",
"2018","WY","83964","HIOS","2017-06-22 02:20:27","Individual","Yes","83-0209667","83964WY0010004","Delta Dental Individual & Family High Plan","83964WY001","7609879839","WYN001","WYS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,"EHB pediatric coverage is not available for anyone over the age of 18.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence","Yes","https://secure.deltadentalwy.org/wyffm/default.aspx","","83964WY0010004-00","Delta Dental Individual & Family High Plan","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwy.org/Subscribers/SubscribersDocuments/d140225.aspx",
"2018","AR","75293","OPM","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1210005","Gold Plan HSA M1","75293AR121","7427051652","ARN201","ARS201","ARF101","Existing","PPO","Gold","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list\exchange\metallicdruglist.aspx?yr=2018","75293AR1210005-01","Gold Plan HSA M1","Standard Gold On Exchange Plan",,"0.760360103414739","Yes","Yes","No","100%",,"$2,700","$0","$500","$90","$2,700","$40","$200","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group",,,,"$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","5.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34045&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","OPM","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1210005","Gold Plan HSA M1","75293AR121","7427051652","ARN201","ARS201","ARF101","Existing","PPO","Gold","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list\exchange\metallicdruglist.aspx?yr=2018","75293AR1210005-02","Gold Plan HSA M1","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$90","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34043&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","OPM","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1210005","Gold Plan HSA M1","75293AR121","7427051652","ARN201","ARS201","ARF101","Existing","PPO","Gold","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list\exchange\metallicdruglist.aspx?yr=2018","75293AR1210005-03","Gold Plan HSA M1","Limited Cost Sharing Plan Variation",,"0.760360103414739","Yes","Yes","No","100%",,"$2,700","$0","$500","$90","$2,700","$40","$200","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group",,,,"$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","5.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34044&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","OPM","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1210002","Silver Plan AWM1","75293AR121","7427051652","ARN201","ARS201","ARF103","Existing","PPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list\exchange\metallicdruglist.aspx?yr=2018","75293AR1210002-01","Silver Plan AWM1","Standard Silver On Exchange Plan",,"0.66009968609512","No","Yes","No","100%",,"$3,000","$200","$1,900","$90","$700","$1,600","$0","$60","$1,600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34015&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","OPM","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1210002","Silver Plan AWM1","75293AR121","7427051652","ARN201","ARS201","ARF103","Existing","PPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list\exchange\metallicdruglist.aspx?yr=2018","75293AR1210002-02","Silver Plan AWM1","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$90","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34015&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","OPM","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1210002","Silver Plan AWM1","75293AR121","7427051652","ARN201","ARS201","ARF103","Existing","PPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list\exchange\metallicdruglist.aspx?yr=2018","75293AR1210002-03","Silver Plan AWM1","Limited Cost Sharing Plan Variation",,"0.66009968609512","No","Yes","No","100%",,"$3,000","$90","$1,900","$90","$200","$2,800","$0","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=33005&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","OPM","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1210004","Silver Plan AWM1A","75293AR121","7427051652","ARN201","ARS201","ARF107","Existing","PPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list\exchange\metallicdruglist.aspx?yr=2018","75293AR1210004-04","Silver Plan AWM1A","73% AV Level Silver Plan",,"0.734703749306939","No","Yes","No","100%",,"$2,400","$90","$2,000","$90","$2,100","$1,300","$0","$60","$1,100","$500","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","20.00%",,,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34049&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","OPM","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1210004","Silver Plan AWM1A","75293AR121","7427051652","ARN201","ARS201","ARF107","Existing","PPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list\exchange\metallicdruglist.aspx?yr=2018","75293AR1210004-05","Silver Plan AWM1A","87% AV Level Silver Plan",,"0.8799179100995","No","Yes","No","100%",,"$500","$90","$1,200","$90","$500","$1,000","$0","$60","$1,200","$400","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","10.00%",,,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$250 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34050&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","26904","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","26904AR0020006","BESTOne Basic Silver","26904AR002",,"ARN001","ARS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/current/AR_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","AR","26904","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","26904AR0020006","BESTOne Basic Silver","26904AR002",,"ARN001","ARS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/current/AR_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","AR","28348","SERFF","2017-08-16 20:15:58","Individual","Yes","71-0561140","28348AR0090001","Delta Dental Pediatric Silver Plan","28348AR009",,"ARN001","ARS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,"Guaranteed Rate",,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes",,"","28348AR0090001-01","Delta Dental Pediatric Silver Plan","Standard Low On Exchange Plan","70.00%",,,,"Yes","30%","70%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalar.com/ACA-Marketplace/2018-pediatric-silver-ehb-plan","http://www.deltadentalar.com/ACA-Marketplace/2018-pediatric-silver-ehb-plan"
"2018","AR","28348","SERFF","2017-08-16 20:15:58","Individual","Yes","71-0561140","28348AR0090002","Delta Dental Pediatric Gold Plan","28348AR009",,"ARN001","ARS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,"Guaranteed Rate",,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes",,"","28348AR0090002-01","Delta Dental Pediatric Gold Plan","Standard High On Exchange Plan","85.00%",,,,"Yes","30%","70%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalar.com/ACA-Marketplace/2018-pediatric-gold-ehb-plan","http://www.deltadentalar.com/ACA-Marketplace/2018-pediatric-gold-ehb-plan"
"2018","AR","28348","SERFF","2017-08-16 20:15:58","Individual","Yes","71-0561140","28348AR0100001","Delta Dental Family Silver Plus Plan","28348AR010",,"ARN001","ARS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes",,"","28348AR0100001-01","Delta Dental Family Silver Plus Plan","Standard Low On Exchange Plan","70.00%",,,,"Yes","30%","70%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalar.com/ACA-Marketplace/2018-family-silver-plus-plan-ehb-covered-benefits","http://www.deltadentalar.com/ACA-Marketplace/2018-family-silver-plus-plan-ehb-covered-benefits"
"2018","AR","28348","SERFF","2017-08-16 20:15:58","Individual","Yes","71-0561140","28348AR0100002","Delta Dental Family Gold Plan","28348AR010",,"ARN001","ARS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes",,"","28348AR0100002-01","Delta Dental Family Gold Plan","Standard High On Exchange Plan","85.00%",,,,"Yes","30%","70%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalar.com/ACA-Marketplace/2018-family-gold-plan-ehb-covered-benefits","http://www.deltadentalar.com/ACA-Marketplace/2018-family-gold-plan-ehb-covered-benefits"
"2018","AR","37903","SERFF","2017-10-17 20:15:27","Individual","No","71-0386640","37903AR0070015","Silver Saver 4000","37903AR007",,"ARN001","ARS001","ARF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","37903AR0070015-00","Silver Saver 4000","Standard Silver Off Exchange Plan",,"0.660037717993509","Yes","Yes","No","100%",,"$4,000","$0","$1,250","$60","$4,000","$0","$1,250","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","45.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Saver_4000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCLH-Mktpl-Plans.pdf"
"2018","AR","37903","SERFF","2017-10-17 20:15:27","Individual","No","71-0386640","37903AR0070015","Silver Saver 4000","37903AR007",,"ARN001","ARS001","ARF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","37903AR0070015-01","Silver Saver 4000","Standard Silver On Exchange Plan",,"0.660037717993509","Yes","Yes","No","100%",,"$4,000","$0","$1,250","$60","$4,000","$0","$1,250","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","45.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Saver_4000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCLH-Mktpl-Plans.pdf"
"2018","AR","37903","SERFF","2017-10-17 20:15:27","Individual","No","71-0386640","37903AR0070015","Silver Saver 4000","37903AR007",,"ARN001","ARS001","ARF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","37903AR0070015-02","Silver Saver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Saver.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCLH-Mktpl-Plans.pdf"
"2018","AR","37903","SERFF","2017-10-17 20:15:27","Individual","No","71-0386640","37903AR0070015","Silver Saver 4000","37903AR007",,"ARN001","ARS001","ARF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","37903AR0070015-03","Silver Saver 4000-I","Limited Cost Sharing Plan Variation",,"0.660037717993509","Yes","Yes","No","100%",,"$4,000","$0","$1,250","$60","$4,000","$0","$1,250","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","45.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Saver_4000_I.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCLH-Mktpl-Plans.pdf"
"2018","AR","37903","SERFF","2017-10-17 20:15:27","Individual","No","71-0386640","37903AR0070015","Silver Saver 4000","37903AR007",,"ARN001","ARS001","ARF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","37903AR0070015-04","Silver Saver 2000","73% AV Level Silver Plan",,"0.720786693567367","Yes","Yes","No","100%",,"$2,000","$0","$2,700","$60","$2,000","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Saver_2000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCLH-Mktpl-Plans.pdf"
"2018","AR","37903","SERFF","2017-10-17 20:15:27","Individual","No","71-0386640","37903AR0070015","Silver Saver 4000","37903AR007",,"ARN001","ARS001","ARF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","37903AR0070015-05","Silver Saver 950","87% AV Level Silver Plan",,"0.860237987144013","Yes","Yes","No","100%",,"$950","$0","$600","$60","$950","$0","$300","$60","$950","$0","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","5.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Saver_950.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCLH-Mktpl-Plans.pdf"
"2018","AR","37903","SERFF","2017-10-17 20:15:27","Individual","No","71-0386640","37903AR0070015","Silver Saver 4000","37903AR007",,"ARN001","ARS001","ARF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","37903AR0070015-06","Silver Saver 575","94% AV Level Silver Plan",,"0.930086443997505","Yes","Yes","No","100%",,"$575","$0","$0","$60","$575","$0","$0","$60","$575","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Saver_575.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCLH-Mktpl-Plans.pdf"
"2018","AR","28348","SERFF","2017-08-16 20:15:58","Individual","Yes","71-0561140","28348AR0100003","Delta Dental Family Silver Plan","28348AR010",,"ARN001","ARS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes",,"","28348AR0100003-01","Delta Dental Family Silver Plan","Standard Low On Exchange Plan","70.00%",,,,"Yes","30%","70%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalar.com/ACA-Marketplace/2018-family-silver-plan-ehb-covered-benefits","http://www.deltadentalar.com/ACA-Marketplace/2018-family-silver-plan-ehb-covered-benefits"
"2018","AR","37903","SERFF","2017-10-17 20:15:27","Individual","No","71-0386640","37903AR0070001","Silver 6500","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","37903AR0070001-00","Silver 6500","Standard Silver Off Exchange Plan",,"0.660003542039775","No","Yes","No","100%",,"$6,450","$900","$0","$60","$6,500","$400","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","50.00%",,,,,"$13,000","$13000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_6500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCLH-Mktpl-Plans.pdf"
"2018","AR","37903","SERFF","2017-10-17 20:15:27","Individual","No","71-0386640","37903AR0070001","Silver 6500","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","37903AR0070001-01","Silver 6500","Standard Silver On Exchange Plan",,"0.660003542039775","No","Yes","No","100%",,"$6,450","$900","$0","$60","$6,500","$400","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","50.00%",,,,,"$13,000","$13000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_6500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCLH-Mktpl-Plans.pdf"
"2018","AR","37903","SERFF","2017-10-17 20:15:27","Individual","No","71-0386640","37903AR0070001","Silver 6500","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","37903AR0070001-02","Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCLH-Mktpl-Plans.pdf"
"2018","AR","37903","SERFF","2017-10-17 20:15:27","Individual","No","71-0386640","37903AR0070001","Silver 6500","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","37903AR0070001-03","Silver 6500-I","Limited Cost Sharing Plan Variation",,"0.660003542039775","No","Yes","No","100%",,"$6,450","$900","$0","$60","$6,500","$400","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","50.00%",,,,,"$13,000","$13000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_6500_I.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCLH-Mktpl-Plans.pdf"
"2018","AR","37903","SERFF","2017-10-17 20:15:27","Individual","No","71-0386640","37903AR0070001","Silver 6500","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","37903AR0070001-04","Silver 3000","73% AV Level Silver Plan",,"0.736510008073203","No","Yes","No","100%",,"$3,000","$400","$200","$60","$3,000","$1,500","$70","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$14,700","$14700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$13,000","$13000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_3000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCLH-Mktpl-Plans.pdf"
"2018","AR","37903","SERFF","2017-10-17 20:15:27","Individual","No","71-0386640","37903AR0070001","Silver 6500","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","37903AR0070001-05","Silver 600","87% AV Level Silver Plan",,"0.868659486571378","No","Yes","No","100%",,"$600","$400","$600","$60","$600","$1,400","$20","$60","$600","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$14,700","$14700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20.00%",,,,,"$13,000","$13000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_600.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCLH-Mktpl-Plans.pdf"
"2018","AR","37903","SERFF","2017-10-17 20:15:27","Individual","No","71-0386640","37903AR0070001","Silver 6500","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","37903AR0070001-06","Silver 550","94% AV Level Silver Plan",,"0.948944251926035","No","Yes","No","100%",,"$550","$0","$200","$60","$550","$200","$10","$60","$550","$40","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$790","$790 per person","$1580 per group",,,,"$14,700","$14700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$550","$550 per person","$1100 per group","0.00%",,,,,"$13,000","$13000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_550.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCLH-Mktpl-Plans.pdf"
"2018","AR","37903","SERFF","2017-10-17 20:15:27","Individual","No","71-0386640","37903AR0070008","Gold 2000","37903AR007",,"ARN001","ARS001","ARF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","37903AR0070008-00","Gold 2000","Standard Gold Off Exchange Plan",,"0.812518532181938","No","Yes","No","100%",,"$2,000","$0","$1,500","$60","$2,000","$1,400","$60","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Gold_2000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCLH-Mktpl-Plans.pdf"
"2018","AR","37903","SERFF","2017-10-17 20:15:27","Individual","No","71-0386640","37903AR0070008","Gold 2000","37903AR007",,"ARN001","ARS001","ARF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","37903AR0070008-01","Gold 2000","Standard Gold On Exchange Plan",,"0.812518532181938","No","Yes","No","100%",,"$2,000","$0","$1,500","$60","$2,000","$1,400","$60","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Gold_2000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCLH-Mktpl-Plans.pdf"
"2018","AR","37903","SERFF","2017-10-17 20:15:27","Individual","No","71-0386640","37903AR0070008","Gold 2000","37903AR007",,"ARN001","ARS001","ARF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","37903AR0070008-02","Gold","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Gold.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCLH-Mktpl-Plans.pdf"
"2018","AR","37903","SERFF","2017-10-17 20:15:27","Individual","No","71-0386640","37903AR0070008","Gold 2000","37903AR007",,"ARN001","ARS001","ARF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","37903AR0070008-03","Gold 2000-I","Limited Cost Sharing Plan Variation",,"0.812518532181938","No","Yes","No","100%",,"$2,000","$0","$1,500","$60","$2,000","$1,400","$60","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Gold_2000_I.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCLH-Mktpl-Plans.pdf"
"2018","AR","60559","SERFF","2017-08-16 20:15:58","Individual","Yes","75-1233841","60559AR0010011","Dentegra Dental PPO Family Basic Plan","60559AR001",,"ARN001","ARS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","60559AR0010011-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","68.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","$90 per person","per group not applicable",,,,,,"$90","$90 per person","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ar/60559ar0010011-18"
"2018","AR","60559","SERFF","2017-08-16 20:15:58","Individual","Yes","75-1233841","60559AR0010012","Dentegra Dental PPO Family Preferred Plan","60559AR001",,"ARN001","ARS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","60559AR0010012-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","85.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$30","$30 per person","per group not applicable","$30","$30 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ar/60559ar0010012-18"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080002","Ambetter Secure Care 2 (2018) with 3 Free PCP Visits","62141AR008",,"ARN001","ARS001","ARF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080002-00","Ambetter Secure Care 2 (2018) with 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,850","$18850 per person","$37700 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080002-00.pdf","https://api.centene.com/Brochures/2018/62141AR0080002-00.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080002","Ambetter Secure Care 2 (2018) with 3 Free PCP Visits","62141AR008",,"ARN001","ARS001","ARF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080002-01","Ambetter Secure Care 2 (2018) with 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,850","$18850 per person","$37700 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080002-01.pdf","https://api.centene.com/Brochures/2018/62141AR0080002-01.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080002","Ambetter Secure Care 2 (2018) with 3 Free PCP Visits","62141AR008",,"ARN001","ARS001","ARF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080002-02","Ambetter Secure Care 2 (2018) with 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080002-02.pdf","https://api.centene.com/Brochures/2018/62141AR0080002-02.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0100005","Ambetter Essential Care 6 (2018) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9245",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0100005-02","Ambetter Essential Care 6 (2018) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080005-02.pdf","https://api.centene.com/Brochures/2018/62141AR0080005-02.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0100005","Ambetter Essential Care 6 (2018) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9245",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0100005-03","Ambetter Essential Care 6 (2018) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.615856356342964","No","Yes","No","100%",,"$2,200","$0","$4,950","$60","$2,300","$1,400","$1,200","$60","$1,200","$0","$700","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$5,500","$5500 per person","$11000 per group","40.00%",,,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080005-03.pdf","https://api.centene.com/Brochures/2018/62141AR0080005-03.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2018) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9245",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0100007-00","Ambetter Balanced Care 7 (2018) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.709672297919102","No","Yes","No","100%",,"$3,650","$2,600","$0","$60","$0","$4,000","$0","$60","$1,100","$500","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,750","$18750 per person","$37500 per group","$5,100","$5100 per person","$10200 per group","20.00%",,,,,"$10,200","$10200 per person","$20400 per group","$15,300","$15300 per person","$30600 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080007-00.pdf","https://api.centene.com/Brochures/2018/62141AR0080007-00.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2018) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9245",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0100007-01","Ambetter Balanced Care 7 (2018) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.709672297919102","No","Yes","No","100%",,"$3,650","$2,600","$0","$60","$0","$4,000","$0","$60","$1,100","$500","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,750","$18750 per person","$37500 per group","$5,100","$5100 per person","$10200 per group","20.00%",,,,,"$10,200","$10200 per person","$20400 per group","$15,300","$15300 per person","$30600 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080007-01.pdf","https://api.centene.com/Brochures/2018/62141AR0080007-01.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2018) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9245",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0100007-02","Ambetter Balanced Care 7 (2018) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080007-02.pdf","https://api.centene.com/Brochures/2018/62141AR0080007-02.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2018) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9245",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0100007-03","Ambetter Balanced Care 7 (2018) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.709672297919102","No","Yes","No","100%",,"$3,650","$2,600","$0","$60","$0","$4,000","$0","$60","$1,100","$500","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,750","$18750 per person","$37500 per group","$5,100","$5100 per person","$10200 per group","20.00%",,,,,"$10,200","$10200 per person","$20400 per group","$15,300","$15300 per person","$30600 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080007-03.pdf","https://api.centene.com/Brochures/2018/62141AR0080007-03.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080002","Ambetter Secure Care 2 (2018) with 3 Free PCP Visits","62141AR008",,"ARN001","ARS001","ARF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080002-03","Ambetter Secure Care 2 (2018) with 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,850","$18850 per person","$37700 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080002-03.pdf","https://api.centene.com/Brochures/2018/62141AR0080002-03.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080005","Ambetter Essential Care 6 (2018)","62141AR008",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080005-00","Ambetter Essential Care 6 (2018)","Standard Bronze Off Exchange Plan",,"0.615856356342964","No","Yes","No","100%",,"$2,200","$0","$4,950","$60","$2,300","$1,400","$1,200","$60","$1,200","$0","$700","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$500","$500 per person","$1000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080005-00.pdf","https://api.centene.com/Brochures/2018/62141AR0080005-00.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080005","Ambetter Essential Care 6 (2018)","62141AR008",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080005-01","Ambetter Essential Care 6 (2018)","Standard Bronze On Exchange Plan",,"0.615856356342964","No","Yes","No","100%",,"$2,200","$0","$4,950","$60","$2,300","$1,400","$1,200","$60","$1,200","$0","$700","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$500","$500 per person","$1000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080005-01.pdf","https://api.centene.com/Brochures/2018/62141AR0080005-01.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080005","Ambetter Essential Care 6 (2018)","62141AR008",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080005-02","Ambetter Essential Care 6 (2018)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080005-02.pdf","https://api.centene.com/Brochures/2018/62141AR0080005-02.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080005","Ambetter Essential Care 6 (2018)","62141AR008",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080005-03","Ambetter Essential Care 6 (2018)","Limited Cost Sharing Plan Variation",,"0.615856356342964","No","Yes","No","100%",,"$2,200","$0","$4,950","$60","$2,300","$1,400","$1,200","$60","$1,200","$0","$700","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$500","$500 per person","$1000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080005-03.pdf","https://api.centene.com/Brochures/2018/62141AR0080005-03.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2018)","62141AR008",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080007-00","Ambetter Balanced Care 7 (2018)","Standard Silver Off Exchange Plan",,"0.709672297919102","No","Yes","No","100%",,"$3,650","$2,600","$0","$60","$0","$4,000","$0","$60","$1,100","$500","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,750","$18750 per person","$37500 per group","$5,100","$5100 per person","$10200 per group","20%",,,,,"$10,200","$10200 per person","$20400 per group","$15,300","$15300 per person","$30600 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080007-00.pdf","https://api.centene.com/Brochures/2018/62141AR0080007-00.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2018)","62141AR008",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080007-01","Ambetter Balanced Care 7 (2018)","Standard Silver On Exchange Plan",,"0.709672297919102","No","Yes","No","100%",,"$3,650","$2,600","$0","$60","$0","$4,000","$0","$60","$1,100","$500","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,750","$18750 per person","$37500 per group","$5,100","$5100 per person","$10200 per group","20%",,,,,"$10,200","$10200 per person","$20400 per group","$15,300","$15300 per person","$30600 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080007-01.pdf","https://api.centene.com/Brochures/2018/62141AR0080007-01.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2018)","62141AR008",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080007-02","Ambetter Balanced Care 7 (2018)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080007-02.pdf","https://api.centene.com/Brochures/2018/62141AR0080007-02.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2018)","62141AR008",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080007-03","Ambetter Balanced Care 7 (2018)","Limited Cost Sharing Plan Variation",,"0.709672297919102","No","Yes","No","100%",,"$3,650","$2,600","$0","$60","$0","$4,000","$0","$60","$1,100","$500","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,750","$18750 per person","$37500 per group","$5,100","$5100 per person","$10200 per group","20%",,,,,"$10,200","$10200 per person","$20400 per group","$15,300","$15300 per person","$30600 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080007-03.pdf","https://api.centene.com/Brochures/2018/62141AR0080007-03.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2018)","62141AR008",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080007-04","Ambetter Balanced Care 7 (2018)","73% AV Level Silver Plan",,"0.736787942342403","No","Yes","No","100%",,"$3,980","$1,870","$0","$60","$0","$3,100","$0","$60","$1,200","$500","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,350","$18350 per person","$36700 per group","$4,950","$4950 per person","$9900 per group","10%",,,,,"$10,200","$10200 per person","$20400 per group","$15,150","$15150 per person","$30300 per group","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080007-04.pdf","https://api.centene.com/Brochures/2018/62141AR0080007-04.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2018)","62141AR008",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080007-05","Ambetter Balanced Care 7 (2018)","87% AV Level Silver Plan",,"0.87954557829517","No","Yes","No","100%",,"$975","$700","$0","$60","$0","$1,200","$0","$60","$975","$100","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$12,500","$12500 per person","$25000 per group","$14,950","$14950 per person","$29900 per group","$975","$975 per person","$1950 per group","5%",,,,,"$10,200","$10200 per person","$20400 per group","$11,175","$11175 per person","$22350 per group","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080007-05.pdf","https://api.centene.com/Brochures/2018/62141AR0080007-05.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2018)","62141AR008",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080007-06","Ambetter Balanced Care 7 (2018)","94% AV Level Silver Plan",,"0.948966831257585","No","Yes","No","100%",,"$550","$200","$0","$60","$0","$400","$0","$60","$550","$50","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$790","$790 per person","$1580 per group",,,,"$12,500","$12500 per person","$25000 per group","$13,290","$13290 per person","$26580 per group","$550","$550 per person","$1100 per group","0%",,,,,"$10,200","$10200 per person","$20400 per group","$10,750","$10750 per person","$21500 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080007-06.pdf","https://api.centene.com/Brochures/2018/62141AR0080007-06.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080008","Ambetter Balanced Care 6 (2018)","62141AR008",,"ARN001","ARS001","ARF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080008-00","Ambetter Balanced Care 6 (2018)","Standard Silver Off Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080008-00.pdf","https://api.centene.com/Brochures/2018/62141AR0080008-00.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080008","Ambetter Balanced Care 6 (2018)","62141AR008",,"ARN001","ARS001","ARF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080008-01","Ambetter Balanced Care 6 (2018)","Standard Silver On Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080008-01.pdf","https://api.centene.com/Brochures/2018/62141AR0080008-01.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080008","Ambetter Balanced Care 6 (2018)","62141AR008",,"ARN001","ARS001","ARF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080008-02","Ambetter Balanced Care 6 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080008-02.pdf","https://api.centene.com/Brochures/2018/62141AR0080008-02.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080008","Ambetter Balanced Care 6 (2018)","62141AR008",,"ARN001","ARS001","ARF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080008-03","Ambetter Balanced Care 6 (2018)","Limited Cost Sharing Plan Variation",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080008-03.pdf","https://api.centene.com/Brochures/2018/62141AR0080008-03.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080008","Ambetter Balanced Care 6 (2018)","62141AR008",,"ARN001","ARS001","ARF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080008-04","Ambetter Balanced Care 6 (2018)","73% AV Level Silver Plan",,"0.739635889295605","Yes","Yes","No","100%",,"$1,950","$1,300","$300","$60","$1,300","$1,700","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$13,000","$13000 per person","$26000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$7,950","$7950 per person","$15900 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080008-04.pdf","https://api.centene.com/Brochures/2018/62141AR0080008-04.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080008","Ambetter Balanced Care 6 (2018)","62141AR008",,"ARN001","ARS001","ARF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080008-05","Ambetter Balanced Care 6 (2018)","87% AV Level Silver Plan",,"0.879959544313859","Yes","Yes","No","100%",,"$675","$200","$300","$60","$675","$300","$600","$60","$675","$20","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$13,000","$13000 per person","$26000 per group","$15,450","$15450 per person","$30900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$6,675","$6675 per person","$13350 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080008-05.pdf","https://api.centene.com/Brochures/2018/62141AR0080008-05.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080008","Ambetter Balanced Care 6 (2018)","62141AR008",,"ARN001","ARS001","ARF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080008-06","Ambetter Balanced Care 6 (2018)","94% AV Level Silver Plan",,"0.949879112635725","Yes","Yes","No","100%",,"$200","$90","$300","$60","$200","$200","$200","$60","$200","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$13,000","$13000 per person","$26000 per group","$13,600","$13600 per person","$27200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$6,200","$6200 per person","$12400 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080008-06.pdf","https://api.centene.com/Brochures/2018/62141AR0080008-06.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080101","Ambetter Balanced Care 4 (2018)","62141AR008",,"ARN001","ARS001","ARF005","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080101-00","Ambetter Balanced Care 4 (2018)","Standard Silver Off Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"$14,100","$14100 per person","$28200 per group","$21,150","$21150 per person","$42300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$14,100","$14100 per person","$28200 per group","$21,150","$21150 per person","$42300 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080101-00.pdf","https://api.centene.com/Brochures/2018/62141AR0080101-00.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080101","Ambetter Balanced Care 4 (2018)","62141AR008",,"ARN001","ARS001","ARF005","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080101-01","Ambetter Balanced Care 4 (2018)","Standard Silver On Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"$14,100","$14100 per person","$28200 per group","$21,150","$21150 per person","$42300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$14,100","$14100 per person","$28200 per group","$21,150","$21150 per person","$42300 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080101-01.pdf","https://api.centene.com/Brochures/2018/62141AR0080101-01.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080101","Ambetter Balanced Care 4 (2018)","62141AR008",,"ARN001","ARS001","ARF005","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080101-02","Ambetter Balanced Care 4 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080101-02.pdf","https://api.centene.com/Brochures/2018/62141AR0080101-02.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080101","Ambetter Balanced Care 4 (2018)","62141AR008",,"ARN001","ARS001","ARF005","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080101-03","Ambetter Balanced Care 4 (2018)","Limited Cost Sharing Plan Variation",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"$14,100","$14100 per person","$28200 per group","$21,150","$21150 per person","$42300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"$14,100","$14100 per person","$28200 per group","$21,150","$21150 per person","$42300 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080101-03.pdf","https://api.centene.com/Brochures/2018/62141AR0080101-03.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080101","Ambetter Balanced Care 4 (2018)","62141AR008",,"ARN001","ARS001","ARF005","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080101-04","Ambetter Balanced Care 4 (2018)","73% AV Level Silver Plan",,"0.727430168333116","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$1,800","$1,300","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$14,100","$14100 per person","$28200 per group","$19,350","$19350 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"$14,100","$14100 per person","$28200 per group","$19,350","$19350 per person","$38700 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080101-04.pdf","https://api.centene.com/Brochures/2018/62141AR0080101-04.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080101","Ambetter Balanced Care 4 (2018)","62141AR008",,"ARN001","ARS001","ARF005","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080101-05","Ambetter Balanced Care 4 (2018)","87% AV Level Silver Plan",,"0.863154651499334","Yes","Yes","No","100%",,"$1,850","$0","$0","$60","$1,850","$0","$0","$60","$1,630","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"$14,100","$14100 per person","$28200 per group","$15,950","$15950 per person","$31900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","0.00%",,,,,"$14,100","$14100 per person","$28200 per group","$15,950","$15950 per person","$31900 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080101-05.pdf","https://api.centene.com/Brochures/2018/62141AR0080101-05.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3500","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070151-01","Silver Classic Saver 3500","Standard Silver On Exchange Plan",,"0.698417431011734","Yes","Yes","No","100%",,"$3,500","$0","$900","$60","$3,500","$0","$400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","10.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_Saver_3500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3500","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070151-02","Silver Classic Saver - 1","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_Saver_1.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3500","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070151-03","Silver Classic Saver 3500-I","Limited Cost Sharing Plan Variation",,"0.698417431011734","Yes","Yes","No","100%",,"$3,500","$0","$900","$60","$3,500","$0","$400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","10.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_Saver_3500_I.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3500","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070151-04","Silver Classic Saver 2500","73% AV Level Silver Plan",,"0.739077174906565","Yes","Yes","No","100%",,"$2,500","$0","$1,000","$60","$2,500","$0","$500","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_Saver_2500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0080101","Ambetter Balanced Care 4 (2018)","62141AR008",,"ARN001","ARS001","ARF005","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0080101-06","Ambetter Balanced Care 4 (2018)","94% AV Level Silver Plan",,"0.940719200046497","Yes","Yes","No","100%",,"$600","$0","$0","$60","$600","$0","$0","$60","$600","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$14,100","$14100 per person","$28200 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"$14,100","$14100 per person","$28200 per group","$14,700","$14700 per person","$29400 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080101-06.pdf","https://api.centene.com/Brochures/2018/62141AR0080101-06.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0100005","Ambetter Essential Care 6 (2018) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9245",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0100005-00","Ambetter Essential Care 6 (2018) + Vision + Adult Dental","Standard Bronze Off Exchange Plan",,"0.615856356342964","No","Yes","No","100%",,"$2,200","$0","$4,950","$60","$2,300","$1,400","$1,200","$60","$1,200","$0","$700","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$5,500","$5500 per person","$11000 per group","40.00%",,,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080005-00.pdf","https://api.centene.com/Brochures/2018/62141AR0080005-00.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0100005","Ambetter Essential Care 6 (2018) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9245",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0100005-01","Ambetter Essential Care 6 (2018) + Vision + Adult Dental","Standard Bronze On Exchange Plan",,"0.615856356342964","No","Yes","No","100%",,"$2,200","$0","$4,950","$60","$2,300","$1,400","$1,200","$60","$1,200","$0","$700","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$21,450","$21450 per person","$42900 per group","$5,500","$5500 per person","$11000 per group","40.00%",,,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080005-01.pdf","https://api.centene.com/Brochures/2018/62141AR0080005-01.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2018) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9245",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0100007-04","Ambetter Balanced Care 7 (2018) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.736787942342403","No","Yes","No","100%",,"$3,980","$1,870","$0","$60","$0","$3,100","$0","$60","$1,200","$500","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,350","$18350 per person","$36700 per group","$4,950","$4950 per person","$9900 per group","10.00%",,,,,"$10,200","$10200 per person","$20400 per group","$15,150","$15150 per person","$30300 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080007-04.pdf","https://api.centene.com/Brochures/2018/62141AR0080007-04.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2018) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9245",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0100007-05","Ambetter Balanced Care 7 (2018) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.87954557829517","No","Yes","No","100%",,"$975","$700","$0","$60","$0","$1,200","$0","$60","$975","$100","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$12,500","$12500 per person","$25000 per group","$14,950","$14950 per person","$29900 per group","$975","$975 per person","$1950 per group","5.00%",,,,,"$10,200","$10200 per person","$20400 per group","$11,175","$11175 per person","$22350 per group","$100","$100 per person","$200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080007-05.pdf","https://api.centene.com/Brochures/2018/62141AR0080007-05.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2018) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9245",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0100007-06","Ambetter Balanced Care 7 (2018) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.948966831257585","No","Yes","No","100%",,"$550","$200","$0","$60","$0","$400","$0","$60","$550","$50","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$790","$790 per person","$1580 per group",,,,"$12,500","$12500 per person","$25000 per group","$13,290","$13290 per person","$26580 per group","$550","$550 per person","$1100 per group","0.00%",,,,,"$10,200","$10200 per person","$20400 per group","$10,750","$10750 per person","$21500 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/62141AR0080007-06.pdf","https://api.centene.com/Brochures/2018/62141AR0080007-06.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0100008","Ambetter Balanced Care 6 (2018) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9245",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0100008-00","Ambetter Balanced Care 6 (2018) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080008-00.pdf","https://api.centene.com/Brochures/2018/62141AR0080008-00.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0100008","Ambetter Balanced Care 6 (2018) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9245",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0100008-01","Ambetter Balanced Care 6 (2018) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080008-01.pdf","https://api.centene.com/Brochures/2018/62141AR0080008-01.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070004","Silver Classic Saver 4000","70525AR007",,"ARN001","ARS002","ARF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070004-01","Silver Classic Saver 4000","Standard Silver On Exchange Plan",,"0.660037717993509","Yes","Yes","No","100%",,"$4,000","$0","$1,250","$60","$4,000","$0","$1,250","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","45.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_Saver_4000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070004","Silver Classic Saver 4000","70525AR007",,"ARN001","ARS002","ARF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070004-02","Silver Classic Saver - 2","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_Saver_2.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070004","Silver Classic Saver 4000","70525AR007",,"ARN001","ARS002","ARF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070004-03","Silver Classic Saver 4000-I","Limited Cost Sharing Plan Variation",,"0.660037717993509","Yes","Yes","No","100%",,"$4,000","$0","$1,250","$60","$4,000","$0","$1,250","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","45.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_Saver_4000_I.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070004","Silver Classic Saver 4000","70525AR007",,"ARN001","ARS002","ARF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070004-04","Silver Classic Saver 2000","73% AV Level Silver Plan",,"0.720786693567367","Yes","Yes","No","100%",,"$2,000","$0","$2,700","$60","$2,000","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_Saver_2000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070004","Silver Classic Saver 4000","70525AR007",,"ARN001","ARS002","ARF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070004-05","Silver Classic Saver 950","87% AV Level Silver Plan",,"0.860237987144013","Yes","Yes","No","100%",,"$950","$0","$600","$60","$950","$0","$300","$60","$950","$0","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","5.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_Saver_950.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0100008","Ambetter Balanced Care 6 (2018) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9245",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0100008-02","Ambetter Balanced Care 6 (2018) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080008-02.pdf","https://api.centene.com/Brochures/2018/62141AR0080008-02.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0100008","Ambetter Balanced Care 6 (2018) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9245",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0100008-03","Ambetter Balanced Care 6 (2018) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080008-03.pdf","https://api.centene.com/Brochures/2018/62141AR0080008-03.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0100008","Ambetter Balanced Care 6 (2018) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9245",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0100008-04","Ambetter Balanced Care 6 (2018) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.739635889295605","Yes","Yes","No","100%",,"$1,950","$1,300","$300","$60","$1,300","$1,700","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$13,000","$13000 per person","$26000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$7,950","$7950 per person","$15900 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080008-04.pdf","https://api.centene.com/Brochures/2018/62141AR0080008-04.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0100008","Ambetter Balanced Care 6 (2018) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9245",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0100008-05","Ambetter Balanced Care 6 (2018) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.879959544313859","Yes","Yes","No","100%",,"$675","$200","$300","$60","$675","$300","$600","$60","$675","$20","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$13,000","$13000 per person","$26000 per group","$15,450","$15450 per person","$30900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$6,675","$6675 per person","$13350 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080008-05.pdf","https://api.centene.com/Brochures/2018/62141AR0080008-05.pdf"
"2018","AR","62141","SERFF","2017-10-16 20:15:22","Individual","No","06-0641618","62141AR0100008","Ambetter Balanced Care 6 (2018) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF004","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9245",,,"2018-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetter.arhealthwellness.com/payments","https://ambetter.arhealthwellness.com/resources/pharmacy-resources.html","62141AR0100008-06","Ambetter Balanced Care 6 (2018) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949879112635725","Yes","Yes","No","100%",,"$200","$90","$300","$60","$200","$200","$200","$60","$200","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$13,000","$13000 per person","$26000 per group","$13,600","$13600 per person","$27200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","$6,200","$6200 per person","$12400 per group","No",,,"https://api.centene.com/SBC/2018/62141AR0080008-06.pdf","https://api.centene.com/Brochures/2018/62141AR0080008-06.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070006","Catastrophic","70525AR007",,"ARN001","ARS001","ARF001","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070006-00","Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,300","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Catastrophic.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/IQC-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070006","Catastrophic","70525AR007",,"ARN001","ARS001","ARF001","Existing","POS","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070006-01","Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,300","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Catastrophic.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070001","Bronze Classic Saver 5000","70525AR007",,"ARN001","ARS001","ARF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070001-00","Bronze Classic Saver 5000","Standard Bronze Off Exchange Plan",,"0.61311887775004","Yes","Yes","No","100%",,"$5,000","$0","$1,450","$60","$5,000","$0","$1,200","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Bronze_Classic_Saver_5000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/IQC-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070001","Bronze Classic Saver 5000","70525AR007",,"ARN001","ARS001","ARF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070001-01","Bronze Classic Saver 5000","Standard Bronze On Exchange Plan",,"0.61311887775004","Yes","Yes","No","100%",,"$5,000","$0","$1,450","$60","$5,000","$0","$1,200","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Bronze_Classic_Saver_5000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070001","Bronze Classic Saver 5000","70525AR007",,"ARN001","ARS001","ARF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070001-02","Bronze Classic Saver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Bronze_Classic_Saver.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070001","Bronze Classic Saver 5000","70525AR007",,"ARN001","ARS001","ARF002","Existing","POS","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070001-03","Bronze Classic Saver 5000-I","Limited Cost Sharing Plan Variation",,"0.61311887775004","Yes","Yes","No","100%",,"$5,000","$0","$1,450","$60","$5,000","$0","$1,200","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Bronze_Classic_Saver_5000_I.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070003","Silver Classic 6500","70525AR007",,"ARN001","ARS002","ARF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070003-00","Silver Classic 6500","Standard Silver Off Exchange Plan",,"0.660003542039775","No","Yes","No","100%",,"$6,450","$900","$0","$60","$6,500","$400","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","50.00%",,,,,"$13,000","$13000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_6500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/IQC-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070003","Silver Classic 6500","70525AR007",,"ARN001","ARS002","ARF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070003-01","Silver Classic 6500","Standard Silver On Exchange Plan",,"0.660003542039775","No","Yes","No","100%",,"$6,450","$900","$0","$60","$6,500","$400","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","50.00%",,,,,"$13,000","$13000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_6500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070003","Silver Classic 6500","70525AR007",,"ARN001","ARS002","ARF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070003-02","Silver Classic","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070003","Silver Classic 6500","70525AR007",,"ARN001","ARS002","ARF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070003-03","Silver Classic 6500-I","Limited Cost Sharing Plan Variation",,"0.660003542039775","No","Yes","No","100%",,"$6,450","$900","$0","$60","$6,500","$400","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","50.00%",,,,,"$13,000","$13000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_6500_I.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070003","Silver Classic 6500","70525AR007",,"ARN001","ARS002","ARF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070003-04","Silver Classic 3000","73% AV Level Silver Plan",,"0.736510008073203","No","Yes","No","100%",,"$3,000","$400","$200","$60","$3,000","$1,500","$70","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$14,700","$14700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$13,000","$13000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_3000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070003","Silver Classic 6500","70525AR007",,"ARN001","ARS002","ARF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070003-05","Silver Classic 600","87% AV Level Silver Plan",,"0.868659486571378","No","Yes","No","100%",,"$600","$400","$600","$60","$600","$1,400","$20","$60","$600","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$14,700","$14700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20.00%",,,,,"$13,000","$13000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_600.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070003","Silver Classic 6500","70525AR007",,"ARN001","ARS002","ARF003","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070003-06","Silver Classic 550","94% AV Level Silver Plan",,"0.948944251926035","No","Yes","No","100%",,"$550","$0","$200","$60","$550","$200","$10","$60","$550","$40","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$790","$790 per person","$1580 per group",,,,"$14,700","$14700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$550","$550 per person","$1100 per group","0.00%",,,,,"$13,000","$13000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_550.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3500","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070151-00","Silver Classic Saver 3500","Standard Silver Off Exchange Plan",,"0.698417431011734","Yes","Yes","No","100%",,"$3,500","$0","$900","$60","$3,500","$0","$400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","10.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_Saver_3500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/IQC-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3500","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070151-05","Silver Classic Saver 850","87% AV Level Silver Plan",,"0.871492489054894","Yes","Yes","No","100%",,"$850","$0","$600","$60","$850","$0","$300","$60","$850","$0","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","5.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_Saver_850.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3500","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070151-06","Silver Classic Saver 500","94% AV Level Silver Plan",,"0.937977340786209","Yes","Yes","No","100%",,"$500","$0","$0","$60","$500","$0","$0","$60","$500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_Saver_500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070050","Gold Classic 2000","70525AR007",,"ARN001","ARS001","ARF005","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070050-00","Gold Classic 2000","Standard Gold Off Exchange Plan",,"0.812518532181938","No","Yes","No","100%",,"$2,000","$0","$1,500","$60","$2,000","$1,400","$60","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Gold_Classic_2000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/IQC-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070050","Gold Classic 2000","70525AR007",,"ARN001","ARS001","ARF005","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070050-01","Gold Classic 2000","Standard Gold On Exchange Plan",,"0.812518532181938","No","Yes","No","100%",,"$2,000","$0","$1,500","$60","$2,000","$1,400","$60","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Gold_Classic_2000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070050","Gold Classic 2000","70525AR007",,"ARN001","ARS001","ARF005","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070050-02","Gold Classic","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Gold_Classic.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070050","Gold Classic 2000","70525AR007",,"ARN001","ARS001","ARF005","Existing","POS","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070050-03","Gold Classic 2000-I","Limited Cost Sharing Plan Variation",,"0.812518532181938","No","Yes","No","100%",,"$2,000","$0","$1,500","$60","$2,000","$1,400","$60","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Gold_Classic_2000_I.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070004","Silver Classic Saver 4000","70525AR007",,"ARN001","ARS002","ARF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070004-00","Silver Classic Saver 4000","Standard Silver Off Exchange Plan",,"0.660037717993509","Yes","Yes","No","100%",,"$4,000","$0","$1,250","$60","$4,000","$0","$1,250","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","45.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_Saver_4000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/IQC-Plans.pdf"
"2018","AR","70525","SERFF","2017-10-17 20:15:27","Individual","No","71-0794605","70525AR0070004","Silver Classic Saver 4000","70525AR007",,"ARN001","ARS002","ARF006","New","POS","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2018-Formulary-Essential-Comp-Med.pdf","70525AR0070004-06","Silver Classic Saver 575","94% AV Level Silver Plan",,"0.930086443997505","Yes","Yes","No","100%",,"$575","$0","$0","$60","$575","$0","$0","$60","$575","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2018/Silver_Classic_Saver_575.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2018/QCA-Mktpl-Plans.pdf"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","Yes","71-0226428","75293AR1230001","Pediatric Dental","75293AR123","7427051652","ARN003","ARS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"0.995","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"","75293AR1230001-00","Pediatric Dental","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200003","Silver Plan 1","75293AR120","7427051652","ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200003-00","Silver Plan 1","Standard Silver Off Exchange Plan",,"0.719410938435217","No","Yes","No","100%",,"$1,400","$90","$3,600","$90","$1,400","$1,800","$500","$60","$1,400","$400","$100","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","40.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34011&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200003","Silver Plan 1","75293AR120","7427051652","ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200003-01","Silver Plan 1","Standard Silver On Exchange Plan",,"0.719410938435217","No","Yes","No","100%",,"$1,400","$90","$3,600","$90","$1,400","$1,800","$500","$60","$1,400","$400","$100","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","40.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34011&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","Yes","71-0226428","75293AR1230001","Pediatric Dental","75293AR123","7427051652","ARN003","ARS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"0.995","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"","75293AR1230001-01","Pediatric Dental","Standard High On Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200003","Silver Plan 1","75293AR120","7427051652","ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200003-02","Silver Plan 1","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$90","$0","$0","$0","$60","$0","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34011&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200003","Silver Plan 1","75293AR120","7427051652","ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200003-03","Silver Plan 1","Limited Cost Sharing Plan Variation",,"0.719410938435217","No","Yes","No","100%",,"$1,400","$90","$4,500","$90","$1,400","$1,800","$500","$60","$1,400","$800","$10","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","40.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=33004&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200003","Silver Plan 1","75293AR120","7427051652","ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200003-04","Silver Plan 1","73% AV Level Silver Plan",,"0.739863500019957","No","Yes","No","100%",,"$1,400","$90","$3,500","$90","$1,400","$1,800","$500","$60","$1,400","$800","$10","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","35.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32020&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200003","Silver Plan 1","75293AR120","7427051652","ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200003-05","Silver Plan 1","87% AV Level Silver Plan",,"0.879994598945252","No","Yes","No","100%",,"$500","$90","$2,400","$90","$500","$1,100","$600","$60","$500","$300","$200","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32021&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200003","Silver Plan 1","75293AR120","7427051652","ARN001","ARS001","ARF001","Existing","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200003-06","Silver Plan 1","94% AV Level Silver Plan",,"0.949932967069126","No","Yes","No","100%",,"$300","$90","$1,100","$90","$300","$800","$600","$60","$300","$200","$200","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32022&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200004","Silver Plan AW1","75293AR120","7427051652","ARN001","ARS001","ARF010","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200004-00","Silver Plan AW1","Standard Silver Off Exchange Plan",,"0.660095058613857","No","Yes","No","100%",,"$2,800","$90","$2,900","$90","$2,400","$1,800","$0","$60","$1,600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","30.00%",,,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34009&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","Yes","71-0226428","75293AR1230003","Dental Gold","75293AR123","7427051652","ARN003","ARS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.995","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"","75293AR1230003-00","Dental Gold","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","Yes","71-0226428","75293AR1230003","Dental Gold","75293AR123","7427051652","ARN003","ARS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.995","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"","75293AR1230003-01","Dental Gold","Standard High On Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200014","Silver Plan 2","75293AR120","7427051652","ARN001","ARS001","ARF020","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200014-00","Silver Plan 2","Standard Silver Off Exchange Plan",,"0.665272924206011","No","Yes","No","100%",,"$4,000","$90","$3,000","$90","$2,300","$1,900","$0","$60","$1,600","$400","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","35.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34018&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200014","Silver Plan 2","75293AR120","7427051652","ARN001","ARS001","ARF020","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200014-01","Silver Plan 2","Standard Silver On Exchange Plan",,"0.665272924206011","No","Yes","No","100%",,"$4,000","$90","$3,000","$90","$2,300","$1,900","$0","$60","$1,600","$400","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","35.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34018&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200014","Silver Plan 2","75293AR120","7427051652","ARN001","ARS001","ARF020","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200014-02","Silver Plan 2","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$90","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34019&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200014","Silver Plan 2","75293AR120","7427051652","ARN001","ARS001","ARF020","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200014-03","Silver Plan 2","Limited Cost Sharing Plan Variation",,"0.665272924206011","No","Yes","No","100%",,"$4,000","$90","$3,000","$90","$2,300","$1,900","$0","$60","$1,000","$900","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","35.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34020&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200014","Silver Plan 2","75293AR120","7427051652","ARN001","ARS001","ARF020","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200014-04","Silver Plan 2","73% AV Level Silver Plan",,"0.739914789452505","No","Yes","No","100%",,"$2,000","$90","$3,200","$90","$2,000","$1,400","$200","$60","$1,400","$500","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34021&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200014","Silver Plan 2","75293AR120","7427051652","ARN001","ARS001","ARF020","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200014-05","Silver Plan 2","87% AV Level Silver Plan",,"0.879909558995558","No","Yes","No","100%",,"$500","$90","$1,800","$90","$500","$1,100","$600","$60","$500","$200","$200","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$525","$525 per person","$1050 per group","15.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34022&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200004","Silver Plan AW1","75293AR120","7427051652","ARN001","ARS001","ARF010","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200004-01","Silver Plan AW1","Standard Silver On Exchange Plan",,"0.660095058613857","No","Yes","No","100%",,"$2,800","$90","$2,900","$90","$2,400","$1,800","$0","$60","$1,600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","30.00%",,,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34009&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200004","Silver Plan AW1","75293AR120","7427051652","ARN001","ARS001","ARF010","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200004-02","Silver Plan AW1","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$90","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34009&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","Yes","71-0226428","75293AR1230004","Dental Gold Plus Vision","75293AR123","7427051652","ARN003","ARS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.817","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"","75293AR1230004-00","Dental Gold Plus Vision","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","Yes","71-0226428","75293AR1230004","Dental Gold Plus Vision","75293AR123","7427051652","ARN003","ARS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.817","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"","75293AR1230004-01","Dental Gold Plus Vision","Standard High On Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200004","Silver Plan AW1","75293AR120","7427051652","ARN001","ARS001","ARF010","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200004-03","Silver Plan AW1","Limited Cost Sharing Plan Variation",,"0.660095058613857","No","Yes","No","100%",,"$2,800","$90","$2,900","$90","$200","$2,900","$0","$60","$800","$900","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","30.00%",,,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=33002&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200004","Silver Plan AW1","75293AR120","7427051652","ARN001","ARS001","ARF010","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200004-04","Silver Plan AW1","73% AV Level Silver Plan",,"0.739919751786027","No","Yes","No","100%",,"$1,600","$90","$2,200","$90","$1,600","$1,100","$400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","20.00%",,,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32008&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200004","Silver Plan AW1","75293AR120","7427051652","ARN001","ARS001","ARF010","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200004-05","Silver Plan AW1","87% AV Level Silver Plan",,"0.879916443511505","No","Yes","No","100%",,"$500","$90","$1,200","$90","$500","$800","$600","$60","$1,600","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$550","$550 per person","$1100 per group","10.00%",,,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","$110 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32009&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200004","Silver Plan AW1","75293AR120","7427051652","ARN001","ARS001","ARF010","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200004-06","Silver Plan AW1","94% AV Level Silver Plan",,"0.948966831257585","No","Yes","No","100%",,"$600","$20","$0","$90","$600","$500","$4,600","$60","$600","$60","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$790","$790 per person","$1580 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$550","$550 per person","$1100 per group","0.00%",,,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32010&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200017","Silver Plan AW1A","75293AR120","7427051652","ARN001","ARS001","ARF015","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200017-00","Silver Plan AW1A","Standard Silver Off Exchange Plan",,"0.66007626868602","No","Yes","No","100%",,"$5,000","$90","$2,300","$90","$5,000","$1,500","$0","$60","$1,100","$500","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34015&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","Yes","71-0226428","75293AR1230002","Dental Silver","75293AR123","7217051652","ARN003","ARS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.995","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"","75293AR1230002-00","Dental Silver","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","Yes","71-0226428","75293AR1230002","Dental Silver","75293AR123","7217051652","ARN003","ARS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.995","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"","75293AR1230002-01","Dental Silver","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200017","Silver Plan AW1A","75293AR120","7427051652","ARN001","ARS001","ARF015","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200017-01","Silver Plan AW1A","Standard Silver On Exchange Plan",,"0.66007626868602","No","Yes","No","100%",,"$5,000","$90","$2,300","$90","$5,000","$1,500","$0","$60","$1,100","$500","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34015&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200017","Silver Plan AW1A","75293AR120","7427051652","ARN001","ARS001","ARF015","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200017-02","Silver Plan AW1A","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$90","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34015&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200017","Silver Plan AW1A","75293AR120","7427051652","ARN001","ARS001","ARF015","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200017-03","Silver Plan AW1A","Limited Cost Sharing Plan Variation",,"0.66007626868602","No","Yes","No","100%",,"$5,000","$90","$2,300","$90","$5,000","$1,500","$0","$60","$1,100","$500","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34015&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200017","Silver Plan AW1A","75293AR120","7427051652","ARN001","ARS001","ARF015","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200017-04","Silver Plan AW1A","73% AV Level Silver Plan",,"0.739954040183653","No","Yes","No","100%",,"$2,400","$90","$2,000","$90","$2,400","$1,200","$0","$60","$1,100","$300","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34015&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200017","Silver Plan AW1A","75293AR120","7427051652","ARN001","ARS001","ARF015","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200017-05","Silver Plan AW1A","87% AV Level Silver Plan",,"0.879983055728172","No","Yes","No","100%",,"$500","$90","$1,200","$90","$500","$900","$0","$60","$1,200","$200","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,375","$2375 per person","$4750 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$250 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34015&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200017","Silver Plan AW1A","75293AR120","7427051652","ARN001","ARS001","ARF015","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200017-06","Silver Plan AW1A","94% AV Level Silver Plan",,"0.949971364364792","No","Yes","No","100%",,"$100","$60","$1,300","$90","$100","$700","$300","$60","$1,300","$100","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$120","$120 per person","$240 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","$60 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34015&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200014","Silver Plan 2","75293AR120","7427051652","ARN001","ARS001","ARF020","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200014-06","Silver Plan 2","94% AV Level Silver Plan",,"0.949914565459005","No","Yes","No","100%",,"$100","$200","$1,100","$90","$100","$1,100","$20","$60","$100","$100","$300","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$560","$560 per person","$1120 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$250 per group","15.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","$60 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34023&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200006","Silver Plan HSA 1","75293AR120","7427051652","ARN001","ARS001","ARF024","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200006-00","Silver Plan HSA 1","Standard Silver Off Exchange Plan",,"0.664348061830027","Yes","Yes","No","100%",,"$3,600","$90","$1,800","$90","$2,500","$1,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","20.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=33006&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200006","Silver Plan HSA 1","75293AR120","7427051652","ARN001","ARS001","ARF024","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200006-01","Silver Plan HSA 1","Standard Silver On Exchange Plan",,"0.664348061830027","Yes","Yes","No","100%",,"$3,600","$90","$1,800","$90","$2,500","$1,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","20.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=33006&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200006","Silver Plan HSA 1","75293AR120","7427051652","ARN001","ARS001","ARF024","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200006-02","Silver Plan HSA 1","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$90","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34012&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200006","Silver Plan HSA 1","75293AR120","7427051652","ARN001","ARS001","ARF024","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200006-03","Silver Plan HSA 1","Limited Cost Sharing Plan Variation",,"0.664348061830027","Yes","Yes","No","100%",,"$3,600","$90","$1,800","$90","$2,500","$1,300","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","20.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=33006&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200006","Silver Plan HSA 1","75293AR120","7427051652","ARN001","ARS001","ARF024","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200006-04","Silver Plan HSA 1","73% AV Level Silver Plan",,"0.739858816413653","Yes","Yes","No","100%",,"$2,700","$90","$500","$90","$2,500","$900","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,475","$3475 per person","$6950 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,725","$2725 per person","$5450 per group","5.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32024&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200006","Silver Plan HSA 1","75293AR120","7427051652","ARN001","ARS001","ARF024","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200006-05","Silver Plan HSA 1","87% AV Level Silver Plan",,"0.879948411060917","Yes","Yes","No","100%",,"$800","$80","$600","$90","$800","$600","$80","$60","$800","$0","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","5.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32025&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200006","Silver Plan HSA 1","75293AR120","7427051652","ARN001","ARS001","ARF024","New","PPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200006-06","Silver Plan HSA 1","94% AV Level Silver Plan",,"0.949929198525077","Yes","Yes","No","100%",,"$200","$80","$600","$90","$200","$600","$100","$60","$300","$0","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$520","$520 per person","$1040 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$225","$225 per person","$450 per group","5.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32026&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200007","Bronze Plan 1","75293AR120","7427051652","ARN001","ARS001","ARF028","New","PPO","Expanded Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200007-00","Bronze Plan 1","Standard Bronze Off Exchange Plan",,"0.639892312437036","No","Yes","No","100%",,"$5,000","$0","$3,900","$90","$2,500","$1,300","$200","$60","$1,900","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34015&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200007","Bronze Plan 1","75293AR120","7427051652","ARN001","ARS001","ARF028","New","PPO","Expanded Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200007-01","Bronze Plan 1","Standard Bronze On Exchange Plan",,"0.639892312437036","No","Yes","No","100%",,"$5,000","$0","$3,900","$90","$2,500","$1,300","$200","$60","$1,900","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34015&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200007","Bronze Plan 1","75293AR120","7427051652","ARN001","ARS001","ARF028","New","PPO","Expanded Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200007-02","Bronze Plan 1","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$90","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34015&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200007","Bronze Plan 1","75293AR120","7427051652","ARN001","ARS001","ARF028","New","PPO","Expanded Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200007-03","Bronze Plan 1","Limited Cost Sharing Plan Variation",,"0.639892312437036","No","Yes","No","100%",,"$5,000","$0","$3,900","$90","$2,500","$1,300","$200","$60","$1,900","$0","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34015&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200008","Bronze Plan HSA 1","75293AR120","7427051652","ARN001","ARS001","ARF029","New","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200008-00","Bronze Plan HSA 1","Standard Bronze Off Exchange Plan",,"0.605309189507699","Yes","Yes","No","100%",,"$6,400","$90","$600","$90","$2,500","$1,600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","10.00%",,,,,"$12,800","$12800 per person","$25600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=25001&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200008","Bronze Plan HSA 1","75293AR120","7427051652","ARN001","ARS001","ARF029","New","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200008-01","Bronze Plan HSA 1","Standard Bronze On Exchange Plan",,"0.605309189507699","Yes","Yes","No","100%",,"$6,400","$90","$600","$90","$2,500","$1,600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","10.00%",,,,,"$12,800","$12800 per person","$25600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=25001&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200008","Bronze Plan HSA 1","75293AR120","7427051652","ARN001","ARS001","ARF029","New","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200008-02","Bronze Plan HSA 1","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$90","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=26001&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","AR","75293","SERFF","2017-10-31 20:15:29","Individual","No","71-0226428","75293AR1200008","Bronze Plan HSA 1","75293AR120","7427051652","ARN001","ARS001","ARF029","New","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9962",,,"2018-01-01","2018-12-31","Yes","Emergency Care","Yes","Benefit Reduction","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/metallicdruglist.aspx?yr=2018","75293AR1200008-03","Bronze Plan HSA 1","Limited Cost Sharing Plan Variation",,"0.605309189507699","Yes","Yes","No","100%",,"$6,400","$90","$600","$90","$2,500","$1,600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","10.00%",,,,,"$12,800","$12800 per person","$25600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=26001&year=2018","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx"
"2018","DE","26018","SERFF","2017-08-16 20:15:58","Individual","Yes","94-2761537","26018DE0010002","Delta Dental PPO Pediatric Preferred Plan","26018DE001",,"DEN001","DES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0010002-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0010002-18"
"2018","DE","26018","SERFF","2017-08-16 20:15:58","Individual","Yes","94-2761537","26018DE0010001","Delta Dental PPO Pediatric Basic Plan","26018DE001",,"DEN001","DES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0010001-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","$85 per person","per group not applicable",,,,,,"$85","$85 per person","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0010001-18"
"2018","DE","26018","SERFF","2017-08-16 20:15:58","Individual","Yes","94-2761537","26018DE0010006","Delta Dental PPO Basic Plan for Families","26018DE001",,"DEN001","DES001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0010006-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","$85 per person","per group not applicable",,,,,,"$85","$85 per person","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0010006-18"
"2018","DE","26018","SERFF","2017-08-16 20:15:58","Individual","Yes","94-2761537","26018DE0010004","Delta Dental PPO Preferred Plan for Families","26018DE001",,"DEN001","DES001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0010004-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0010004-18"
"2018","DE","60359","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","13-5581829","60359DE0090001","EHB Basic Dental Plan (Low)","60359DE009",,"DEN001","DES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","60359DE0090001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","71.88%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","DE","67775","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","54-1808292","67775DE0040004","Choice PPO Basic","67775DE004","7962405180","DEN002","DES002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","67775DE0040004-00","Choice PPO Basic","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBLSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBLSMGFAMEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","Individual","Yes","54-1808292","67775DE0020005","Elite PPO Basic Kids","67775DE002","7962405180","DEN003","DES003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020005-00","Elite PPO Basic Kids","Standard Low Off Exchange Plan","71.7%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBLINDPEDEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","Individual","Yes","54-1808292","67775DE0020005","Elite PPO Basic Kids","67775DE002","7962405180","DEN003","DES003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020005-01","Elite PPO Basic Kids","Standard Low On Exchange Plan","71.7%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBLINDPEDEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","54-1808292","67775DE0040004","Choice PPO Basic","67775DE004","7962405180","DEN002","DES002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","67775DE0040004-01","Choice PPO Basic","Standard High On Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBLSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBLSMGFAMEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","54-1808292","67775DE0040005","Choice PPO Premium","67775DE004","7962405180","DEN002","DES002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","67775DE0040005-00","Choice PPO Premium","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBHSMGFAMEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","Individual","Yes","54-1808292","67775DE0020003","Elite PPO Premium Kids","67775DE002","7962405180","DEN003","DES003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020003-00","Elite PPO Premium Kids","Standard High Off Exchange Plan","84.2%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$100 per person","$200 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBHINDPEDEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","Individual","Yes","54-1808292","67775DE0020003","Elite PPO Premium Kids","67775DE002","7962405180","DEN003","DES003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020003-01","Elite PPO Premium Kids","Standard High On Exchange Plan","84.2%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$100 per person","$200 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBHINDPEDEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","54-1808292","67775DE0040005","Choice PPO Premium","67775DE004","7962405180","DEN002","DES002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","67775DE0040005-01","Choice PPO Premium","Standard High On Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBHSMGFAMEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","Individual","Yes","54-1808292","67775DE0010003","Select Plan Basic Kids","67775DE001","7962405180","DEN001","DES001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010003-00","Select Plan Basic Kids","Standard Low Off Exchange Plan","70.2%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBLINDPEDEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","54-1808292","67775DE0030004","Select Plan Premium","67775DE003","7962405180","DEN001","DES001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0030004-01","Select Plan Premium","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBHSMGFAMEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","Individual","Yes","54-1808292","67775DE0010006","Select Plan Premium","67775DE001","7962405180","DEN001","DES001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010006-00","Select Plan Premium","Standard High Off Exchange Plan","87.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBHINDFAMEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","Individual","Yes","54-1808292","67775DE0010003","Select Plan Basic Kids","67775DE001","7962405180","DEN001","DES001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010003-01","Select Plan Basic Kids","Standard Low On Exchange Plan","70.2%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBLINDPEDEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","Individual","Yes","54-1808292","67775DE0010005","Select Plan Premium Kids","67775DE001","7962405180","DEN001","DES001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010005-00","Select Plan Premium Kids","Standard High Off Exchange Plan","87.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBHINDPEDEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","Individual","Yes","54-1808292","67775DE0010005","Select Plan Premium Kids","67775DE001","7962405180","DEN001","DES001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010005-01","Select Plan Premium Kids","Standard High On Exchange Plan","87.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBHINDPEDEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","54-1808292","67775DE0030004","Select Plan Premium","67775DE003","7962405180","DEN001","DES001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0030004-00","Select Plan Premium","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBHSMGFAMEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","Individual","Yes","54-1808292","67775DE0010004","Select Plan Basic","67775DE001","7962405180","DEN001","DES001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010004-00","Select Plan Basic","Standard Low Off Exchange Plan","70.2%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBLINDFAMEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","Individual","Yes","54-1808292","67775DE0010004","Select Plan Basic","67775DE001","7962405180","DEN001","DES001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010004-01","Select Plan Basic","Standard Low On Exchange Plan","70.2%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBLINDFAMEHB.PDF"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0400001","Major Events Blue EPO 7350","76168DE040",,"DEN001","DES001","DEF013","Existing","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9958",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0400001-01","Major Events Blue EPO 7350","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$7,350","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0400001-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","HI","10046","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","10046HI0020004","BESTOne Plus Gold","10046HI002",,"HIN001","HIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/current/HI_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","HI","10046","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","10046HI0020004","BESTOne Plus Gold","10046HI002",,"HIN001","HIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/current/HI_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","HI","10046","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","10046HI0020005","BESTOne Plus Silver","10046HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/current/HI_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","HI","10046","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","10046HI0020005","BESTOne Plus Silver","10046HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/current/HI_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","Individual","Yes","54-1808292","67775DE0010006","Select Plan Premium","67775DE001","7962405180","DEN001","DES001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010006-01","Select Plan Premium","Standard High On Exchange Plan","87.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18DBHINDFAMEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","Individual","Yes","54-1808292","67775DE0020004","Elite PPO Basic","67775DE002","7962405180","DEN003","DES003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020004-00","Elite PPO Basic","Standard Low Off Exchange Plan","71.7%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBLINDFAMEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","54-1808292","67775DE0040006","Choice PPO Plus","67775DE004","7962405180","DEN002","DES002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","67775DE0040006-00","Choice PPO Plus","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SB2SMGFAM@@@.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SB2SMGFAM@@@.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","Individual","Yes","54-1808292","67775DE0020004","Elite PPO Basic","67775DE002","7962405180","DEN003","DES003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020004-01","Elite PPO Basic","Standard Low On Exchange Plan","71.7%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBLINDFAMEHB.PDF"
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","Yes","99-0040115","18350HI0920001","HMSA Individual Dental PPP High","18350HI092",,"HIN006","HIS002",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Out of area service benefits are available as defined in the Policy but members may have a higher cost share","Yes",,"","18350HI0920001-01","HMSA Individual Dental PPP High","Standard High On Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hmsa.com/sbc/2018/individual-dental-ppp-high.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880007","HMSA Gold PPO","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9876",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880007-01","HMSA Gold PPO","Standard Gold On Exchange Plan",,"0.817002173079651","Yes","Yes","No","100%",,"$0","$100","$3,700","$60","$0","$1,300","$600","$60","$0","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/gold-ppo.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880007","HMSA Gold PPO","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9876",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880007-02","HMSA Gold PPO Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/gold-ppo-ai-an-zero-cs.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880007","HMSA Gold PPO","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9876",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880007-03","HMSA Gold PPO Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.817002173079651","Yes","Yes","No","100%",,"$0","$100","$3,700","$60","$0","$1,300","$600","$60","$0","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/gold-ppo-ai-an-limited-cs.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880013","HMSA Gold PPO 1000","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9868",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880013-00","HMSA Gold PPO 1000","Standard Gold Off Exchange Plan",,"0.80706618320242","Yes","Yes","No","100%",,"$1,000","$70","$2,500","$60","$1,000","$800","$400","$60","$900","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2018/gold-ppo-1000.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","Yes","99-0040115","18350HI0920002","HMSA Individual Dental PPP Basic","18350HI092",,"HIN006","HIS002",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Out of area service benefits are available as defined in the Policy but members may have a higher cost share","Yes",,"","18350HI0920002-01","HMSA Individual Dental PPP Basic","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hmsa.com/sbc/2018/individual-dental-ppp-basic.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880013","HMSA Gold PPO 1000","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9868",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880013-01","HMSA Gold PPO 1000","Standard Gold On Exchange Plan",,"0.80706618320242","Yes","Yes","No","100%",,"$1,000","$70","$2,500","$60","$1,000","$800","$400","$60","$900","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2018/gold-ppo-1000.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880013","HMSA Gold PPO 1000","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9868",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880013-02","HMSA Gold PPO 1000 Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/gold-ppo-1000-ai-an-zero-cs.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880013","HMSA Gold PPO 1000","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9868",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880013-03","HMSA Gold PPO 1000 Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.80706618320242","Yes","Yes","No","100%",,"$1,000","$70","$2,500","$60","$1,000","$800","$400","$60","$900","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2018/gold-ppo-1000-ai-an-limited-cs.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 2000","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9882",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880017-00","HMSA Silver PPO 2000","Standard Silver Off Exchange Plan",,"0.718091440563784","Yes","Yes","No","100%",,"$2,000","$200","$3,900","$60","$2,000","$1,600","$600","$60","$700","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","No",,,"http://www.hmsa.com/sbc/2018/silver-ppo-2000.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","Yes","99-0040115","18350HI0930001","HMSA Individual Dental HMO Basic","18350HI093",,"HIN007","HIS002",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only","No",,"","18350HI0930001-01","HMSA Individual Dental HMO Basic","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hmsa.com/sbc/2018/individual-dental-hmo-basic.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 2000","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9882",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880017-01","HMSA Silver PPO 2000","Standard Silver On Exchange Plan",,"0.718091440563784","Yes","Yes","No","100%",,"$2,000","$200","$3,900","$60","$2,000","$1,600","$600","$60","$700","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","No",,,"http://www.hmsa.com/sbc/2018/silver-ppo-2000.pdf",
"2018","DE","67775","SERFF","2017-08-16 20:15:58","Individual","Yes","54-1808292","67775DE0020006","Elite PPO Premium","67775DE002","7962405180","DEN003","DES003",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020006-00","Elite PPO Premium","Standard High Off Exchange Plan","84.2%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBHINDFAMEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","Individual","Yes","54-1808292","67775DE0020006","Elite PPO Premium","67775DE002","7962405180","DEN003","DES003",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020006-01","Elite PPO Premium","Standard High On Exchange Plan","84.2%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SBHINDFAMEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","Individual","Yes","54-1808292","67775DE0020007","Elite PPO Plus","67775DE002","7962405180","DEN003","DES003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020007-00","Elite PPO Plus","Standard Low Off Exchange Plan","71.7%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SB2INDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SB2INDFAMEHB.PDF"
"2018","DE","67775","SERFF","2017-08-16 20:15:58","Individual","Yes","54-1808292","67775DE0020007","Elite PPO Plus","67775DE002","7962405180","DEN003","DES003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020007-01","Elite PPO Plus","Standard Low On Exchange Plan","71.7%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SB2INDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNDE18SB2INDFAMEHB.PDF"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3500","76168DE042",,"DEN001","DES001","DEF015","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0420004-00","Health Savings Embedded Blue EPO 3500","Standard Silver Off Exchange Plan",,"0.680891908634842","Yes","Yes","No","100%",,"$3,500","$0","$900","$0","$3,500","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3500","76168DE042",,"DEN001","DES001","DEF015","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0420004-01","Health Savings Embedded Blue EPO 3500","Standard Silver On Exchange Plan",,"0.680891908634842","Yes","Yes","No","100%",,"$3,500","$0","$900","$0","$3,500","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0420004-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3500","76168DE042",,"DEN001","DES001","DEF015","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0420004-02","Health Savings Embedded Blue EPO 3500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0420004-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3500","76168DE042",,"DEN001","DES001","DEF015","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0420004-03","Health Savings Embedded Blue EPO 3500","Limited Cost Sharing Plan Variation",,"0.680891908634842","Yes","Yes","No","100%",,"$3,500","$0","$900","$0","$3,500","$0","$400","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0420004-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3500","76168DE042",,"DEN001","DES001","DEF015","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0420004-04","Health Savings Embedded Blue EPO 3500","73% AV Level Silver Plan",,"0.723436606671459","Yes","Yes","No","100%",,"$2,600","$0","$1,000","$0","$2,600","$0","$500","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0420004-04_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3500","76168DE042",,"DEN001","DES001","DEF015","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0420004-05","Health Savings Embedded Blue EPO 3500","87% AV Level Silver Plan",,"0.877045431928285","Yes","Yes","No","100%",,"$600","$0","$1,200","$0","$600","$0","$700","$0","$600","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0420004-05_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3500","76168DE042",,"DEN001","DES001","DEF015","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0420004-06","Health Savings Embedded Blue EPO 3500","94% AV Level Silver Plan",,"0.939255186215939","Yes","Yes","No","100%",,"$200","$0","$600","$0","$200","$0","$600","$0","$200","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0420004-06_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0420001","Health Savings Embedded Blue EPO 6550","76168DE042",,"DEN001","DES001","DEF013","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0420001-00","Health Savings Embedded Blue EPO 6550","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0420001","Health Savings Embedded Blue EPO 6550","76168DE042",,"DEN001","DES001","DEF013","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0420001-01","Health Savings Embedded Blue EPO 6550","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0420001-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0420001","Health Savings Embedded Blue EPO 6550","76168DE042",,"DEN001","DES001","DEF013","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0420001-02","Health Savings Embedded Blue EPO 6550","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0420001-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0420001","Health Savings Embedded Blue EPO 6550","76168DE042",,"DEN001","DES001","DEF013","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0420001-03","Health Savings Embedded Blue EPO 6550","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$6,550","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0420001-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0400001","Major Events Blue EPO 7350","76168DE040",,"DEN001","DES001","DEF013","Existing","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9958",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0400001-00","Major Events Blue EPO 7350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$7,350","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410012","Shared Cost Blue EPO 1400","76168DE041",,"DEN001","DES001","DEF018","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410012-00","Shared Cost Blue EPO 1400","Standard Gold Off Exchange Plan",,"0.780453303089595","No","Yes","No","100%",,"$1,400","$0","$2,100","$0","$1,500","$900","$200","$0","$800","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410012","Shared Cost Blue EPO 1400","76168DE041",,"DEN001","DES001","DEF018","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410012-01","Shared Cost Blue EPO 1400","Standard Gold On Exchange Plan",,"0.780453303089595","No","Yes","No","100%",,"$1,400","$0","$2,100","$0","$1,500","$900","$200","$0","$800","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0410012-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410012","Shared Cost Blue EPO 1400","76168DE041",,"DEN001","DES001","DEF018","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410012-02","Shared Cost Blue EPO 1400","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0410012-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410012","Shared Cost Blue EPO 1400","76168DE041",,"DEN001","DES001","DEF018","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410012-03","Shared Cost Blue EPO 1400","Limited Cost Sharing Plan Variation",,"0.780453303089595","No","Yes","No","100%",,"$1,400","$0","$2,100","$0","$1,500","$900","$200","$0","$800","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0410012-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 3500","76168DE041",,"DEN001","DES001","DEF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410013-00","Shared Cost Blue EPO 3500","Standard Silver Off Exchange Plan",,"0.706197650833301","No","Yes","No","100%",,"$3,500","$100","$2,400","$0","$2,400","$1,000","$0","$0","$800","$700","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 3500","76168DE041",,"DEN001","DES001","DEF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410013-01","Shared Cost Blue EPO 3500","Standard Silver On Exchange Plan",,"0.706197650833301","No","Yes","No","100%",,"$3,500","$100","$2,400","$0","$2,400","$1,000","$0","$0","$800","$700","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0410013-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 3500","76168DE041",,"DEN001","DES001","DEF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410013-02","Shared Cost Blue EPO 3500","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0410013-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 3500","76168DE041",,"DEN001","DES001","DEF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410013-03","Shared Cost Blue EPO 3500","Limited Cost Sharing Plan Variation",,"0.706197650833301","No","Yes","No","100%",,"$3,500","$100","$2,400","$0","$2,400","$1,000","$0","$0","$800","$700","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0410013-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 3500","76168DE041",,"DEN001","DES001","DEF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410013-04","Shared Cost Blue EPO 3500","73% AV Level Silver Plan",,"0.738680978554597","No","Yes","No","100%",,"$3,500","$100","$1,600","$0","$2,400","$1,000","$0","$0","$800","$700","$0","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0410013-04_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 3500","76168DE041",,"DEN001","DES001","DEF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410013-05","Shared Cost Blue EPO 3500","87% AV Level Silver Plan",,"0.878015408086321","No","Yes","No","100%",,"$800","$50","$650","$0","$1,050","$350","$100","$0","$800","$400","$10","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0410013-05_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 3500","76168DE041",,"DEN001","DES001","DEF016","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410013-06","Shared Cost Blue EPO 3500","94% AV Level Silver Plan",,"0.944787452215182","No","Yes","No","100%",,"$300","$30","$170","$0","$450","$0","$0","$0","$200","$200","$70","$0",,"0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0410013-06_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410010","Shared Cost Blue EPO 6950","76168DE041",,"DEN001","DES001","DEF013","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410010-00","Shared Cost Blue EPO 6950","Standard Bronze Off Exchange Plan",,"0.613867445999214","Yes","Yes","No","100%",,"$6,950","$0","$0","$0","$6,500","$200","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410010","Shared Cost Blue EPO 6950","76168DE041",,"DEN001","DES001","DEF013","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410010-01","Shared Cost Blue EPO 6950","Standard Bronze On Exchange Plan",,"0.613867445999214","Yes","Yes","No","100%",,"$6,950","$0","$0","$0","$6,500","$200","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0410010-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410010","Shared Cost Blue EPO 6950","76168DE041",,"DEN001","DES001","DEF013","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410010-02","Shared Cost Blue EPO 6950","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0410010-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410010","Shared Cost Blue EPO 6950","76168DE041",,"DEN001","DES001","DEF013","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410010-03","Shared Cost Blue EPO 6950","Limited Cost Sharing Plan Variation",,"0.613867445999214","Yes","Yes","No","100%",,"$6,950","$0","$0","$0","$6,500","$200","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0410010-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410017","Shared Cost Blue EPO 7150","76168DE041",,"DEN001","DES001","DEF017","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410017-00","Shared Cost Blue EPO 7150","Standard Silver Off Exchange Plan",,"0.664231510434882","No","Yes","No","100%",,"$7,150","$0","$200","$0","$6,500","$300","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410017","Shared Cost Blue EPO 7150","76168DE041",,"DEN001","DES001","DEF017","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410017-01","Shared Cost Blue EPO 7150","Standard Silver On Exchange Plan",,"0.664231510434882","No","Yes","No","100%",,"$7,150","$0","$200","$0","$6,500","$300","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0410017-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410017","Shared Cost Blue EPO 7150","76168DE041",,"DEN001","DES001","DEF017","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410017-02","Shared Cost Blue EPO 7150","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0410017-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410017","Shared Cost Blue EPO 7150","76168DE041",,"DEN001","DES001","DEF017","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410017-03","Shared Cost Blue EPO 7150","Limited Cost Sharing Plan Variation",,"0.664231510434882","No","Yes","No","100%",,"$7,150","$0","$200","$0","$6,500","$300","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0410017-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410017","Shared Cost Blue EPO 7150","76168DE041",,"DEN001","DES001","DEF017","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410017-04","Shared Cost Blue EPO 7150","73% AV Level Silver Plan",,"0.737720139787741","No","Yes","No","100%",,"$4,500","$0","$1,000","$0","$4,500","$200","$400","$0","$1,600","$60","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0410017-04_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410017","Shared Cost Blue EPO 7150","76168DE041",,"DEN001","DES001","DEF017","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410017-05","Shared Cost Blue EPO 7150","87% AV Level Silver Plan",,"0.872396879682824","No","Yes","No","100%",,"$800","$0","$1,100","$0","$800","$30","$70","$0","$800","$30","$70","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0410017-05_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","DE","76168","SERFF","2017-09-22 20:15:56","Individual","No","51-0020405","76168DE0410017","Shared Cost Blue EPO 7150","76168DE041",,"DEN001","DES001","DEF017","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=3597426829","76168DE0410017-06","Shared Cost Blue EPO 7150","94% AV Level Silver Plan",,"0.946953386445661","No","Yes","No","100%",,"$200","$0","$400","$0","$200","$80","$320","$0","$200","$20","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/DE/Individual/I_76168DE0410017-06_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DE2018_ProductBrochure.pdf"
"2018","HI","10046","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","10046HI0020003","BESTOne Advantage Gold","10046HI002",,"HIN001","HIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/current/HI_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","HI","10046","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","10046HI0020003","BESTOne Advantage Gold","10046HI002",,"HIN001","HIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/current/HI_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","HI","10046","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","10046HI0020006","BESTOne Basic Silver","10046HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/current/HI_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","HI","10046","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","10046HI0020006","BESTOne Basic Silver","10046HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/current/HI_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","Yes","99-0040115","18350HI0920005","HMSA Individual Dental PPP Pediatric Essential","18350HI092",,"HIN006","HIS002",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Out of area service benefits are available as defined in the Policy but members may have a higher cost share","Yes",,"","18350HI0920005-01","HMSA Individual Dental PPP Pediatric Essential","Standard High On Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hmsa.com/sbc/2018/individual-dental-ppp-pediatric-essential.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880001","HMSA Platinum PPO","18350HI088",,"HIN002","HIS001","HIF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9816",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880001-00","HMSA Platinum PPO","Standard Platinum Off Exchange Plan",,"0.884312959914888","Yes","Yes","No","100%",,"$0","$70","$2,100","$60","$0","$800","$200","$60","$0","$100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/platinum-ppo.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880001","HMSA Platinum PPO","18350HI088",,"HIN002","HIS001","HIF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9816",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880001-01","HMSA Platinum PPO","Standard Platinum On Exchange Plan",,"0.884312959914888","Yes","Yes","No","100%",,"$0","$70","$2,100","$60","$0","$800","$200","$60","$0","$100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/platinum-ppo.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880001","HMSA Platinum PPO","18350HI088",,"HIN002","HIS001","HIF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9816",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880001-02","HMSA Platinum PPO Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/platinum-ppo-ai-an-zero-cs.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880001","HMSA Platinum PPO","18350HI088",,"HIN002","HIS001","HIF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9816",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880001-03","HMSA Platinum PPO Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.884312959914888","Yes","Yes","No","100%",,"$0","$70","$2,100","$60","$0","$800","$200","$60","$0","$100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/platinum-ppo-ai-an-limited-cs.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880007","HMSA Gold PPO","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9876",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880007-00","HMSA Gold PPO","Standard Gold Off Exchange Plan",,"0.817002173079651","Yes","Yes","No","100%",,"$0","$100","$3,700","$60","$0","$1,300","$600","$60","$0","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/gold-ppo.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 2000","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9882",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880017-02","HMSA Silver PPO 2000 Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/silver-ppo-2000-ai-an-zero-cs.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 2000","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9882",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880017-03","HMSA Silver PPO 2000 Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.718091440563784","Yes","Yes","No","100%",,"$2,000","$200","$3,900","$60","$2,000","$1,600","$600","$60","$700","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","No",,,"http://www.hmsa.com/sbc/2018/silver-ppo-2000-ai-an-limited-cs.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 2000","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9882",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880017-04","HMSA Silver PPO 2000 CSR 73","73% AV Level Silver Plan",,"0.739183546308918","Yes","Yes","No","100%",,"$1,800","$100","$3,900","$60","$1,800","$1,600","$600","$60","$700","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30.00%",,,,,"$1,800","$1800 per person","$3600 per group","$1,800","$1800 per person","$3600 per group","No",,,"http://www.hmsa.com/sbc/2018/silver-ppo-2000-csr-73.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 2000","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9882",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880017-05","HMSA Silver PPO 2000 CSR 87","87% AV Level Silver Plan",,"0.867971626034525","Yes","Yes","No","100%",,"$1,000","$0","$1,500","$60","$1,000","$1,000","$400","$60","$700","$90","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2018/silver-ppo-2000-csr-87.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 2000","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9882",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880017-06","HMSA Silver PPO 2000 CSR 94","94% AV Level Silver Plan",,"0.937339649132397","Yes","Yes","No","100%",,"$0","$30","$1,200","$60","$0","$600","$200","$60","$0","$30","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/silver-ppo-2000-csr-94.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880021","HMSA Silver PPO 3500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9881",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880021-00","HMSA Silver PPO 3500","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,500","$400","$60","$900","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.hmsa.com/sbc/2018/silver-ppo-3500.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880021","HMSA Silver PPO 3500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9881",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880021-01","HMSA Silver PPO 3500","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,500","$400","$60","$900","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.hmsa.com/sbc/2018/silver-ppo-3500.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880021","HMSA Silver PPO 3500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9881",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880021-02","HMSA Silver PPO 3500","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.hmsa.com/sbc/2018/silver-ppo-3500-ai-an-zero-cs.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880021","HMSA Silver PPO 3500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9881",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880021-03","HMSA Silver PPO 3500","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,500","$400","$60","$900","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.hmsa.com/sbc/2018/silver-ppo-3500-ai-an-limited-cs.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880021","HMSA Silver PPO 3500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9881",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880021-04","HMSA Silver PPO 3500","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$100","$2,500","$60","$1,500","$1,500","$400","$60","$900","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$200","$200 per person","$400 per group","40.00%",,,,,"$200","$200 per person","$400 per group","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.hmsa.com/sbc/2018/silver-ppo-3500-csr-73.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880021","HMSA Silver PPO 3500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9881",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880021-05","HMSA Silver PPO 3500","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,800","$60","$700","$600","$400","$60","$700","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","$700","$700 per person","$1400 per group","20.00%",,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.hmsa.com/sbc/2018/silver-ppo-3500-csr-87.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880021","HMSA Silver PPO 3500","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9881",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880021-06","HMSA Silver PPO 3500","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$300","$20","$600","$60","$300","$200","$90","$60","$300","$60","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$1,250","$1250 per person","$2500 per group","$1,250","$1250 per person","$2500 per group","$250","$250 per person","$500 per group","5.00%",,,,,"$250","$250 per person","$500 per group","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.hmsa.com/sbc/2018/silver-ppo-3500-csr-94.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880033","HMSA Bronze PPO 7350","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9823",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880033-00","HMSA Bronze PPO 7350","Standard Bronze Off Exchange Plan","60.54%","0.604708350862288","Yes","Yes","No","100%",,"$7,350","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$7,350","$7350 per person","$7350 per group","$7,350","$7350 per person","$14700 per group","No",,,"http://www.hmsa.com/sbc/2018/bronze-ppo-7350.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880033","HMSA Bronze PPO 7350","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9823",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880033-01","HMSA Bronze PPO 7350","Standard Bronze On Exchange Plan","60.54%","0.604708350862288","Yes","Yes","No","100%",,"$7,350","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$7,350","$7350 per person","$7350 per group","$7,350","$7350 per person","$14700 per group","No",,,"http://www.hmsa.com/sbc/2018/bronze-ppo-7350.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880033","HMSA Bronze PPO 7350","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9823",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880033-02","HMSA Bronze PPO 7350 Zero Cost Sharing","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/bronze-ppo-7350-ai-an-zero-cs.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880033","HMSA Bronze PPO 7350","18350HI088",,"HIN004","HIS001","HIF001","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9823",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880033-03","HMSA Bronze PPO 7350 Limited Cost Sharing","Limited Cost Sharing Plan Variation","60.54%","0.604708350862288","Yes","Yes","No","100%",,"$7,350","$0","$0","$150","$5,270","$0","$0","$80","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$7,350","$7350 per person","$7350 per group","$7,350","$7350 per person","$14700 per group","No",,,"http://www.hmsa.com/sbc/2018/bronze-ppo-7350-ai-an-limited-cs.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880003","HMSA Catastrophic Plan","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9824",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880003-00","HMSA Catastrophic Plan","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$400","$0","$60","$2,000","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","per group not applicable",,,,"$7,350","$7350 per person","per group not applicable","$7,350","$7350 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","per group not applicable","0.00%",,,,,"$7,350","$7350 per person","per group not applicable","$7,350","$7350 per person","per group not applicable","No",,,"http://www.hmsa.com/sbc/2018/catastrophic-plan.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0880003","HMSA Catastrophic Plan","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9824",,,"2018-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0880003-01","HMSA Catastrophic Plan","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$400","$0","$60","$2,000","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","per group not applicable",,,,"$7,350","$7350 per person","per group not applicable","$7,350","$7350 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","per group not applicable","0.00%",,,,,"$7,350","$7350 per person","per group not applicable","$7,350","$7350 per person","per group not applicable","No",,,"http://www.hmsa.com/sbc/2018/catastrophic-plan.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0890003","HMSA Platinum HMO","18350HI089",,"HIN003","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9818",,,"2018-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890003-00","HMSA Platinum HMO","Standard Platinum Off Exchange Plan",,"0.894331201360994","Yes","Yes","No","100%",,"$0","$500","$200","$60","$0","$900","$200","$60","$0","$100","$80","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/platinum-hmo.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0890003","HMSA Platinum HMO","18350HI089",,"HIN003","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9818",,,"2018-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890003-01","HMSA Platinum HMO","Standard Platinum On Exchange Plan",,"0.894331201360994","Yes","Yes","No","100%",,"$0","$500","$200","$60","$0","$900","$200","$60","$0","$100","$80","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/platinum-hmo.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0890003","HMSA Platinum HMO","18350HI089",,"HIN003","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9818",,,"2018-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890003-02","HMSA Platinum HMO Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/platinum-hmo-ai-an-zero-cs.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0890003","HMSA Platinum HMO","18350HI089",,"HIN003","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9818",,,"2018-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890003-03","HMSA Platinum HMO Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.894331201360994","Yes","Yes","No","100%",,"$0","$500","$200","$60","$0","$900","$200","$60","$0","$100","$80","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/platinum-hmo-ai-an-limited-cs.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0890004","HMSA Gold HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9869",,,"2018-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890004-00","HMSA Gold HMO","Standard Gold Off Exchange Plan",,"0.819308055278204","Yes","Yes","No","100%",,"$1,000","$600","$500","$60","$1,000","$1,000","$300","$60","$700","$200","$200","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2018/gold-hmo.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0890004","HMSA Gold HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9869",,,"2018-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890004-01","HMSA Gold HMO","Standard Gold On Exchange Plan",,"0.819308055278204","Yes","Yes","No","100%",,"$1,000","$600","$500","$60","$1,000","$1,000","$300","$60","$700","$200","$200","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2018/gold-hmo.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0890004","HMSA Gold HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9869",,,"2018-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890004-02","HMSA Gold HMO Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/gold-hmo-ai-an-zero-cs.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0890004","HMSA Gold HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9869",,,"2018-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890004-03","HMSA Gold HMO Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.819308055278204","Yes","Yes","No","100%",,"$1,000","$600","$500","$60","$1,000","$1,000","$300","$60","$700","$200","$200","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2018/gold-hmo-ai-an-limited-cs.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9882",,,"2018-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890005-00","HMSA Silver HMO","Standard Silver Off Exchange Plan",,"0.717312837423907","Yes","Yes","No","100%",,"$2,500","$800","$700","$60","$2,500","$1,800","$500","$60","$700","$300","$200","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hmsa.com/sbc/2018/silver-hmo.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9882",,,"2018-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890005-01","HMSA Silver HMO","Standard Silver On Exchange Plan",,"0.717312837423907","Yes","Yes","No","100%",,"$2,500","$800","$700","$60","$2,500","$1,800","$500","$60","$700","$300","$200","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hmsa.com/sbc/2018/silver-hmo.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9882",,,"2018-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890005-02","HMSA Silver HMO Zero Cost Sharing","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/silver-hmo-ai-an-zero-cs.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9882",,,"2018-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890005-03","HMSA Silver HMO Limited Cost Sharing","Limited Cost Sharing Plan Variation",,"0.717312837423907","Yes","Yes","No","100%",,"$2,500","$800","$700","$60","$2,500","$1,800","$500","$60","$700","$300","$200","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hmsa.com/sbc/2018/silver-hmo-ai-an-limited-cs.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9882",,,"2018-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890005-04","HMSA Silver HMO CSR 73","73% AV Level Silver Plan",,"0.738660485829139","Yes","Yes","No","100%",,"$2,200","$800","$700","$60","$2,200","$1,800","$500","$60","$700","$300","$200","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"$5,750","$5750 per person","$11500 per group","$5,750","$5750 per person","$11500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","30.00%",,,,,"$2,200","$2200 per person","$4400 per group","$2,200","$2200 per person","$4400 per group","No",,,"http://www.hmsa.com/sbc/2018/silver-hmo-csr-73.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9882",,,"2018-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890005-05","HMSA Silver HMO CSR 87","87% AV Level Silver Plan",,"0.864290530576717","Yes","Yes","No","100%",,"$1,000","$400","$500","$60","$1,000","$1,100","$300","$60","$800","$100","$200","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2018/silver-hmo-csr-87.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9882",,,"2018-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890005-06","HMSA Silver HMO CSR 94","94% AV Level Silver Plan",,"0.935165979460044","Yes","Yes","No","100%",,"$0","$300","$200","$60","$0","$800","$200","$60","$0","$80","$80","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/silver-hmo-csr-94.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0890006","HMSA Bronze HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9819",,,"2018-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890006-00","HMSA Bronze HMO","Standard Bronze Off Exchange Plan","61.44%","0.613170165603424","Yes","Yes","No","100%",,"$5,300","$1,100","$1,000","$60","$4,100","$2,500","$700","$60","$1,200","$400","$300","$0",,"4","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","No",,,"http://www.hmsa.com/sbc/2018/bronze-hmo.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0890006","HMSA Bronze HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9819",,,"2018-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890006-01","HMSA Bronze HMO","Standard Bronze On Exchange Plan","61.44%","0.613170165603424","Yes","Yes","No","100%",,"$5,300","$1,100","$1,000","$60","$4,100","$2,500","$700","$60","$1,200","$400","$300","$0",,"4","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","No",,,"http://www.hmsa.com/sbc/2018/bronze-hmo.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0890006","HMSA Bronze HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9819",,,"2018-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890006-02","HMSA Bronze HMO Zero Cost Sharing","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2018/bronze-hmo-ai-an-zero-cs.pdf",
"2018","HI","18350","SERFF","2017-10-11 20:15:22","Individual","No","99-0040115","18350HI0890006","HMSA Bronze HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9819",,,"2018-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf","18350HI0890006-03","HMSA Bronze HMO Limited Cost Sharing","Limited Cost Sharing Plan Variation","61.44%","0.613170165603424","Yes","Yes","No","100%",,"$5,300","$1,100","$1,000","$60","$4,100","$2,500","$700","$60","$1,200","$400","$300","$0",,"4","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","No",,,"http://www.hmsa.com/sbc/2018/bronze-hmo-ai-an-limited-cs.pdf",
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110004","KP Silver II $35 - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.965887923170926",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110004-02","KP Silver II $35- Fit - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$50","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Silver_II_35_Fit_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110004","KP Silver II $35 - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.965887923170926",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110004-03","KP Silver II $35 - Fit - AI/LTD","Limited Cost Sharing Plan Variation","71.94%","0.734423050278799","No","Yes","No","100%",,"$4,000","$10","$2,300","$50","$500","$900","$2,400","$60","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Silver_II_35_Fit_AI_LTD.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110004","KP Silver II $35 - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.965887923170926",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110004-04","KP Silver II $30 - Fit - CSR 73","73% AV Level Silver Plan","73.98%","0.753245607390633","No","Yes","No","100%",,"$4,000","$10","$1,800","$50","$500","$800","$2,400","$60","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Silver_II_30_Fit_CSR_73.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110004","KP Silver II $35 - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.965887923170926",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110004-05","KP Silver II $15 - Fit - CSR 87","87% AV Level Silver Plan","87.90%","0.884545933275898","No","Yes","No","100%",,"$100","$10","$2,300","$50","$50","$500","$1,900","$60","$50","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$50","$50 per person","$100 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Silver_II_15_Fit_CSR_87.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110004","KP Silver II $35 - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.965887923170926",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110004-06","KP Silver II $5 - Fit - CSR 94","94% AV Level Silver Plan","94.05%","0.94381301077511","No","Yes","No","100%",,"$0","$10","$900","$50","$0","$200","$1,200","$60","$0","$30","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Silver_II_5_Fit_CSR_94.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110013","KP Silver III $40 - Fit","60612HI011",,"HIN001","HIS001","HIF005","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.964817129076998",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110013-01","KP Silver III $40 - Fit","Standard Silver On Exchange Plan","70.96%","0.710778770314025","No","Yes","No","100%",,"$7,000","$10","$300","$50","$0","$900","$2,700","$60","$1,000","$300","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Silver_III_40_Fit.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","46082","SERFF","2017-08-18 20:15:51","Individual","Yes","99-0107971","46082HI0020001","HDS Individual Dental Plan for Children","46082HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), the maximum benefit from the plan is received when visiting a Delta Dental participating dentist.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes",,"","46082HI0020001-00","HDS Individual Dental Plan for Children","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.hawaiidentalservice.com","http://www.hawaiidentalservice.com"
"2018","HI","46082","SERFF","2017-08-18 20:15:51","Individual","Yes","99-0107971","46082HI0020001","HDS Individual Dental Plan for Children","46082HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), the maximum benefit from the plan is received when visiting a Delta Dental participating dentist.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes",,"","46082HI0020001-01","HDS Individual Dental Plan for Children","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.hawaiidentalservice.com","http://www.hawaiidentalservice.com"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110007","KP Gold I $20 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF002","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.958152722678869",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110007-01","KP Gold I $20 - ChiroAcuMassage - Fit","Standard Gold On Exchange Plan","81.93%","0.826055165495116","Yes","Yes","No","100%",,"$0","$10","$2,700","$50","$0","$1,300","$900","$60","$0","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Gold_I_20_ChiroAcuMassage_Fit.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110007","KP Gold I $20 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF002","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.958152722678869",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110007-02","KP Gold I $20 - ChiroAcuMassage - Fit - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Gold_I_20_ChiroAcuMassage_Fit_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110007","KP Gold I $20 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF002","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.958152722678869",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110007-03","KP Gold I $20 - ChiroAcuMassage - Fit - AI/LTD","Limited Cost Sharing Plan Variation","81.93%","0.826055165495116","Yes","Yes","No","100%",,"$0","$10","$2,700","$50","$0","$1,300","$900","$60","$0","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Gold_I_20_ChiroAcuMassage_Fit_AI_LTD.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","IA","11738","SERFF","2017-08-16 20:15:58","Individual","Yes","36-3757528","11738IA0010001","TruAssure Basic Adult or Child Dental Plan","11738IA001",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","11738IA0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$115","$115 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IA","https://www.truassure.com/brochure?state=IA"
"2018","IA","11738","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","36-3757528","11738IA0030001","TruAssure Dental Small Group Basic Plan","11738IA003",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","11738IA0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IA","11738","SERFF","2017-08-16 20:15:58","Individual","Yes","36-3757528","11738IA0010001","TruAssure Basic Adult or Child Dental Plan","11738IA001",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","11738IA0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$115","$115 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IA","https://www.truassure.com/brochure?state=IA"
"2018","IA","11738","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","36-3757528","11738IA0040001","TruAssure Dental Small Group Preferred Plan","11738IA004",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","11738IA0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","HI","46082","SERFF","2017-08-18 20:15:51","Individual","Yes","99-0107971","46082HI0020003","HDS Preferred Dental Plan","46082HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Adult and Child-Only",,,,,"0.884","Guaranteed Rate","2018-01-01","2018-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), the maximum benefit from the plan is received when visiting a Delta Dental participating dentist.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes",,"","46082HI0020003-00","HDS Preferred Dental Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.hawaiidentalservice.com","http://www.hawaiidentalservice.com"
"2018","HI","46082","SERFF","2017-08-18 20:15:51","Individual","Yes","99-0107971","46082HI0020003","HDS Preferred Dental Plan","46082HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Adult and Child-Only",,,,,"0.884","Guaranteed Rate","2018-01-01","2018-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), the maximum benefit from the plan is received when visiting a Delta Dental participating dentist.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes",,"","46082HI0020003-01","HDS Preferred Dental Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.hawaiidentalservice.com","http://www.hawaiidentalservice.com"
"2018","HI","46082","SERFF","2017-08-18 20:15:51","Individual","Yes","99-0107971","46082HI0020004","HDS Classic Dental Plan","46082HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), the maximum benefit from the plan is received when visiting a Delta Dental participating dentist.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes",,"","46082HI0020004-00","HDS Classic Dental Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.hawaiidentalservice.com","http://www.hawaiidentalservice.com"
"2018","HI","46082","SERFF","2017-08-18 20:15:51","Individual","Yes","99-0107971","46082HI0020004","HDS Classic Dental Plan","46082HI002",,"HIN001","HIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), the maximum benefit from the plan is received when visiting a Delta Dental participating dentist.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes",,"","46082HI0020004-01","HDS Classic Dental Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.hawaiidentalservice.com","http://www.hawaiidentalservice.com"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110001","KP Platinum $10 - Fit","60612HI011",,"HIN001","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.960068584928645",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110001-01","KP Platinum $10 - Fit","Standard Platinum On Exchange Plan",,"0.884097297180694","Yes","Yes","No","100%",,"$0","$300","$0","$50","$0","$900","$900","$60","$0","$300","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Platinum_10_Fit.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110001","KP Platinum $10 - Fit","60612HI011",,"HIN001","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.960068584928645",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110001-02","KP Platinum $10 - Fit - AI/0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$50","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Platinum_10_Fit_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110001","KP Platinum $10 - Fit","60612HI011",,"HIN001","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.960068584928645",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110001-03","KP Platinum $10 - Fit - AI/LTD","Limited Cost Sharing Plan Variation",,"0.884097297180694","Yes","Yes","No","100%",,"$0","$300","$0","$50","$0","$900","$900","$60","$0","$300","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Platinum_10_Fit_AI_LTD.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110002","KP Gold I $20 - Fit","60612HI011",,"HIN001","HIS001","HIF002","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.971062522895129",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110002-01","KP Gold I $20 - Fit","Standard Gold On Exchange Plan","81.93%","0.826055165495116","Yes","Yes","No","100%",,"$0","$10","$2,700","$50","$0","$1,300","$900","$60","$0","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Gold_I_20_Fit.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110002","KP Gold I $20 - Fit","60612HI011",,"HIN001","HIS001","HIF002","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.971062522895129",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110002-02","KP Gold I $20 - Fit - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Gold_I_20_Fit_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110002","KP Gold I $20 - Fit","60612HI011",,"HIN001","HIS001","HIF002","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.971062522895129",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110002-03","KP Gold I $20 - Fit - AI/LTD","Limited Cost Sharing Plan Variation","81.93%","0.826055165495116","Yes","Yes","No","100%",,"$0","$10","$2,700","$50","$0","$1,300","$900","$60","$0","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Gold_I_20_Fit_AI_LTD.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110011","KP Gold III $20 - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.969139905875797",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110011-01","KP Gold III $20 - Fit","Standard Gold On Exchange Plan",,"0.787865972821325","No","Yes","No","100%",,"$300","$10","$0","$50","$200","$600","$2,600","$60","$700","$100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$200","$200 per person","$400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Gold_III_20_Fit.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110011","KP Gold III $20 - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.969139905875797",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110011-02","KP Gold III $20 - Fit - AI/0","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$50","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Gold_III_20_Fit_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110011","KP Gold III $20 - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Gold","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.969139905875797",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110011-03","KP Gold III $20 - Fit - AI/LTD","Limited Cost Sharing Plan Variation",,"0.787865972821325","No","Yes","No","100%",,"$300","$10","$0","$50","$200","$600","$2,600","$60","$700","$100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$200","$200 per person","$400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Gold_III_20_Fit_AI_LTD.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110005","KP Bronze I $50 - Fit","60612HI011",,"HIN001","HIS001","HIF006","Existing","HMO","Expanded Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.962693237321532",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110005-01","KP Bronze I $50 - Fit","Standard Bronze On Exchange Plan","63.94%","0.661130208321979","No","Yes","No","100%",,"$11,600","$10","$0","$50","$1,000","$1,200","$2,200","$60","$1,000","$300","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$1,000","$1000 per person","$2000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Bronze_I_50_Fit.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110005","KP Bronze I $50 - Fit","60612HI011",,"HIN001","HIS001","HIF006","Existing","HMO","Expanded Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.962693237321532",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110005-02","KP Bronze I $50 - Fit - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$50","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Bronze_I_50_Fit_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110005","KP Bronze I $50 - Fit","60612HI011",,"HIN001","HIS001","HIF006","Existing","HMO","Expanded Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.962693237321532",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110005-03","KP Bronze I $50 - Fit - AI/LTD","Limited Cost Sharing Plan Variation","63.94%","0.661130208321979","No","Yes","No","100%",,"$11,600","$10","$0","$50","$1,000","$1,200","$2,200","$60","$1,000","$300","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$1,000","$1000 per person","$2000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Bronze_I_50_Fit_AI_LTD.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110015","KP Bronze II 30% - Fit","60612HI011",,"HIN001","HIS001","HIF007","Existing","HMO","Bronze","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.961877902350924",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110015-01","KP Bronze II 30% - Fit","Standard Bronze On Exchange Plan",,"0.609403534337515","Yes","Yes","No","100%",,"$11,000","$0","$0","$50","$5,500","$0","$500","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Bronze_II_30_Fit.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110015","KP Bronze II 30% - Fit","60612HI011",,"HIN001","HIS001","HIF007","Existing","HMO","Bronze","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.961877902350924",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110015-02","KP Bronze II 30% - Fit - AI/0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$50","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Bronze_II_30_Fit_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110015","KP Bronze II 30% - Fit","60612HI011",,"HIN001","HIS001","HIF007","Existing","HMO","Bronze","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.961877902350924",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110015-03","KP Bronze II 30% - Fit - AI/LTD","Limited Cost Sharing Plan Variation",,"0.609403534337515","Yes","Yes","No","100%",,"$11,000","$0","$0","$50","$5,500","$0","$500","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Bronze_II_30_Fit_AI_LTD.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110004","KP Silver II $35 - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.965887923170926",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110004-01","KP Silver II $35 - Fit","Standard Silver On Exchange Plan","71.94%","0.734423050278799","No","Yes","No","100%",,"$4,000","$10","$2,300","$50","$500","$900","$2,400","$60","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Silver_II_35_Fit.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110013","KP Silver III $40 - Fit","60612HI011",,"HIN001","HIS001","HIF005","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.964817129076998",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110013-02","KP Silver III $40 Fit - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$50","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Silver_III_40_Fit_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110013","KP Silver III $40 - Fit","60612HI011",,"HIN001","HIS001","HIF005","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.964817129076998",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110013-03","KP Silver III $40 Fit - AI/LTD","Limited Cost Sharing Plan Variation","70.96%","0.710778770314025","No","Yes","No","100%",,"$7,000","$10","$300","$50","$0","$900","$2,700","$60","$1,000","$300","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Silver_III_40_Fit_AI_LTD.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110013","KP Silver III $40 - Fit","60612HI011",,"HIN001","HIS001","HIF005","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.964817129076998",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110013-04","KP Silver III $35 - Fit - CSR 73","73% AV Level Silver Plan","73.90%","0.739943884124035","No","Yes","No","100%",,"$6,000","$10","$0","$50","$0","$900","$2,700","$60","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Silver_III_35_Fit_CSR_73.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110013","KP Silver III $40 - Fit","60612HI011",,"HIN001","HIS001","HIF005","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.964817129076998",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110013-05","KP Silver III $5 - Fit - CSR 87","87% AV Level Silver Plan","87.93%","0.888123323264323","No","Yes","No","100%",,"$100","$10","$2,300","$50","$0","$600","$2,700","$60","$50","$50","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$50","$50 per person","$100 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Silver_III_5_Fit_CSR_87.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110013","KP Silver III $40 - Fit","60612HI011",,"HIN001","HIS001","HIF005","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.964817129076998",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110013-06","KP Silver III $5 - Fit - CSR 94","94% AV Level Silver Plan","94.19%","0.948074886632041","No","Yes","No","100%",,"$0","$10","$900","$50","$0","$400","$1,000","$60","$0","$30","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Silver_III_5_Fit_CSR_94.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110006","KP Platinum $10 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.948832181278293",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110006-01","KP Platinum $10 - ChiroAcuMassage - Fit","Standard Platinum On Exchange Plan",,"0.884097297180694","Yes","Yes","No","100%",,"$0","$300","$0","$50","$0","$900","$900","$60","$0","$300","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Platinum_10_ChiroAcuMassage_Fit.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110006","KP Platinum $10 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.948832181278293",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110006-02","KP Platinum $10 - ChiroAcuMassage - Fit - AI/0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$50","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Platinum_10_ChiroAcuMassage_Fit_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110006","KP Platinum $10 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF001","Existing","HMO","Platinum","Not Applicable","No","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.948832181278293",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110006-03","KP Platinum $10 - ChiroAcuMassage - Fit - AI/LTD","Limited Cost Sharing Plan Variation",,"0.884097297180694","Yes","Yes","No","100%",,"$0","$300","$0","$50","$0","$900","$900","$60","$0","$300","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Platinum_10_ChiroAcuMassage_Fit_AI_LTD.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","IA","11738","SERFF","2017-08-16 20:15:58","Individual","Yes","36-3757528","11738IA0020001","TruAssure Preferred Adult or Child Dental Plan","11738IA002",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","11738IA0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IA","https://www.truassure.com/brochure?state=IA"
"2018","IA","11738","SERFF","2017-08-16 20:15:58","Individual","Yes","36-3757528","11738IA0020001","TruAssure Preferred Adult or Child Dental Plan","11738IA002",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","11738IA0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IA","https://www.truassure.com/brochure?state=IA"
"2018","IA","41482","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","13-5581829","41482IA0070001","EHB Basic Dental Plan (Low)","41482IA007",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","41482IA0070001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","69.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IA","61284","SERFF","2017-08-16 20:15:58","Individual","Yes","75-1233841","61284IA0010007","Dentegra Dental PPO Pediatric Basic Plan","61284IA001",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","61284IA0010007-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ia/61284ia0010007-18"
"2018","IA","61284","SERFF","2017-08-16 20:15:58","Individual","Yes","75-1233841","61284IA0010012","Dentegra Dental PPO Family Preferred Plan","61284IA001",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","61284IA0010012-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$40","$40 per person","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ia/61284ia0010012-18"
"2018","IA","61284","SERFF","2017-08-16 20:15:58","Individual","Yes","75-1233841","61284IA0010011","Dentegra Dental PPO Family Basic Plan","61284IA001",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","61284IA0010011-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ia/61284ia0010011-18"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110010","KP Bronze I $50 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF006","Existing","HMO","Expanded Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.945177793039308",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110010-01","KP Bronze I $50 - ChiroAcuMassage - Fit","Standard Bronze On Exchange Plan","63.94%","0.661130208321979","No","Yes","No","100%",,"$11,600","$10","$0","$50","$1,000","$1,200","$2,200","$60","$1,000","$300","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$1,000","$1000 per person","$2000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Bronze_I_50_ChiroAcuMassage_Fit.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110010","KP Bronze I $50 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF006","Existing","HMO","Expanded Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.945177793039308",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110010-02","KP Bronze I $50 - ChiroAcuMassage - Fit - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$50","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Bronze_I_50_ChiroAcuMassage_Fit_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110010","KP Bronze I $50 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF006","Existing","HMO","Expanded Bronze","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.945177793039308",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110010-03","KP Bronze I $50 - ChiroAcuMassage - Fit - AI/LTD","Limited Cost Sharing Plan Variation","63.94%","0.661130208321979","No","Yes","No","100%",,"$11,600","$10","$0","$50","$1,000","$1,200","$2,200","$60","$1,000","$300","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$6,500","$6500 per person","$13000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$1,000","$1000 per person","$2000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Bronze_I_50_ChiroAcuMassage_Fit_AI_LTD.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110009","KP Silver II $35 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.95041980846997",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110009-01","KP Silver II $35 - ChiroAcuMassage - Fit","Standard Silver On Exchange Plan","71.94%","0.734423050278799","No","Yes","No","100%",,"$4,000","$10","$2,300","$50","$500","$900","$2,400","$60","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Silver_II_35_ChiroAcuMassage_Fit.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110009","KP Silver II $35 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.95041980846997",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110009-02","KP Silver II $35 - ChiroAcuMassage - Fit - AI/0","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$50","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Silver_II_35_ChiroAcuMassage_Fit_AI_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110009","KP Silver II $35 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.95041980846997",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110009-03","KP Silver II $35 - ChiroAcuMassage - Fit - AI/LTD","Limited Cost Sharing Plan Variation","71.94%","0.734423050278799","No","Yes","No","100%",,"$4,000","$10","$2,300","$50","$500","$900","$2,400","$60","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Silver_II_35_ChiroAcuMassage_Fit_AI_LTD.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110009","KP Silver II $35 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.95041980846997",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110009-04","KP Silver II $30 - ChiroAcuMassage - Fit - CSR 73","73% AV Level Silver Plan","73.98%","0.753245607390633","No","Yes","No","100%",,"$4,000","$10","$1,800","$50","$500","$800","$2,400","$60","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$500","$500 per person","$1000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Silver_II_30_ChiroAcuMassage_Fit_CSR_73.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110009","KP Silver II $35 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.95041980846997",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110009-05","KP Silver II $15 - ChiroAcuMassage - Fit - CSR 87","87% AV Level Silver Plan","87.90%","0.884545933275898","No","Yes","No","100%",,"$100","$10","$2,300","$50","$50","$500","$1,900","$60","$50","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$50","$50 per person","$100 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Silver_II_15_ChiroAcuMassage_Fit_CSR_87.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","HI","60612","SERFF","2017-11-01 20:15:29","Individual","No","94-1340523","60612HI0110009","KP Silver II $35 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","No","Yes","Referral required for certain specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.95041980846997",,,"2018-01-01",,"Yes","Emergency Services","Yes","Emergency Services, Urgent Care and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/hi/hi_marketplace_formulary.pdf","60612HI0110009-06","KP Silver II $5 - ChiroAcuMassage - Fit - CSR 94","94% AV Level Silver Plan","94.05%","0.94381301077511","No","Yes","No","100%",,"$0","$10","$900","$50","$0","$200","$1,200","$60","$0","$30","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/hawaii/individual/pdfs/2018-ON-Exchange/KP_Silver_II_5_ChiroAcuMassage_Fit_CSR_94.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/hi2018planbrochure.pdf"
"2018","IA","63366","SERFF","2017-08-16 20:15:58","Individual","Yes","42-0959302","63366IA0020001","Delta Dental PPO Plus Premier® Individual Choice - Preferred Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,"Non-medically necessary orthodontia -Child, orthodontia-Adult",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes","https://deltadentalia.softheon.com/Marketplace/PaymentCenter/Payment.aspx","","63366IA0020001-01","Delta Dental PPO Plus Premier® Individual Choice - Preferred Plus","Standard High On Exchange Plan","85.70%",,,,"Yes","38%","62%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalia.com/webres/File/individual/indprefplus-sum.pdf","https://www.deltadentalia.com/aca/brochure18/"
"2018","IA","63366","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","42-0959302","63366IA0010003","Delta Dental Premier® Plan A Plus - L","63366IA001","7790788922","IAN001","IAS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia, child corrective orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010003-00","Delta Dental Premier® Plan A Plus - L","Standard Low Off Exchange Plan","70.40%",,,,"Yes","96%","4%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IA","63366","SERFF","2017-08-16 20:15:58","Individual","Yes","42-0959302","63366IA0020003","Delta Dental PPO Plus Premier® Individual Choice - Preferred Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Non-medically necessary orthodontia -Child, orthodontia-Adult",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes","https://www.deltadentalia.com/shop-for-plans/","","63366IA0020003-00","Delta Dental PPO Plus Premier® Individual Choice - Preferred Plus","Standard High Off Exchange Plan","85.70%",,,,"Yes","38%","62%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalia.com/webres/File/individual/indprefplus-sum.pdf","https://www.deltadentalia.com/aca/brochure18/"
"2018","IA","63366","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","42-0959302","63366IA0010004","Delta Dental Premier® Plan B Plus - H","63366IA001","7790788922","IAN001","IAS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia, child corrective orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010004-00","Delta Dental Premier® Plan B Plus - H","Standard High Off Exchange Plan","85.10%",,,,"Yes","97%","3%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IA","63366","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","42-0959302","63366IA0010005","Delta Dental Premier® Plan C Plus - H","63366IA001","7790788922","IAN001","IAS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia, child corrective orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010005-00","Delta Dental Premier® Plan C Plus - H","Standard High Off Exchange Plan","85.10%",,,,"Yes","99%","1%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IA","63366","SERFF","2017-08-16 20:15:58","Individual","Yes","42-0959302","63366IA0020002","Delta Dental PPO Plus Premier® Individual Choice - Preventive Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,"Major Dental Care and Orthodntia - Adult, non-medically necessary orthodontia - Child",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes","https://deltadentalia.softheon.com/Marketplace/PaymentCenter/Payment.aspx","","63366IA0020002-01","Delta Dental PPO Plus Premier® Individual Choice - Preventive Plus","Standard High On Exchange Plan","85.70%",,,,"Yes","31%","69%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalia.com/webres/File/individual/indpreventplus18-sum.pdf","https://www.deltadentalia.com/aca/brochure18/"
"2018","IA","63366","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","42-0959302","63366IA0010008","Delta Dental Premier® Plan A Plus - LC","63366IA001","7790788922","IAN001","IAS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Claims can be submitted for reimbursement.","Yes","Claims can be submitted for reimbursement.","Yes",,"","63366IA0010008-01","Delta Dental Premier® Plan A Plus - LC","Standard Low On Exchange Plan","70.40%",,,,"Yes","95%","5%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IA","63366","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","42-0959302","63366IA0010009","Delta Dental Premier® Plan B Plus - HC","63366IA001","7790788922","IAN001","IAS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Claims can be submitted for reimbursement.","Yes","Claims can be submitted for reimbursement.","Yes",,"","63366IA0010009-01","Delta Dental Premier® Plan B Plus - HC","Standard High On Exchange Plan","85.10%",,,,"Yes","93%","7%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IA","63366","SERFF","2017-08-16 20:15:58","Individual","Yes","42-0959302","63366IA0020004","Delta Dental PPO Plus Premier® Individual Choice - Preventive Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Major Dental Care and Orthodntia - Adult, non-medically necessary orthodontia - Child",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes","https://www.deltadentalia.com/shop-for-plans/","","63366IA0020004-00","Delta Dental PPO Plus Premier® Individual Choice - Preventive Plus","Standard High Off Exchange Plan","85.70%",,,,"Yes","31%","69%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalia.com/webres/File/individual/indpreventplus18-sum.pdf","https://www.deltadentalia.com/aca/brochure18/"
"2018","IA","63366","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","42-0959302","63366IA0010010","Delta Dental Premier® Plan C Plus - HC","63366IA001","7790788922","IAN001","IAS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Claims can be submitted for reimbursement.","Yes","Claims can be submitted for reimbursement.","Yes",,"","63366IA0010010-00","Delta Dental Premier® Plan C Plus - HC","Standard High Off Exchange Plan","85.10%",,,,"Yes","93%","7%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IA","63366","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","42-0959302","63366IA0010012","Delta Dental PPO Plus Premier® Plan A Plus - L","63366IA001","7790788922","IAN002","IAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia, child corrective orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010012-00","Delta Dental PPO Plus Premier® Plan A Plus - L","Standard Low Off Exchange Plan","71.40%",,,,"Yes","39%","61%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,"$75","$75 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IA","63366","SERFF","2017-08-16 20:15:58","Individual","Yes","42-0959302","63366IA0020006","Delta Dental PPO Plus Premier® Individual Choice - Platinum Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,"Non-medically necessary orthodontia - Child, Orthodontia - Adult",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes","https://deltadentalia.softheon.com/Marketplace/PaymentCenter/Payment.aspx","","63366IA0020006-01","Delta Dental PPO Plus Premier® Individual Choice - Platinum Plus","Standard High On Exchange Plan","85.70%",,,,"Yes","38%","62%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalia.com/webres/File/individual/indplatplus-sum.pdf","https://www.deltadentalia.com/aca/brochure18/"
"2018","IA","63366","SERFF","2017-08-16 20:15:58","Individual","Yes","42-0959302","63366IA0020007","Delta Dental PPO Plus Premier® Individual Choice - Platinum Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Non-medically necessary orthodontia - Child, Orthodontia - Adult",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes","https://www.deltadentalia.com/shop-for-plans/","","63366IA0020007-00","Delta Dental PPO Plus Premier® Individual Choice - Platinum Plus","Standard High Off Exchange Plan","85.70%",,,,"Yes","38%","62%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalia.com/webres/File/individual/indplatplus-sum.pdf","https://www.deltadentalia.com/aca/brochure18/"
"2018","IA","63366","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","42-0959302","63366IA0010013","Delta Dental PPO Plus Premier® Plan B Plus - H","63366IA001","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia, child corrective orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010013-01","Delta Dental PPO Plus Premier® Plan B Plus - H","Standard High On Exchange Plan","85.70%",,,,"Yes","44%","56%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IA","63366","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","42-0959302","63366IA0010014","Delta Dental PPO Plus Premier® Plan C Plus - H","63366IA001","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia, child corrective orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010014-00","Delta Dental PPO Plus Premier® Plan C Plus - H","Standard High Off Exchange Plan","85.70%",,,,"Yes","37%","63%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IA","85930","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","No","91-1842494","85930IA0060011","Sanford Simplicity $5,000","85930IA006",,"IAN001","IAS001","IAF026","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060011-01","Sanford Simplicity $5,000","Standard Bronze On Exchange Plan",,"0.649614631115679","Yes","Yes","No","100%",,"$5,000","$40","$1,600","$60","$300","$2,600","$0","$60","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","$10,000","$10000 per person","$20000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2018/sg_ia_simplicity_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2018.pdf"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010019","Medica Insure Gold Copay Plus","93078IA001",,"IAN001","IAS001","IAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010019-01","Medica Insure Gold Copay Plus","Standard Gold On Exchange Plan",,"0.789036171260507","Yes","Yes","Yes","75%","25%","$1,000","$300","$400","$60","$1,000","$500","$300","$0","$1,000","$300","$30","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%","$1,500","per person not applicable","$4500 per group","30.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IGPCIA&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010019","Medica Insure Gold Copay Plus","93078IA001",,"IAN001","IAS001","IAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010019-02","Medica Insure Gold Copay Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","75%","25%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IGPCIAZ&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010019","Medica Insure Gold Copay Plus","93078IA001",,"IAN001","IAS001","IAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010019-03","Medica Insure Gold Copay Plus","Limited Cost Sharing Plan Variation",,"0.789036171260507","Yes","Yes","Yes","75%","25%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%","$1,500","per person not applicable","$4500 per group","30.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IGPCIAL&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","63366","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","42-0959302","63366IA0010016","Delta Dental PPO Plus Premier® Plan A Plus - LC","63366IA001","7790788922","IAN002","IAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Adult Orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010016-00","Delta Dental PPO Plus Premier® Plan A Plus - LC","Standard Low Off Exchange Plan","71.40%",,,,"Yes","39%","61%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,"$75","$75 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IA","63366","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","42-0959302","63366IA0010017","Delta Dental PPO Plus Premier® Plan B Plus - HC","63366IA001","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult Orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010017-01","Delta Dental PPO Plus Premier® Plan B Plus - HC","Standard High On Exchange Plan","85.70%",,,,"Yes","44%","56%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IA","63366","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","42-0959302","63366IA0010018","Delta Dental PPO Plus Premier® Plan C Plus - HC","63366IA001","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult Orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010018-00","Delta Dental PPO Plus Premier® Plan C Plus - HC","Standard High Off Exchange Plan","85.70%",,,,"Yes","42%","58%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IA","63366","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","42-0959302","63366IA0010020","Delta Dental PPO Plus Premier® Employee Choice - Preventive Plus","63366IA001","7790788922","IAN002","IAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Adult extrations, oral surgery and orthodontia, child corrective orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Claims can be submitted for reinbursement","Yes","Claims can be submitted for reinbursement","Yes",,"","63366IA0010020-00","Delta Dental PPO Plus Premier® Employee Choice - Preventive Plus","Standard Low Off Exchange Plan","71.40%",,,,"Yes","31%","69%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,"$75","$75 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IA","63366","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","42-0959302","63366IA0010023","Delta Dental PPO Plus Premier® Employee Choice - Platinum Plus","63366IA001","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia, child corrective orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010023-01","Delta Dental PPO Plus Premier® Employee Choice - Platinum Plus","Standard High On Exchange Plan","85.70%",,,,"Yes","49%","51%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IA","63366","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","42-0959302","63366IA0010022","Delta Dental PPO Plus Premier® Employee Choice - Preferred Plus","63366IA001","7790788922","IAN002","IAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Adult orthodontia, child corrective orthodontia",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes",,"","63366IA0010022-00","Delta Dental PPO Plus Premier® Employee Choice - Preferred Plus","Standard High Off Exchange Plan","85.70%",,,,"Yes","53%","47%",,,,,,,,,,,,,,"0","0","0","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IA","71051","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","71051IA0020003","BESTOne Advantage Gold","71051IA002",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Network or UCR","Yes","https://www.bestlife.com/exchange/paybill.html","","71051IA0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/current/IA_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","IA","71051","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","71051IA0010007","BESTDental Premium","71051IA001",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010007-00","BESTDental Premium","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/current/IA_BESTDental_Premium_Plan.pdf"
"2018","IA","71051","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","71051IA0010007","BESTDental Premium","71051IA001",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010007-01","BESTDental Premium","Standard High On Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/current/IA_BESTDental_Premium_Plan.pdf"
"2018","IA","71051","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","71051IA0020003","BESTOne Advantage Gold","71051IA002",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Network or UCR","Yes","https://www.bestlife.com/exchange/paybill.html","","71051IA0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/current/IA_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","IA","71051","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","71051IA0020004","BESTOne Plus Gold","71051IA002",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Network or UCR","Yes","https://www.bestlife.com/exchange/paybill.html","","71051IA0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/current/IA_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","IA","71051","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","71051IA0010008","BESTDental Standard - H","71051IA001",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/current/IA_BESTDental_Standard-H_Plan.pdf"
"2018","IA","71051","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","71051IA0010008","BESTDental Standard - H","71051IA001",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/current/IA_BESTDental_Standard-H_Plan.pdf"
"2018","IA","71051","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","71051IA0020004","BESTOne Plus Gold","71051IA002",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Network or UCR","Yes","https://www.bestlife.com/exchange/paybill.html","","71051IA0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/current/IA_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","IA","71051","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","71051IA0010010","BESTDental Choice - H","71051IA001",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/current/IA_BESTDental_Choice-H_Plan.pdf"
"2018","IA","71051","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","71051IA0010010","BESTDental Choice - H","71051IA001",,"IAN001","IAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/current/IA_BESTDental_Choice-H_Plan.pdf"
"2018","IA","71051","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","71051IA0010009","BESTDental Standard - L","71051IA001",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/current/IA_BESTDental_Standard-L_Plan.pdf"
"2018","IA","71051","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","71051IA0020005","BESTOne Dental Plus - Silver","71051IA002",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/exchange/paybill.html","","71051IA0020005-00","BESTOne Dental Plus - Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","IA","71051","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","71051IA0020005","BESTOne Dental Plus - Silver","71051IA002",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/exchange/paybill.html","","71051IA0020005-01","BESTOne Dental Plus - Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","IA","71051","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","71051IA0010009","BESTDental Standard - L","71051IA001",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/current/IA_BESTDental_Standard-L_Plan.pdf"
"2018","IA","71051","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","71051IA0010011","BESTDental Choice - L","71051IA001",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/current/IA_BESTDental_Choice-L_Plan.pdf"
"2018","IA","71051","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","71051IA0020006","BESTOne Dental Basic - Silver","71051IA002",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/exchange/paybill.html","","71051IA0020006-00","BESTOne Dental Basic - Silver","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","IA","71051","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","71051IA0020006","BESTOne Dental Basic - Silver","71051IA002",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/exchange/paybill.html","","71051IA0020006-01","BESTOne Dental Basic - Silver","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2017/IA_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","IA","71051","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","71051IA0010011","BESTDental Choice - L","71051IA001",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/current/IA_BESTDental_Choice-L_Plan.pdf"
"2018","IA","71051","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","71051IA0010012","BESTDental Value","71051IA001",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/current/IA_BESTDental_Value_Plan.pdf"
"2018","IA","71051","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","71051IA0010012","BESTDental Value","71051IA001",,"IAN001","IAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/current/IA_BESTDental_Value_Plan.pdf"
"2018","IA","85930","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","No","91-1842494","85930IA0060011","Sanford Simplicity $5,000","85930IA006",,"IAN001","IAS001","IAF026","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060011-00","Sanford Simplicity $5,000","Standard Bronze Off Exchange Plan",,"0.649614631115679","Yes","Yes","No","100%",,"$5,000","$40","$1,600","$60","$300","$2,600","$0","$60","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","$10,000","$10000 per person","$20000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2018/sg_ia_simplicity_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2018.pdf"
"2018","IA","85930","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","No","91-1842494","85930IA0060007","Sanford Simplicity $1,250","85930IA006",,"IAN001","IAS001","IAF008","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060007-00","Sanford Simplicity $1,250","Standard Gold Off Exchange Plan",,"0.812484821028003","Yes","Yes","No","100%",,"$1,250","$30","$1,500","$60","$100","$1,200","$0","$60","$1,250","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2018/sg_ia_simplicity_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2018.pdf"
"2018","IA","85930","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","No","91-1842494","85930IA0060007","Sanford Simplicity $1,250","85930IA006",,"IAN001","IAS001","IAF008","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060007-01","Sanford Simplicity $1,250","Standard Gold On Exchange Plan",,"0.812484821028003","Yes","Yes","No","100%",,"$1,250","$30","$1,500","$60","$100","$1,200","$0","$60","$1,250","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2018/sg_ia_simplicity_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2018.pdf"
"2018","IA","85930","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","No","91-1842494","85930IA0060001","Sanford Simplicity $500","85930IA006",,"IAN001","IAS001","IAF027","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060001-00","Sanford Simplicity $500","Standard Platinum Off Exchange Plan",,"0.909971278107127","Yes","Yes","No","100%",,"$500","$0","$500","$60","$100","$900","$0","$60","$500","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2018/sg_ia_simplicity_500.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2018.pdf"
"2018","IA","85930","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","No","91-1842494","85930IA0060001","Sanford Simplicity $500","85930IA006",,"IAN001","IAS001","IAF027","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060001-01","Sanford Simplicity $500","Standard Platinum On Exchange Plan",,"0.909971278107127","Yes","Yes","No","100%",,"$500","$0","$500","$60","$100","$900","$0","$60","$500","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2018/sg_ia_simplicity_500.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2018.pdf"
"2018","IA","85930","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","No","91-1842494","85930IA0060010","Sanford Simplicity $4500 HSA/HDHP","85930IA006",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060010-00","Sanford Simplicity $4500 HSA/HDHP","Standard Silver Off Exchange Plan",,"0.681162826616788","Yes","Yes","No","100%",,"$4,500","$0","$0","$60","$4,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2018/sg_ia_simplicity_4500.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2018.pdf"
"2018","IA","85930","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","No","91-1842494","85930IA0060010","Sanford Simplicity $4500 HSA/HDHP","85930IA006",,"IAN001","IAS001","IAF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060010-01","Sanford Simplicity $4500 HSA/HDHP","Standard Silver On Exchange Plan",,"0.681162826616788","Yes","Yes","No","100%",,"$4,500","$0","$0","$60","$4,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2018/sg_ia_simplicity_4500.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2018.pdf"
"2018","IA","85930","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","No","91-1842494","85930IA0060003","Sanford Simplicity $3,500","85930IA006",,"IAN001","IAS001","IAF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060003-00","Sanford Simplicity $3,500","Standard Silver Off Exchange Plan",,"0.719799914352739","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$100","$1,800","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2018/sg_ia_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2018.pdf"
"2018","IA","85930","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","No","91-1842494","85930IA0060003","Sanford Simplicity $3,500","85930IA006",,"IAN001","IAS001","IAF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060003-01","Sanford Simplicity $3,500","Standard Silver On Exchange Plan",,"0.719799914352739","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$100","$1,800","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2018/sg_ia_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2018.pdf"
"2018","IA","85930","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","No","91-1842494","85930IA0060008","Sanford Simplicity $2,700 HSA/HDHP","85930IA006",,"IAN001","IAS001","IAF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060008-00","Sanford Simplicity $2,700 HSA/HDHP","Standard Silver Off Exchange Plan",,"0.703127193341871","Yes","Yes","No","100%",,"$2,700","$0","$1,800","$60","$2,700","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2018/sg_ia_simplicity_2700.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2018.pdf"
"2018","IA","85930","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","No","91-1842494","85930IA0060008","Sanford Simplicity $2,700 HSA/HDHP","85930IA006",,"IAN001","IAS001","IAF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060008-01","Sanford Simplicity $2,700 HSA/HDHP","Standard Silver On Exchange Plan",,"0.703127193341871","Yes","Yes","No","100%",,"$2,700","$0","$1,800","$60","$2,700","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2018/sg_ia_simplicity_2700.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2018.pdf"
"2018","IA","85930","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","No","91-1842494","85930IA0060009","Sanford Simplicity $2,250","85930IA006",,"IAN001","IAS001","IAF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060009-00","Sanford Simplicity $2,250","Standard Silver Off Exchange Plan",,"0.718187645415684","Yes","Yes","No","100%",,"$2,250","$40","$2,700","$60","$100","$1,900","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","40.00%",,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2018/sg_ia_simplicity_2250.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2018.pdf"
"2018","IA","85930","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","No","91-1842494","85930IA0060009","Sanford Simplicity $2,250","85930IA006",,"IAN001","IAS001","IAF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060009-01","Sanford Simplicity $2,250","Standard Silver On Exchange Plan",,"0.718187645415684","Yes","Yes","No","100%",,"$2,250","$40","$2,700","$60","$100","$1,900","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","40.00%",,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2018/sg_ia_simplicity_2250.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2018.pdf"
"2018","IA","85930","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","No","91-1842494","85930IA0060005","Sanford Simplicity $6,000","85930IA006",,"IAN001","IAS001","IAF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060005-00","Sanford Simplicity $6,000","Standard Bronze Off Exchange Plan",,"0.606846570796385","Yes","Yes","No","100%",,"$6,000","$0","$1,150","$60","$4,400","$700","$0","$60","$1,800","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2018/sg_ia_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2018.pdf"
"2018","IA","85930","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","No","91-1842494","85930IA0060005","Sanford Simplicity $6,000","85930IA006",,"IAN001","IAS001","IAF003","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060005-01","Sanford Simplicity $6,000","Standard Bronze On Exchange Plan",,"0.606846570796385","Yes","Yes","No","100%",,"$6,000","$0","$1,150","$60","$4,400","$700","$0","$60","$1,800","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/2018/sg_ia_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0339-2018.pdf"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010019","Medica Insure Gold Copay Plus","93078IA001",,"IAN001","IAS001","IAF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010019-00","Medica Insure Gold Copay Plus","Standard Gold Off Exchange Plan",,"0.789036171260507","Yes","Yes","Yes","75%","25%","$1,000","$300","$400","$60","$1,000","$500","$300","$0","$1,000","$300","$30","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%","$1,500","per person not applicable","$4500 per group","30.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IGPCIA&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030019","Inspire by Medica Gold Copay Plus","93078IA003",,"IAN003","IAS003","IAF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030019-00","Inspire by Medica Gold Copay Plus","Standard Gold Off Exchange Plan",,"0.804018566628916","Yes","Yes","No","100%",,"$1,000","$300","$400","$60","$1,000","$500","$300","$0","$1,000","$300","$30","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMGPCIA&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030019","Inspire by Medica Gold Copay Plus","93078IA003",,"IAN003","IAS003","IAF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030019-01","Inspire by Medica Gold Copay Plus","Standard Gold On Exchange Plan",,"0.804018566628916","Yes","Yes","No","100%",,"$1,000","$300","$400","$60","$1,000","$500","$300","$0","$1,000","$300","$30","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMGPCIA&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030019","Inspire by Medica Gold Copay Plus","93078IA003",,"IAN003","IAS003","IAF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030019-02","Inspire by Medica Gold Copay Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMGPCIAZ&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030019","Inspire by Medica Gold Copay Plus","93078IA003",,"IAN003","IAS003","IAF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030019-03","Inspire by Medica Gold Copay Plus","Limited Cost Sharing Plan Variation",,"0.804018566628916","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMGPCIAL&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040019","Medica with CHI Health Gold Copay Plus","93078IA004",,"IAN004","IAS004","IAF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040019-00","Medica with CHI Health Gold Copay Plus","Standard Gold Off Exchange Plan",,"0.804018566628916","Yes","Yes","No","100%",,"$1,000","$300","$400","$60","$1,000","$500","$300","$0","$1,000","$300","$30","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHGPCIA&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040019","Medica with CHI Health Gold Copay Plus","93078IA004",,"IAN004","IAS004","IAF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040019-01","Medica with CHI Health Gold Copay Plus","Standard Gold On Exchange Plan",,"0.804018566628916","Yes","Yes","No","100%",,"$1,000","$300","$400","$60","$1,000","$500","$300","$0","$1,000","$300","$30","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHGPCIA&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040019","Medica with CHI Health Gold Copay Plus","93078IA004",,"IAN004","IAS004","IAF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040019-02","Medica with CHI Health Gold Copay Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHGPCIAZ&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040019","Medica with CHI Health Gold Copay Plus","93078IA004",,"IAN004","IAS004","IAF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040019-03","Medica with CHI Health Gold Copay Plus","Limited Cost Sharing Plan Variation",,"0.804018566628916","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHGPCIAL&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010003-00","Medica Insure Silver Copay","Standard Silver Off Exchange Plan",,"0.678807172953134","Yes","Yes","Yes","75%","25%","$3,500","$10","$3,100","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%","$4,500","per person not applicable","$13500 per group","40.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ISCIA&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010003-01","Medica Insure Silver Copay","Standard Silver On Exchange Plan",,"0.678807172953134","Yes","Yes","Yes","75%","25%","$3,500","$10","$3,100","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%","$4,500","per person not applicable","$13500 per group","40.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ISCIA&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010003-02","Medica Insure Silver Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","75%","25%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ISCIAZ&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010003-03","Medica Insure Silver Copay","Limited Cost Sharing Plan Variation",,"0.678807172953134","Yes","Yes","Yes","75%","25%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%","$4,500","per person not applicable","$13500 per group","40.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ISCIAL&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010003-04","Medica Insure Silver Copay","73% AV Level Silver Plan",,"0.728378078020517","Yes","Yes","Yes","75%","25%","$2,500","$10","$2,600","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","30.00%","$2,500","per person not applicable","$7500 per group","30.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ISCIA73&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010003-05","Medica Insure Silver Copay","87% AV Level Silver Plan",,"0.867990381647021","Yes","Yes","Yes","75%","25%","$500","$0","$1,500","$60","$500","$500","$400","$0","$500","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1500 per group","20.00%","$500","per person not applicable","$1500 per group","20.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ISCIA87&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010003-06","Medica Insure Silver Copay","94% AV Level Silver Plan",,"0.930441983785859","Yes","Yes","Yes","75%","25%","$100","$10","$600","$60","$100","$500","$100","$0","$100","$100","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","5.00%","$100","per person not applicable","$300 per group","5.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ISCIA94&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030003","Inspire by Medica Silver Copay","93078IA003",,"IAN003","IAS003","IAF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030003-00","Inspire by Medica Silver Copay","Standard Silver Off Exchange Plan",,"0.68768656753985","Yes","Yes","No","100%",,"$3,500","$10","$3,100","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMSCIA&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030003","Inspire by Medica Silver Copay","93078IA003",,"IAN003","IAS003","IAF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030003-01","Inspire by Medica Silver Copay","Standard Silver On Exchange Plan",,"0.68768656753985","Yes","Yes","No","100%",,"$3,500","$10","$3,100","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMSCIA&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030003","Inspire by Medica Silver Copay","93078IA003",,"IAN003","IAS003","IAF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030003-02","Inspire by Medica Silver Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMSCIAZ&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030003","Inspire by Medica Silver Copay","93078IA003",,"IAN003","IAS003","IAF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030003-03","Inspire by Medica Silver Copay","Limited Cost Sharing Plan Variation",,"0.68768656753985","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMSCIAL&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030003","Inspire by Medica Silver Copay","93078IA003",,"IAN003","IAS003","IAF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030003-04","Inspire by Medica Silver Copay","73% AV Level Silver Plan",,"0.728378078020517","Yes","Yes","No","100%",,"$2,500","$10","$2,600","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMSCIA73&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030003","Inspire by Medica Silver Copay","93078IA003",,"IAN003","IAS003","IAF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030003-05","Inspire by Medica Silver Copay","87% AV Level Silver Plan",,"0.867990381647021","Yes","Yes","No","100%",,"$500","$0","$1,500","$60","$500","$500","$400","$0","$500","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1500 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMSCIA87&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030003","Inspire by Medica Silver Copay","93078IA003",,"IAN003","IAS003","IAF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030003-06","Inspire by Medica Silver Copay","94% AV Level Silver Plan",,"0.930441983785859","Yes","Yes","No","100%",,"$100","$10","$600","$60","$100","$500","$100","$0","$100","$100","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","5.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMSCIA94&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040003","Medica with CHI Health Silver Copay","93078IA004",,"IAN004","IAS004","IAF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040003-00","Medica with CHI Health Silver Copay","Standard Silver Off Exchange Plan",,"0.68768656753985","Yes","Yes","No","100%",,"$3,500","$10","$3,100","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHSCIA&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040003","Medica with CHI Health Silver Copay","93078IA004",,"IAN004","IAS004","IAF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040003-01","Medica with CHI Health Silver Copay","Standard Silver On Exchange Plan",,"0.68768656753985","Yes","Yes","No","100%",,"$3,500","$10","$3,100","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHSCIA&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040003","Medica with CHI Health Silver Copay","93078IA004",,"IAN004","IAS004","IAF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040003-02","Medica with CHI Health Silver Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHSCIAZ&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040003","Medica with CHI Health Silver Copay","93078IA004",,"IAN004","IAS004","IAF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040003-03","Medica with CHI Health Silver Copay","Limited Cost Sharing Plan Variation",,"0.68768656753985","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHSCIAL&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040003","Medica with CHI Health Silver Copay","93078IA004",,"IAN004","IAS004","IAF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040003-04","Medica with CHI Health Silver Copay","73% AV Level Silver Plan",,"0.728378078020517","Yes","Yes","No","100%",,"$2,500","$10","$2,600","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHSCIA73&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040003","Medica with CHI Health Silver Copay","93078IA004",,"IAN004","IAS004","IAF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040003-05","Medica with CHI Health Silver Copay","87% AV Level Silver Plan",,"0.867990381647021","Yes","Yes","No","100%",,"$500","$0","$1,500","$60","$500","$500","$400","$0","$500","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1500 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHSCIA87&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040003","Medica with CHI Health Silver Copay","93078IA004",,"IAN004","IAS004","IAF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040003-06","Medica with CHI Health Silver Copay","94% AV Level Silver Plan",,"0.930441983785859","Yes","Yes","No","100%",,"$100","$10","$600","$60","$100","$500","$100","$0","$100","$100","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","5.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHSCIA94&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010005","Medica Insure Bronze Copay","93078IA001",,"IAN001","IAS001","IAF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010005-00","Medica Insure Bronze Copay","Standard Bronze Off Exchange Plan",,"0.605824547797741","Yes","Yes","Yes","75%","25%","$6,850","$0","$500","$60","$2,300","$1,000","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%","$6,850","per person not applicable","$13700 per group","50.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IBCIA&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010005","Medica Insure Bronze Copay","93078IA001",,"IAN001","IAS001","IAF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010005-01","Medica Insure Bronze Copay","Standard Bronze On Exchange Plan",,"0.605824547797741","Yes","Yes","Yes","75%","25%","$6,850","$0","$500","$60","$2,300","$1,000","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%","$6,850","per person not applicable","$13700 per group","50.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IBCIA&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010005","Medica Insure Bronze Copay","93078IA001",,"IAN001","IAS001","IAF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010005-02","Medica Insure Bronze Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","75%","25%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IBCIAZ&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010005","Medica Insure Bronze Copay","93078IA001",,"IAN001","IAS001","IAF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010005-03","Medica Insure Bronze Copay","Limited Cost Sharing Plan Variation",,"0.605824547797741","Yes","Yes","Yes","75%","25%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%","$6,850","per person not applicable","$13700 per group","50.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IBCIAL&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030005","Inspire by Medica Bronze Copay","93078IA003",,"IAN003","IAS003","IAF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030005-00","Inspire by Medica Bronze Copay","Standard Bronze Off Exchange Plan",,"0.60854298019876","Yes","Yes","No","100%",,"$6,850","$0","$500","$60","$2,300","$1,000","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMBCIA&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030005","Inspire by Medica Bronze Copay","93078IA003",,"IAN003","IAS003","IAF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030005-01","Inspire by Medica Bronze Copay","Standard Bronze On Exchange Plan",,"0.60854298019876","Yes","Yes","No","100%",,"$6,850","$0","$500","$60","$2,300","$1,000","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMBCIA&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030005","Inspire by Medica Bronze Copay","93078IA003",,"IAN003","IAS003","IAF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030005-02","Inspire by Medica Bronze Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMBCIAZ&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030005","Inspire by Medica Bronze Copay","93078IA003",,"IAN003","IAS003","IAF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030005-03","Inspire by Medica Bronze Copay","Limited Cost Sharing Plan Variation",,"0.60854298019876","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMBCIAL&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040005","Medica with CHI Health Bronze Copay","93078IA004",,"IAN004","IAS004","IAF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040005-00","Medica with CHI Health Bronze Copay","Standard Bronze Off Exchange Plan",,"0.60854298019876","Yes","Yes","No","100%",,"$6,850","$0","$500","$60","$2,300","$1,000","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBCIA&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040005","Medica with CHI Health Bronze Copay","93078IA004",,"IAN004","IAS004","IAF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040005-01","Medica with CHI Health Bronze Copay","Standard Bronze On Exchange Plan",,"0.60854298019876","Yes","Yes","No","100%",,"$6,850","$0","$500","$60","$2,300","$1,000","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBCIA&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040005","Medica with CHI Health Bronze Copay","93078IA004",,"IAN004","IAS004","IAF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040005-02","Medica with CHI Health Bronze Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBCIAZ&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040005","Medica with CHI Health Bronze Copay","93078IA004",,"IAN004","IAS004","IAF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040005-03","Medica with CHI Health Bronze Copay","Limited Cost Sharing Plan Variation",,"0.60854298019876","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBCIAL&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010011","Medica Insure Bronze HSA","93078IA001",,"IAN001","IAS001","IAF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010011-00","Medica Insure Bronze HSA","Standard Bronze Off Exchange Plan",,"0.60472271107099","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IBHIA&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010011","Medica Insure Bronze HSA","93078IA001",,"IAN001","IAS001","IAF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010011-01","Medica Insure Bronze HSA","Standard Bronze On Exchange Plan",,"0.60472271107099","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IBHIA&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010011","Medica Insure Bronze HSA","93078IA001",,"IAN001","IAS001","IAF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010011-02","Medica Insure Bronze HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IBHIAZ&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010011","Medica Insure Bronze HSA","93078IA001",,"IAN001","IAS001","IAF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010011-03","Medica Insure Bronze HSA","Limited Cost Sharing Plan Variation",,"0.60472271107099","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IBHIAL&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030011","Inspire by Medica Bronze HSA","93078IA003",,"IAN003","IAS003","IAF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030011-00","Inspire by Medica Bronze HSA","Standard Bronze Off Exchange Plan",,"0.60472271107099","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMBHIA&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030011","Inspire by Medica Bronze HSA","93078IA003",,"IAN003","IAS003","IAF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030011-01","Inspire by Medica Bronze HSA","Standard Bronze On Exchange Plan",,"0.60472271107099","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMBHIA&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030011","Inspire by Medica Bronze HSA","93078IA003",,"IAN003","IAS003","IAF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030011-02","Inspire by Medica Bronze HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMBHIAZ&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030011","Inspire by Medica Bronze HSA","93078IA003",,"IAN003","IAS003","IAF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030011-03","Inspire by Medica Bronze HSA","Limited Cost Sharing Plan Variation",,"0.60472271107099","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMBHIAL&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040011","Medica with CHI Health Bronze HSA","93078IA004",,"IAN004","IAS004","IAF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040011-00","Medica with CHI Health Bronze HSA","Standard Bronze Off Exchange Plan",,"0.60472271107099","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBHIA&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040011","Medica with CHI Health Bronze HSA","93078IA004",,"IAN004","IAS004","IAF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040011-01","Medica with CHI Health Bronze HSA","Standard Bronze On Exchange Plan",,"0.60472271107099","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBHIA&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040011","Medica with CHI Health Bronze HSA","93078IA004",,"IAN004","IAS004","IAF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040011-02","Medica with CHI Health Bronze HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBHIAZ&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040011","Medica with CHI Health Bronze HSA","93078IA004",,"IAN004","IAS004","IAF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040011-03","Medica with CHI Health Bronze HSA","Limited Cost Sharing Plan Variation",,"0.60472271107099","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBHIAL&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010023","Medica Insure Bronze HSA Plus","93078IA001",,"IAN001","IAS001","IAF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010023-00","Medica Insure Bronze HSA Plus","Standard Bronze Off Exchange Plan",,"0.648961269523038","Yes","Yes","No","100%",,"$2,600","$0","$3,400","$60","$2,600","$0","$1,800","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBPHIA&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010023","Medica Insure Bronze HSA Plus","93078IA001",,"IAN001","IAS001","IAF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010023-01","Medica Insure Bronze HSA Plus","Standard Bronze On Exchange Plan",,"0.648961269523038","Yes","Yes","No","100%",,"$2,600","$0","$3,400","$60","$2,600","$0","$1,800","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBPHIA&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010023","Medica Insure Bronze HSA Plus","93078IA001",,"IAN001","IAS001","IAF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010023-02","Medica Insure Bronze HSA Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBPHIAZ&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040023","Medica with CHI Health Bronze HSA Plus","93078IA004",,"IAN004","IAS004","IAF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040023-02","Medica with CHI Health Bronze HSA Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBPHIAZ&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040023","Medica with CHI Health Bronze HSA Plus","93078IA004",,"IAN004","IAS004","IAF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040023-03","Medica with CHI Health Bronze HSA Plus","Limited Cost Sharing Plan Variation",,"0.648961269523038","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBPHIAL&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010013","Medica Insure Catastrophic","93078IA001",,"IAN001","IAS001","IAF007","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010013-00","Medica Insure Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICIA&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010013","Medica Insure Catastrophic","93078IA001",,"IAN001","IAS001","IAF007","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010013-01","Medica Insure Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICIA&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030013","Inspire by Medica Catastrophic","93078IA003",,"IAN003","IAS003","IAF007","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030013-00","Inspire by Medica Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMCIA&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030013","Inspire by Medica Catastrophic","93078IA003",,"IAN003","IAS003","IAF007","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030013-01","Inspire by Medica Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMCIA&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040013","Medica with CHI Health Catastrophic","93078IA004",,"IAN004","IAS004","IAF007","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040013-00","Medica with CHI Health Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHCIA&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0010023","Medica Insure Bronze HSA Plus","93078IA001",,"IAN001","IAS001","IAF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0010023-03","Medica Insure Bronze HSA Plus","Limited Cost Sharing Plan Variation",,"0.648961269523038","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBPHIAL&uid=FFM","https://www.medica.com/2018insureIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030023","Inspire by Medica Bronze HSA Plus","93078IA003",,"IAN003","IAS003","IAF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030023-00","Inspire by Medica Bronze HSA Plus","Standard Bronze Off Exchange Plan",,"0.648961269523038","Yes","Yes","No","100%",,"$2,600","$0","$3,400","$60","$2,600","$0","$1,800","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMBPHIA&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030023","Inspire by Medica Bronze HSA Plus","93078IA003",,"IAN003","IAS003","IAF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030023-01","Inspire by Medica Bronze HSA Plus","Standard Bronze On Exchange Plan",,"0.648961269523038","Yes","Yes","No","100%",,"$2,600","$0","$3,400","$60","$2,600","$0","$1,800","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMBPHIA&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030023","Inspire by Medica Bronze HSA Plus","93078IA003",,"IAN003","IAS003","IAF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030023-02","Inspire by Medica Bronze HSA Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMBPHIAZ&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0030023","Inspire by Medica Bronze HSA Plus","93078IA003",,"IAN003","IAS003","IAF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0030023-03","Inspire by Medica Bronze HSA Plus","Limited Cost Sharing Plan Variation",,"0.648961269523038","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IMBPHIAL&uid=FFM","https://www.medica.com/2018InspireIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040023","Medica with CHI Health Bronze HSA Plus","93078IA004",,"IAN004","IAS004","IAF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040023-00","Medica with CHI Health Bronze HSA Plus","Standard Bronze Off Exchange Plan",,"0.648961269523038","Yes","Yes","No","100%",,"$2,600","$0","$3,400","$60","$2,600","$0","$1,800","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBPHIA&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040023","Medica with CHI Health Bronze HSA Plus","93078IA004",,"IAN004","IAS004","IAF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040023-01","Medica with CHI Health Bronze HSA Plus","Standard Bronze On Exchange Plan",,"0.648961269523038","Yes","Yes","No","100%",,"$2,600","$0","$3,400","$60","$2,600","$0","$1,800","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBPHIA&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IA","93078","SERFF","2017-09-26 20:16:14","Individual","No","41-1490988","93078IA0040013","Medica with CHI Health Catastrophic","93078IA004",,"IAN004","IAS004","IAF007","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","93078IA0040013-01","Medica with CHI Health Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHCIA&uid=FFM","https://www.medica.com/2018CHIHealthIA"
"2018","IL","18715","SERFF","2017-08-16 20:15:58","Individual","Yes","75-1233841","18715IL0010010","Dentegra Dental PPO Pediatric Basic Plan","18715IL001",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","18715IL0010010-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","$65 per person","per group not applicable",,,,,,"$65","$65 per person","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/il/18715il0010010-18"
"2018","IL","18715","SERFF","2017-08-16 20:15:58","Individual","Yes","75-1233841","18715IL0010011","Dentegra Dental PPO Family Basic Plan","18715IL001",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","18715IL0010011-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","$65 per person","per group not applicable",,,,,,"$65","$65 per person","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/il/18715il0010011-18"
"2018","IL","18715","SERFF","2017-08-16 20:15:58","Individual","Yes","75-1233841","18715IL0010012","Dentegra Dental PPO Family Preferred Plan","18715IL001",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","18715IL0010012-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","$70 per person","per group not applicable",,,,,,"$70","$70 per person","per group not applicable","$70","$70 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/il/18715il0010012-18"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320088","HMO 500 Elite Platinum","20129IL032","7740283974","ILN001","ILS001","ILF007","New","HMO","Platinum","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320088-00","HMO 500 Elite Platinum","Standard Platinum Off Exchange Plan",,"0.865866103489461","No","Yes","No","100%",,"$500","$30","$2,400","$60","$500","$900","$300","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_500_ELITE_PLATINUM.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_500_ELITE_PLATINUM.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330026","HMO 3800 Elite Bronze","20129IL033","7740283974","ILN001","ILS004","ILF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330026-00","HMO 3800 Elite Bronze","Standard Bronze Off Exchange Plan",,"0.616980872532646","Yes","Yes","No","100%",,"$3,800","$0","$2,456","$60","$3,800","$700","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_3800_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_3800_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330026","HMO 3800 Elite Bronze","20129IL033","7740283974","ILN001","ILS004","ILF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330026-01","HMO 3800 Elite Bronze","Standard Bronze On Exchange Plan",,"0.616980872532646","Yes","Yes","No","100%",,"$3,800","$0","$2,456","$60","$3,800","$700","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3800_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3800_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320088","HMO 500 Elite Platinum","20129IL032","7740283974","ILN001","ILS001","ILF007","New","HMO","Platinum","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320088-01","HMO 500 Elite Platinum","Standard Platinum On Exchange Plan",,"0.865866103489461","No","Yes","No","100%",,"$500","$30","$2,400","$60","$500","$900","$300","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_500_ELITE_PLATINUM.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_500_ELITE_PLATINUM.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330026","HMO 3800 Elite Bronze","20129IL033","7740283974","ILN001","ILS004","ILF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330026-02","HMO 3800 Elite Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3800_ELITE_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3800_ELITE_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330026","HMO 3800 Elite Bronze","20129IL033","7740283974","ILN001","ILS004","ILF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330026-03","HMO 3800 Elite Bronze","Limited Cost Sharing Plan Variation",,"0.616980872532646","Yes","Yes","No","100%",,"$3,800","$0","$2,456","$60","$3,800","$700","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3800_ELITE_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3800_ELITE_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330027","HMO 4000d Elite Bronze","20129IL033","7740283974","ILN001","ILS004","ILF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330027-00","HMO 4000d Elite Bronze","Standard Bronze Off Exchange Plan",,"0.613357337382559","Yes","Yes","No","100%",,"$4,000","$0","$1,556","$60","$4,000","$20","$1,500","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_4000D_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_4000D_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320090","HMO 500 Methodist Platinum","20129IL032","7740283974","ILN002","ILS002","ILF007","New","HMO","Platinum","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320090-00","HMO 500 Methodist Platinum","Standard Platinum Off Exchange Plan",,"0.865866103489461","No","Yes","No","100%",,"$500","$30","$2,400","$60","$500","$900","$300","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_HMO_500_METHODIST_PLATINUM.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_HMO_500_METHODIST_PLATINUM.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320090","HMO 500 Methodist Platinum","20129IL032","7740283974","ILN002","ILS002","ILF007","New","HMO","Platinum","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320090-01","HMO 500 Methodist Platinum","Standard Platinum On Exchange Plan",,"0.865866103489461","No","Yes","No","100%",,"$500","$30","$2,400","$60","$500","$900","$300","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_500_METHODIST_PLATINUM.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_500_METHODIST_PLATINUM.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330027","HMO 4000d Elite Bronze","20129IL033","7740283974","ILN001","ILS004","ILF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330027-01","HMO 4000d Elite Bronze","Standard Bronze On Exchange Plan",,"0.613357337382559","Yes","Yes","No","100%",,"$4,000","$0","$1,556","$60","$4,000","$20","$1,500","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000D_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000D_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330027","HMO 4000d Elite Bronze","20129IL033","7740283974","ILN001","ILS004","ILF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330027-02","HMO 4000d Elite Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000D_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000D_ELITE_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330027","HMO 4000d Elite Bronze","20129IL033","7740283974","ILN001","ILS004","ILF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330027-03","HMO 4000d Elite Bronze","Limited Cost Sharing Plan Variation",,"0.613357337382559","Yes","Yes","No","100%",,"$4,000","$0","$1,556","$60","$4,000","$20","$1,500","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000D_ELITE_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000D_ELITE_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330020","HMO 7350 Elite Catastrophic","20129IL033","7740283974","ILN001","ILS005","ILF013","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330020-00","HMO 7350 Elite Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,700","$0","$0","$60","$400","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_7350_ELITE_CATASTROPHIC.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_7350_ELITE_CATASTROPHIC.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320092","HMO 500 OSF Platinum","20129IL032","7740283974","ILN001","ILS002","ILF007","New","HMO","Platinum","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320092-00","HMO 500 OSF Platinum","Standard Platinum Off Exchange Plan",,"0.865866103489461","No","Yes","No","100%",,"$500","$30","$2,400","$60","$500","$900","$300","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_HMO_500_OSF_PLATINUM.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_HMO_500_OSF_PLATINUM.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320092","HMO 500 OSF Platinum","20129IL032","7740283974","ILN001","ILS002","ILF007","New","HMO","Platinum","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320092-01","HMO 500 OSF Platinum","Standard Platinum On Exchange Plan",,"0.865866103489461","No","Yes","No","100%",,"$500","$30","$2,400","$60","$500","$900","$300","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_500_OSF_PLATINUM.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_500_OSF_PLATINUM.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330020","HMO 7350 Elite Catastrophic","20129IL033","7740283974","ILN001","ILS005","ILF013","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330020-01","HMO 7350 Elite Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,700","$0","$0","$60","$400","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_7350_ELITE_CATASTROPHIC.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_7350_ELITE_CATASTROPHIC.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330023","HMO 3100 Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330023-00","HMO 3100 Elite Silver","Standard Silver Off Exchange Plan",,"0.719233110825319","No","Yes","No","100%",,"$3,100","$30","$2,800","$60","$2,200","$1,100","$0","$60","$300","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_3100_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_3100_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330023","HMO 3100 Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330023-03","HMO 3100 Elite Silver","Limited Cost Sharing Plan Variation",,"0.719233110825319","No","Yes","No","100%",,"$3,100","$30","$2,800","$60","$2,200","$1,100","$0","$60","$300","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3100_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3100_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330023","HMO 3100 Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330023-04","HMO 3100 Elite Silver","73% AV Level Silver Plan",,"0.739507085147661","No","Yes","No","100%",,"$3,100","$30","$2,800","$60","$2,200","$1,100","$0","$60","$300","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3100_ELITE_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3100_ELITE_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330023","HMO 3100 Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330023-05","HMO 3100 Elite Silver","87% AV Level Silver Plan",,"0.877439210785406","No","Yes","No","100%",,"$3,100","$30","$900","$60","$2,200","$1,000","$0","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3100_ELITE_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3100_ELITE_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330023","HMO 3100 Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330023-06","HMO 3100 Elite Silver","94% AV Level Silver Plan",,"0.944845243227994","No","Yes","No","100%",,"$250","$30","$0","$60","$250","$500","$0","$60","$250","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","2.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3100_ELITE_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3100_ELITE_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320070","HMO 1000 Elite Gold","20129IL032","7740283974","ILN001","ILS001","ILF007","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320070-00","HMO 1000 Elite Gold","Standard Gold Off Exchange Plan",,"0.818212890099002","No","Yes","No","100%",,"$1,000","$30","$2,300","$60","$1,000","$900","$200","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_1000_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_1000_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320070","HMO 1000 Elite Gold","20129IL032","7740283974","ILN001","ILS001","ILF007","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320070-01","HMO 1000 Elite Gold","Standard Gold On Exchange Plan",,"0.818212890099002","No","Yes","No","100%",,"$1,000","$30","$2,300","$60","$1,000","$900","$200","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_1000_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_1000_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330023","HMO 3100 Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330023-01","HMO 3100 Elite Silver","Standard Silver On Exchange Plan",,"0.719233110825319","No","Yes","No","100%",,"$3,100","$30","$2,800","$60","$2,200","$1,100","$0","$60","$300","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3100_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3100_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320073","HMO 1000 Methodist Gold","20129IL032","7740283974","ILN002","ILS002","ILF007","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320073-01","HMO 1000 Methodist Gold","Standard Gold On Exchange Plan",,"0.818212890099002","No","Yes","No","100%",,"$1,000","$30","$2,300","$60","$1,000","$900","$200","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_1000_METHODIST_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_1000_METHODIST_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330017","HMO 2000 Elite Gold","20129IL033","7740283974","ILN001","ILS004","ILF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330017-01","HMO 2000 Elite Gold","Standard Gold On Exchange Plan",,"0.819272883022064","No","Yes","No","100%",,"$2,000","$200","$100","$60","$1,200","$900","$0","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_2000_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_2000_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330017","HMO 2000 Elite Gold","20129IL033","7740283974","ILN001","ILS004","ILF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330017-02","HMO 2000 Elite Gold","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_2000_ELITE_GOLD_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_2000_ELITE_GOLD_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330023","HMO 3100 Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330023-02","HMO 3100 Elite Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3100_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3100_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330017","HMO 2000 Elite Gold","20129IL033","7740283974","ILN001","ILS004","ILF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330017-00","HMO 2000 Elite Gold","Standard Gold Off Exchange Plan",,"0.819272883022064","No","Yes","No","100%",,"$2,000","$200","$100","$60","$1,200","$900","$0","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_2000_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_2000_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320073","HMO 1000 Methodist Gold","20129IL032","7740283974","ILN002","ILS002","ILF007","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320073-00","HMO 1000 Methodist Gold","Standard Gold Off Exchange Plan",,"0.818212890099002","No","Yes","No","100%",,"$1,000","$30","$2,300","$60","$1,000","$900","$200","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_HMO_1000_METHODIST_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_HMO_1000_METHODIST_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330017","HMO 2000 Elite Gold","20129IL033","7740283974","ILN001","ILS004","ILF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330017-03","HMO 2000 Elite Gold","Limited Cost Sharing Plan Variation",,"0.819272883022064","No","Yes","No","100%",,"$2,000","$200","$100","$60","$1,200","$900","$0","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_2000_ELITE_GOLD_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_2000_ELITE_GOLD_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330053","HMO 6650a Elite Bronze","20129IL033","7740283974","ILN001","ILS004","ILF008","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330053-00","HMO 6650a Elite Bronze","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,800","$700","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_6650A_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_6650A_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320075","HMO 1000 OSF Gold","20129IL032","7740283974","ILN001","ILS002","ILF007","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320075-00","HMO 1000 OSF Gold","Standard Gold Off Exchange Plan",,"0.818212890099002","No","Yes","No","100%",,"$1,000","$30","$2,300","$60","$1,000","$900","$200","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_1000_OSF_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_1000_OSF_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320075","HMO 1000 OSF Gold","20129IL032","7740283974","ILN001","ILS002","ILF007","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320075-01","HMO 1000 OSF Gold","Standard Gold On Exchange Plan",,"0.818212890099002","No","Yes","No","100%",,"$1,000","$30","$2,300","$60","$1,000","$900","$200","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_1000_OSF_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_1000_OSF_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330053","HMO 6650a Elite Bronze","20129IL033","7740283974","ILN001","ILS004","ILF008","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330053-01","HMO 6650a Elite Bronze","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,800","$700","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_6650A_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_6650A_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330053","HMO 6650a Elite Bronze","20129IL033","7740283974","ILN001","ILS004","ILF008","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330053-02","HMO 6650a Elite Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_6650A_ELITE_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_6650A_ELITE_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330053","HMO 6650a Elite Bronze","20129IL033","7740283974","ILN001","ILS004","ILF008","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330053-03","HMO 6650a Elite Bronze","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,800","$700","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_6650A_ELITE_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_6650A_ELITE_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290018","HMO HSA 6000 Elite Bronze","20129IL029","7740283974","ILN001","ILS004","ILF013","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290018-00","HMO HSA 6000 Elite Bronze","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_HSA_6000_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_HSA_6000_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320076","HMO 2000a Elite Gold","20129IL032","7740283974","ILN001","ILS001","ILF007","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320076-00","HMO 2000a Elite Gold","Standard Gold Off Exchange Plan",,"0.817888822830039","No","Yes","No","100%",,"$2,000","$30","$1,000","$60","$2,000","$900","$20","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_2000A_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_2000A_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320076","HMO 2000a Elite Gold","20129IL032","7740283974","ILN001","ILS001","ILF007","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320076-01","HMO 2000a Elite Gold","Standard Gold On Exchange Plan",,"0.817888822830039","No","Yes","No","100%",,"$2,000","$30","$1,000","$60","$2,000","$900","$20","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_2000A_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_2000A_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290018","HMO HSA 6000 Elite Bronze","20129IL029","7740283974","ILN001","ILS004","ILF013","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290018-01","HMO HSA 6000 Elite Bronze","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_6000_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_6000_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290018","HMO HSA 6000 Elite Bronze","20129IL029","7740283974","ILN001","ILS004","ILF013","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290018-02","HMO HSA 6000 Elite Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_6000_ELITE_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_6000_ELITE_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290018","HMO HSA 6000 Elite Bronze","20129IL029","7740283974","ILN001","ILS004","ILF013","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290018-03","HMO HSA 6000 Elite Bronze","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_6000_ELITE_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_6000_ELITE_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330055","HMO 2000 Methodist Gold","20129IL033","7740283974","ILN002","ILS002","ILF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330055-00","HMO 2000 Methodist Gold","Standard Gold Off Exchange Plan",,"0.819272883022064","No","Yes","No","100%",,"$2,000","$200","$100","$60","$1,200","$900","$0","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_2000_METHODIST_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_2000_METHODIST_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320079","HMO 2000a Methodist Gold","20129IL032","7740283974","ILN002","ILS002","ILF007","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320079-00","HMO 2000a Methodist Gold","Standard Gold Off Exchange Plan",,"0.817888822830039","No","Yes","No","100%",,"$2,000","$30","$1,000","$60","$2,000","$900","$20","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_2000A_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_2000A_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320079","HMO 2000a Methodist Gold","20129IL032","7740283974","ILN002","ILS002","ILF007","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320079-01","HMO 2000a Methodist Gold","Standard Gold On Exchange Plan",,"0.817888822830039","No","Yes","No","100%",,"$2,000","$30","$1,000","$60","$2,000","$900","$20","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_2000A_METHODIST_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_2000A_METHODIST_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330055","HMO 2000 Methodist Gold","20129IL033","7740283974","ILN002","ILS002","ILF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330055-01","HMO 2000 Methodist Gold","Standard Gold On Exchange Plan",,"0.819272883022064","No","Yes","No","100%",,"$2,000","$200","$100","$60","$1,200","$900","$0","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_2000_METHODIST_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_2000_METHODIST_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330055","HMO 2000 Methodist Gold","20129IL033","7740283974","ILN002","ILS002","ILF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330055-02","HMO 2000 Methodist Gold","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_2000_METHODIST_GOLD_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_2000_METHODIST_GOLD_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330055","HMO 2000 Methodist Gold","20129IL033","7740283974","ILN002","ILS002","ILF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330055-03","HMO 2000 Methodist Gold","Limited Cost Sharing Plan Variation",,"0.819272883022064","No","Yes","No","100%",,"$2,000","$200","$100","$60","$1,200","$900","$0","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_2000_METHODIST_GOLD_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_2000_METHODIST_GOLD_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330056","HMO 2000 OSF Gold","20129IL033","7740283974","ILN001","ILS002","ILF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330056-00","HMO 2000 OSF Gold","Standard Gold Off Exchange Plan",,"0.819272883022064","No","Yes","No","100%",,"$2,000","$200","$100","$60","$1,200","$900","$0","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_2000_OSF_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_2000_OSF_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320081","HMO 2000a OSF Gold","20129IL032","7740283974","ILN001","ILS002","ILF007","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320081-00","HMO 2000a OSF Gold","Standard Gold Off Exchange Plan",,"0.817888822830039","No","Yes","No","100%",,"$2,000","$30","$1,000","$60","$2,000","$900","$20","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_2000A_OSF_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_2000A_OSF_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320081","HMO 2000a OSF Gold","20129IL032","7740283974","ILN001","ILS002","ILF007","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320081-01","HMO 2000a OSF Gold","Standard Gold On Exchange Plan",,"0.817888822830039","No","Yes","No","100%",,"$2,000","$30","$1,000","$60","$2,000","$900","$20","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_2000A_OSF_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_2000A_OSF_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330056","HMO 2000 OSF Gold","20129IL033","7740283974","ILN001","ILS002","ILF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330056-01","HMO 2000 OSF Gold","Standard Gold On Exchange Plan",,"0.819272883022064","No","Yes","No","100%",,"$2,000","$200","$100","$60","$1,200","$900","$0","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_2000_OSF_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_2000_OSF_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330056","HMO 2000 OSF Gold","20129IL033","7740283974","ILN001","ILS002","ILF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330056-02","HMO 2000 OSF Gold","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_2000_OSF_GOLD_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_2000_OSF_GOLD_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330056","HMO 2000 OSF Gold","20129IL033","7740283974","ILN001","ILS002","ILF005","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330056-03","HMO 2000 OSF Gold","Limited Cost Sharing Plan Variation",,"0.819272883022064","No","Yes","No","100%",,"$2,000","$200","$100","$60","$1,200","$900","$0","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_2000_OSF_GOLD_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_2000_OSF_GOLD_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330064","HMO 3800 Methodist Bronze","20129IL033","7740283974","ILN002","ILS002","ILF004","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330064-00","HMO 3800 Methodist Bronze","Standard Bronze Off Exchange Plan",,"0.616980872532646","Yes","Yes","No","100%",,"$3,800","$0","$2,456","$60","$3,800","$700","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_3800_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_3800_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290022","HMO 3700 Methodist Bronze","20129IL029","7740283974","ILN002","ILS002","ILF012","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290022-01","HMO 3700 Methodist Bronze","Standard Bronze On Exchange Plan",,"0.618521112002904","Yes","Yes","No","100%",,"$3,700","$0","$2,606","$60","$3,700","$600","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3700_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3700_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290022","HMO 3700 Methodist Bronze","20129IL029","7740283974","ILN002","ILS002","ILF012","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290022-02","HMO 3700 Methodist Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3700_METHODIST_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3700_METHODIST_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290022","HMO 3700 Methodist Bronze","20129IL029","7740283974","ILN002","ILS002","ILF012","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290022-03","HMO 3700 Methodist Bronze","Limited Cost Sharing Plan Variation",,"0.618521112002904","Yes","Yes","No","100%",,"$3,700","$0","$2,606","$60","$3,700","$600","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3700_METHODIST_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3700_METHODIST_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290023","HMO 3700 OSF Bronze","20129IL029","7740283974","ILN001","ILS002","ILF012","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290023-00","HMO 3700 OSF Bronze","Standard Bronze Off Exchange Plan",,"0.618521112002904","Yes","Yes","No","100%",,"$3,700","$0","$2,606","$60","$3,700","$600","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_3700_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_3700_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320082","HMO 2500 Elite Gold","20129IL032","7740283974","ILN001","ILS001","ILF007","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320082-00","HMO 2500 Elite Gold","Standard Gold Off Exchange Plan",,"0.818661315583483","No","Yes","No","100%",,"$2,500","$100","$90","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_2500_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_2500_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320082","HMO 2500 Elite Gold","20129IL032","7740283974","ILN001","ILS001","ILF007","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320082-01","HMO 2500 Elite Gold","Standard Gold On Exchange Plan",,"0.818661315583483","No","Yes","No","100%",,"$2,500","$100","$90","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_2500_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_2500_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330064","HMO 3800 Methodist Bronze","20129IL033","7740283974","ILN002","ILS002","ILF004","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330064-01","HMO 3800 Methodist Bronze","Standard Bronze On Exchange Plan",,"0.616980872532646","Yes","Yes","No","100%",,"$3,800","$0","$2,456","$60","$3,800","$700","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3800_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3800_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310096","POS 1500b OSF Gold","20129IL031","7740283974","ILN001","ILS002","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310096-01","POS 1500b OSF Gold","Standard Gold On Exchange Plan",,"0.793748720993868","No","Yes","No","100%",,"$1,500","$30","$1,100","$60","$1,500","$70","$900","$60","$300","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$13000 per group",,,,"$14,700","$14700 per person","$26000 per group","$20,350","$20350 per person","$40700 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_1500B_OSF_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_1500B_OSF_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290023","HMO 3700 OSF Bronze","20129IL029","7740283974","ILN001","ILS002","ILF012","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290023-01","HMO 3700 OSF Bronze","Standard Bronze On Exchange Plan",,"0.618521112002904","Yes","Yes","No","100%",,"$3,700","$0","$2,606","$60","$3,700","$600","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3700_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3700_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290023","HMO 3700 OSF Bronze","20129IL029","7740283974","ILN001","ILS002","ILF012","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290023-02","HMO 3700 OSF Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3700_OSF_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3700_OSF_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330064","HMO 3800 Methodist Bronze","20129IL033","7740283974","ILN002","ILS002","ILF004","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330064-02","HMO 3800 Methodist Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3800_METHODIST_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3800_METHODIST_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330064","HMO 3800 Methodist Bronze","20129IL033","7740283974","ILN002","ILS002","ILF004","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330064-03","HMO 3800 Methodist Bronze","Limited Cost Sharing Plan Variation",,"0.616980872532646","Yes","Yes","No","100%",,"$3,800","$0","$2,456","$60","$3,800","$700","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3800_METHODIST_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3800_METHODIST_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330065","HMO 3800 OSF Bronze","20129IL033","7740283974","ILN001","ILS002","ILF004","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330065-00","HMO 3800 OSF Bronze","Standard Bronze Off Exchange Plan",,"0.616980872532646","Yes","Yes","No","100%",,"$3,800","$0","$2,456","$60","$3,800","$700","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_3800_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_3800_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320085","HMO 2500 Methodist Gold","20129IL032","7740283974","ILN002","ILS002","ILF007","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320085-00","HMO 2500 Methodist Gold","Standard Gold Off Exchange Plan",,"0.818661315583483","No","Yes","No","100%",,"$2,500","$100","$90","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_2500_METHODIST_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_2500_METHODIST_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320085","HMO 2500 Methodist Gold","20129IL032","7740283974","ILN002","ILS002","ILF007","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320085-01","HMO 2500 Methodist Gold","Standard Gold On Exchange Plan",,"0.818661315583483","No","Yes","No","100%",,"$2,500","$100","$90","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_2500_METHODIST_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_2500_METHODIST_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330065","HMO 3800 OSF Bronze","20129IL033","7740283974","ILN001","ILS002","ILF004","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330065-01","HMO 3800 OSF Bronze","Standard Bronze On Exchange Plan",,"0.616980872532646","Yes","Yes","No","100%",,"$3,800","$0","$2,456","$60","$3,800","$700","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3800_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3800_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330065","HMO 3800 OSF Bronze","20129IL033","7740283974","ILN001","ILS002","ILF004","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330065-02","HMO 3800 OSF Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3800_OSF_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3800_OSF_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330065","HMO 3800 OSF Bronze","20129IL033","7740283974","ILN001","ILS002","ILF004","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330065-03","HMO 3800 OSF Bronze","Limited Cost Sharing Plan Variation",,"0.616980872532646","Yes","Yes","No","100%",,"$3,800","$0","$2,456","$60","$3,800","$700","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3800_OSF_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3800_OSF_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290021","HMO 3700 Elite Bronze","20129IL029","7740283974","ILN001","ILS004","ILF012","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290021-00","HMO 3700 Elite Bronze","Standard Bronze Off Exchange Plan",,"0.618521112002904","Yes","Yes","No","100%",,"$3,700","$0","$2,606","$60","$3,700","$600","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_3700_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_3700_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320087","HMO 2500 OSF Gold","20129IL032","7740283974","ILN001","ILS002","ILF007","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320087-00","HMO 2500 OSF Gold","Standard Gold Off Exchange Plan",,"0.818661315583483","No","Yes","No","100%",,"$2,500","$100","$90","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_2500_OSF_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_2500_OSF_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0320087","HMO 2500 OSF Gold","20129IL032","7740283974","ILN001","ILS002","ILF007","New","HMO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0320087-01","HMO 2500 OSF Gold","Standard Gold On Exchange Plan",,"0.818661315583483","No","Yes","No","100%",,"$2,500","$100","$90","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_2500_OSF_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_2500_OSF_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290021","HMO 3700 Elite Bronze","20129IL029","7740283974","ILN001","ILS004","ILF012","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290021-01","HMO 3700 Elite Bronze","Standard Bronze On Exchange Plan",,"0.618521112002904","Yes","Yes","No","100%",,"$3,700","$0","$2,606","$60","$3,700","$600","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3700_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3700_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290021","HMO 3700 Elite Bronze","20129IL029","7740283974","ILN001","ILS004","ILF012","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290021-02","HMO 3700 Elite Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3700_ELITE_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3700_ELITE_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290021","HMO 3700 Elite Bronze","20129IL029","7740283974","ILN001","ILS004","ILF012","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290021-03","HMO 3700 Elite Bronze","Limited Cost Sharing Plan Variation",,"0.618521112002904","Yes","Yes","No","100%",,"$3,700","$0","$2,606","$60","$3,700","$600","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3700_ELITE_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3700_ELITE_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330014","HMO 4000b Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330014-00","HMO 4000b Elite Silver","Standard Silver Off Exchange Plan",,"0.712523423704602","No","Yes","No","100%",,"$2,400","$1,200","$0","$60","$1,100","$1,000","$0","$60","$200","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_4000B_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_4000B_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310091","POS 1500b Elite Gold","20129IL031","7740283974","ILN001","ILS001","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310091-00","POS 1500b Elite Gold","Standard Gold Off Exchange Plan",,"0.793748720993868","No","Yes","No","100%",,"$1,500","$30","$1,100","$60","$1,500","$70","$900","$60","$300","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$13,000","$13000 per person","$26000 per group","$20,350","$20350 per person","$40700 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_1500B_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_1500B_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310091","POS 1500b Elite Gold","20129IL031","7740283974","ILN001","ILS001","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310091-01","POS 1500b Elite Gold","Standard Gold On Exchange Plan",,"0.793748720993868","No","Yes","No","100%",,"$1,500","$30","$1,100","$60","$1,500","$70","$900","$60","$300","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$13,000","$13000 per person","$26000 per group","$20,350","$20350 per person","$40700 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_1500B_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_1500B_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330014","HMO 4000b Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330014-01","HMO 4000b Elite Silver","Standard Silver On Exchange Plan",,"0.712523423704602","No","Yes","No","100%",,"$2,400","$1,200","$0","$60","$1,100","$1,000","$0","$60","$200","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000B_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000B_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330014","HMO 4000b Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330014-02","HMO 4000b Elite Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000B_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000B_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330014","HMO 4000b Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330014-03","HMO 4000b Elite Silver","Limited Cost Sharing Plan Variation",,"0.712523423704602","No","Yes","No","100%",,"$2,400","$1,200","$0","$60","$1,100","$1,000","$0","$60","$200","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000B_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000B_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330014","HMO 4000b Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330014-04","HMO 4000b Elite Silver","73% AV Level Silver Plan",,"0.736436203183915","No","Yes","No","100%",,"$2,400","$1,200","$0","$60","$1,100","$1,000","$0","$60","$200","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000B_ELITE_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000B_ELITE_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330014","HMO 4000b Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330014-05","HMO 4000b Elite Silver","87% AV Level Silver Plan",,"0.87906917337977","No","Yes","No","100%",,"$200","$600","$40","$60","$200","$1,000","$20","$60","$200","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","2.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000B_ELITE_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000B_ELITE_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330014","HMO 4000b Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330014-06","HMO 4000b Elite Silver","94% AV Level Silver Plan",,"0.932123027987302","No","Yes","No","100%",,"$0","$300","$50","$60","$0","$1,000","$20","$60","$0","$100","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","2.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000B_ELITE_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000B_ELITE_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290022","HMO 3700 Methodist Bronze","20129IL029","7740283974","ILN002","ILS002","ILF012","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290022-00","HMO 3700 Methodist Bronze","Standard Bronze Off Exchange Plan",,"0.618521112002904","Yes","Yes","No","100%",,"$3,700","$0","$2,606","$60","$3,700","$600","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_3700_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_3700_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310094","POS 1500b Methodist Gold","20129IL031","7740283974","ILN002","ILS002","ILF007","Existing","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310094-00","POS 1500b Methodist Gold","Standard Gold Off Exchange Plan",,"0.793748720993868","No","Yes","No","100%",,"$1,500","$30","$1,100","$60","$1,500","$70","$900","$60","$300","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$13,000","$13000 per person","$26000 per group","$20,350","$20350 per person","$40700 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_1500B_METHODIST_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_1500B_METHODIST_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310094","POS 1500b Methodist Gold","20129IL031","7740283974","ILN002","ILS002","ILF007","Existing","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310094-01","POS 1500b Methodist Gold","Standard Gold On Exchange Plan",,"0.793748720993868","No","Yes","No","100%",,"$1,500","$30","$1,100","$60","$1,500","$70","$900","$60","$300","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$13,000","$13000 per person","$26000 per group","$20,350","$20350 per person","$40700 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_1500B_METHODIST_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_1500B_METHODIST_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310096","POS 1500b OSF Gold","20129IL031","7740283974","ILN001","ILS002","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310096-00","POS 1500b OSF Gold","Standard Gold Off Exchange Plan",,"0.793748720993868","No","Yes","No","100%",,"$1,500","$30","$1,100","$60","$1,500","$70","$900","$60","$300","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$13000 per group",,,,"$14,700","$14700 per person","$26000 per group","$20,350","$20350 per person","$40700 per group","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_1500B_OSF_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_1500B_OSF_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290023","HMO 3700 OSF Bronze","20129IL029","7740283974","ILN001","ILS002","ILF012","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290023-03","HMO 3700 OSF Bronze","Limited Cost Sharing Plan Variation",,"0.618521112002904","Yes","Yes","No","100%",,"$3,700","$0","$2,606","$60","$3,700","$600","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7150 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3700_OSF_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3700_OSF_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330071","HMO 4000d Methodist Bronze","20129IL033","7740283974","ILN002","ILS002","ILF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330071-00","HMO 4000d Methodist Bronze","Standard Bronze Off Exchange Plan",,"0.613357337382559","Yes","Yes","No","100%",,"$4,000","$0","$1,556","$60","$4,000","$20","$1,500","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_4000D_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_4000D_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310103","POS 2500 Elite Gold","20129IL031","7740283974","ILN001","ILS001","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310103-01","POS 2500 Elite Gold","Standard Gold On Exchange Plan",,"0.781287606274358","No","Yes","No","100%",,"$2,500","$30","$2,000","$60","$220","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,000","$21000 per person","$42000 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_2500_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_2500_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290026","HMO HSA 6000 OSF Bronze","20129IL029","7740283974","ILN002","ILS002","ILF013","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290026-01","HMO HSA 6000 OSF Bronze","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_6000_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_6000_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290026","HMO HSA 6000 OSF Bronze","20129IL029","7740283974","ILN002","ILS002","ILF013","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290026-02","HMO HSA 6000 OSF Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_6000_OSF_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_6000_OSF_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290026","HMO HSA 6000 OSF Bronze","20129IL029","7740283974","ILN002","ILS002","ILF013","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290026-03","HMO HSA 6000 OSF Bronze","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_6000_OSF_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_6000_OSF_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330081","HMO 6650a Methodist Bronze","20129IL033","7740283974","ILN002","ILS002","ILF008","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330081-00","HMO 6650a Methodist Bronze","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,800","$700","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_6650A_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_6650A_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310097","POS 2000b Elite Gold","20129IL031","7740283974","ILN001","ILS001","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310097-00","POS 2000b Elite Gold","Standard Gold Off Exchange Plan",,"0.798797332386735","No","Yes","No","100%",,"$2,000","$0","$2,000","$60","$2,000","$900","$40","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$14,000","$14000 per person","$28000 per group","$19,000","$19000 per person","$38000 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_2000B_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_2000B_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310097","POS 2000b Elite Gold","20129IL031","7740283974","ILN001","ILS001","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310097-01","POS 2000b Elite Gold","Standard Gold On Exchange Plan",,"0.798797332386735","No","Yes","No","100%",,"$2,000","$0","$2,000","$60","$2,000","$900","$40","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$14,000","$14000 per person","$28000 per group","$19,000","$19000 per person","$38000 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_2000B_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_2000B_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330071","HMO 4000d Methodist Bronze","20129IL033","7740283974","ILN002","ILS002","ILF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330071-01","HMO 4000d Methodist Bronze","Standard Bronze On Exchange Plan",,"0.613357337382559","Yes","Yes","No","100%",,"$4,000","$0","$1,556","$60","$4,000","$20","$1,500","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000D_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000D_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330081","HMO 6650a Methodist Bronze","20129IL033","7740283974","ILN002","ILS002","ILF008","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330081-01","HMO 6650a Methodist Bronze","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,800","$700","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_6650A_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_6650A_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330081","HMO 6650a Methodist Bronze","20129IL033","7740283974","ILN002","ILS002","ILF008","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330081-02","HMO 6650a Methodist Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_6650A_METHODIST_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_6650A_METHODIST_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330081","HMO 6650a Methodist Bronze","20129IL033","7740283974","ILN002","ILS002","ILF008","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330081-03","HMO 6650a Methodist Bronze","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,800","$700","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_6650A_METHODIST_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_6650A_METHODIST_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330071","HMO 4000d Methodist Bronze","20129IL033","7740283974","ILN002","ILS002","ILF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330071-02","HMO 4000d Methodist Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000D_METHODIST_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000D_METHODIST_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330071","HMO 4000d Methodist Bronze","20129IL033","7740283974","ILN002","ILS002","ILF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330071-03","HMO 4000d Methodist Bronze","Limited Cost Sharing Plan Variation",,"0.613357337382559","Yes","Yes","No","100%",,"$4,000","$0","$1,556","$60","$4,000","$20","$1,500","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000D_METHODIST_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000D_METHODIST_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330072","HMO 4000d OSF Bronze","20129IL033","7740283974","ILN001","ILS002","ILF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330072-00","HMO 4000d OSF Bronze","Standard Bronze Off Exchange Plan",,"0.613357337382559","Yes","Yes","No","100%",,"$4,000","$0","$1,556","$60","$4,000","$20","$1,500","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_4000D_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_4000D_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310100","POS 2000b Methodist Gold","20129IL031","7740283974","ILN002","ILS002","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310100-00","POS 2000b Methodist Gold","Standard Gold Off Exchange Plan",,"0.798797332386735","No","Yes","No","100%",,"$2,000","$0","$2,000","$60","$2,000","$900","$40","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$14,000","$14000 per person","$28000 per group","$19,000","$19000 per person","$38000 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_2000B_METHODIST_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_2000B_METHODIST_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310100","POS 2000b Methodist Gold","20129IL031","7740283974","ILN002","ILS002","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310100-01","POS 2000b Methodist Gold","Standard Gold On Exchange Plan",,"0.798797332386735","No","Yes","No","100%",,"$2,000","$0","$2,000","$60","$2,000","$900","$40","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$14,000","$14000 per person","$28000 per group","$19,000","$19000 per person","$38000 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_2000B_METHODIST_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_2000B_METHODIST_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330072","HMO 4000d OSF Bronze","20129IL033","7740283974","ILN001","ILS002","ILF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330072-01","HMO 4000d OSF Bronze","Standard Bronze On Exchange Plan",,"0.613357337382559","Yes","Yes","No","100%",,"$4,000","$0","$1,556","$60","$4,000","$20","$1,500","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000D_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000D_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330072","HMO 4000d OSF Bronze","20129IL033","7740283974","ILN001","ILS002","ILF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330072-02","HMO 4000d OSF Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000D_OSF_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000D_OSF_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330072","HMO 4000d OSF Bronze","20129IL033","7740283974","ILN001","ILS002","ILF006","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330072-03","HMO 4000d OSF Bronze","Limited Cost Sharing Plan Variation",,"0.613357337382559","Yes","Yes","No","100%",,"$4,000","$0","$1,556","$60","$4,000","$20","$1,500","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000D_OSF_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000D_OSF_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290025","HMO HSA 6000 Methodist Bronze","20129IL029","7740283974","ILN002","ILS002","ILF013","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290025-00","HMO HSA 6000 Methodist Bronze","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_HSA_6000_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_HSA_6000_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310102","POS 2000b OSF Gold","20129IL031","7740283974","ILN001","ILS002","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Availabel","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310102-00","POS 2000b OSF Gold","Standard Gold Off Exchange Plan",,"0.798797332386735","No","Yes","No","100%",,"$2,000","$0","$2,000","$60","$2,000","$900","$40","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$14,000","$14000 per person","$28000 per group","$19,000","$19000 per person","$38000 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_2000B_OSF_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_2000B_OSF_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310102","POS 2000b OSF Gold","20129IL031","7740283974","ILN001","ILS002","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Availabel","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310102-01","POS 2000b OSF Gold","Standard Gold On Exchange Plan",,"0.798797332386735","No","Yes","No","100%",,"$2,000","$0","$2,000","$60","$2,000","$900","$40","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$14,000","$14000 per person","$28000 per group","$19,000","$19000 per person","$38000 per group","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_2000B_OSF_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_2000B_OSF_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290025","HMO HSA 6000 Methodist Bronze","20129IL029","7740283974","ILN002","ILS002","ILF013","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290025-01","HMO HSA 6000 Methodist Bronze","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_6000_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_6000_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290025","HMO HSA 6000 Methodist Bronze","20129IL029","7740283974","ILN002","ILS002","ILF013","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290025-02","HMO HSA 6000 Methodist Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_6000_METHODIST_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_6000_METHODIST_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290025","HMO HSA 6000 Methodist Bronze","20129IL029","7740283974","ILN002","ILS002","ILF013","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290025-03","HMO HSA 6000 Methodist Bronze","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_6000_METHODIST_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_6000_METHODIST_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290026","HMO HSA 6000 OSF Bronze","20129IL029","7740283974","ILN002","ILS002","ILF013","New","HMO","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290026-00","HMO HSA 6000 OSF Bronze","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_HSA_6000_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_HSA_6000_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310103","POS 2500 Elite Gold","20129IL031","7740283974","ILN001","ILS001","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310103-00","POS 2500 Elite Gold","Standard Gold Off Exchange Plan",,"0.781287606274358","No","Yes","No","100%",,"$2,500","$30","$2,000","$60","$220","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,000","$21000 per person","$42000 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_2500_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_2500_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310106","POS 2500 Methodist Gold","20129IL031","7740283974","ILN002","ILS002","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310106-00","POS 2500 Methodist Gold","Standard Gold Off Exchange Plan",,"0.781287606274358","No","Yes","No","100%",,"$2,500","$30","$2,000","$60","$220","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,000","$21000 per person","$42000 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_2500_METHODIST_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_2500_METHODIST_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310106","POS 2500 Methodist Gold","20129IL031","7740283974","ILN002","ILS002","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310106-01","POS 2500 Methodist Gold","Standard Gold On Exchange Plan",,"0.781287606274358","No","Yes","No","100%",,"$2,500","$30","$2,000","$60","$220","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,000","$21000 per person","$42000 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_2500_METHODIST_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_2500_METHODIST_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330082","HMO 6650a OSF Bronze","20129IL033","7740283974","ILN001","ILS002","ILF008","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330082-00","HMO 6650a OSF Bronze","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,800","$700","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_6650A_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_6650A_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310108","POS 2500 OSF Gold","20129IL031","7740283974","ILN001","ILS002","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310108-00","POS 2500 OSF Gold","Standard Gold Off Exchange Plan",,"0.781287606274358","No","Yes","No","100%",,"$2,500","$30","$2,000","$60","$220","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,000","$21000 per person","$42000 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_2500_OSF_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_2500_OSF_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310108","POS 2500 OSF Gold","20129IL031","7740283974","ILN001","ILS002","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310108-01","POS 2500 OSF Gold","Standard Gold On Exchange Plan",,"0.781287606274358","No","Yes","No","100%",,"$2,500","$30","$2,000","$60","$220","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,000","$21000 per person","$42000 per group","$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_2500_OSF_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_2500_OSF_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330082","HMO 6650a OSF Bronze","20129IL033","7740283974","ILN001","ILS002","ILF008","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330082-01","HMO 6650a OSF Bronze","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,800","$700","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_6650A_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_6650A_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330082","HMO 6650a OSF Bronze","20129IL033","7740283974","ILN001","ILS002","ILF008","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330082-02","HMO 6650a OSF Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_6650A_OSF_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_6650A_OSF_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330082","HMO 6650a OSF Bronze","20129IL033","7740283974","ILN001","ILS002","ILF008","New","HMO","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330082-03","HMO 6650a OSF Bronze","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,800","$700","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_6650A_OSF_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_6650A_OSF_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340021","POS 5000a Methodist Bronze","20129IL034","7740283974","ILN002","ILS002","ILF016","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340021-00","POS 5000a Methodist Bronze","Standard Bronze Off Exchange Plan",,"0.611072798631118","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$60","$5,000","$20","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20.00%",,,,,"$12,700","$12700 per person","$25400 per group","$17,700","$17700 per person","$38100 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_5000A_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_5000A_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310109","POS 3000 Elite Gold","20129IL031","7740283974","ILN001","ILS001","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310109-00","POS 3000 Elite Gold","Standard Gold Off Exchange Plan",,"0.784910983015652","No","Yes","No","100%",,"$3,000","$30","$900","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$14,000","$14000 per person","$28000 per group","$20,000","$20000 per person","$40000 per group","$3,000","$3000 per person","$6000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_3000_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_3000_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310109","POS 3000 Elite Gold","20129IL031","7740283974","ILN001","ILS001","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310109-01","POS 3000 Elite Gold","Standard Gold On Exchange Plan",,"0.784910983015652","No","Yes","No","100%",,"$3,000","$30","$900","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$14,000","$14000 per person","$28000 per group","$20,000","$20000 per person","$40000 per group","$3,000","$3000 per person","$6000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_3000_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_3000_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340021","POS 5000a Methodist Bronze","20129IL034","7740283974","ILN002","ILS002","ILF016","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340021-01","POS 5000a Methodist Bronze","Standard Bronze On Exchange Plan",,"0.611072798631118","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$60","$5,000","$20","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20.00%",,,,,"$12,700","$12700 per person","$25400 per group","$17,700","$17700 per person","$38100 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_5000A_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_5000A_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340035","POS 6650a Elite Bronze","20129IL034","7740283974","ILN001","ILS004","ILF018","New","POS","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340035-00","POS 6650a Elite Bronze","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,800","$700","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_6650A_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_6650A_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310115","POS 4000 Elite Silver","20129IL031","7740283974","ILN001","ILS001","ILF011","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310115-00","POS 4000 Elite Silver","Standard Silver Off Exchange Plan",,"0.719988761848844","No","Yes","No","100%",,"$3,400","$300","$1,700","$60","$2,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$18,000","$18000 per person","$36000 per group","$25,350","$25350 per person","$50700 per group","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_4000_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_4000_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310115","POS 4000 Elite Silver","20129IL031","7740283974","ILN001","ILS001","ILF011","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310115-01","POS 4000 Elite Silver","Standard Silver On Exchange Plan",,"0.719988761848844","No","Yes","No","100%",,"$3,400","$300","$1,700","$60","$2,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$18,000","$18000 per person","$36000 per group","$25,350","$25350 per person","$50700 per group","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_4000_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_4000_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340035","POS 6650a Elite Bronze","20129IL034","7740283974","ILN001","ILS004","ILF018","New","POS","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340035-01","POS 6650a Elite Bronze","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,800","$700","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6650A_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6650A_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340021","POS 5000a Methodist Bronze","20129IL034","7740283974","ILN002","ILS002","ILF016","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340021-02","POS 5000a Methodist Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_5000A_METHODIST_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_5000A_METHODIST_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340021","POS 5000a Methodist Bronze","20129IL034","7740283974","ILN002","ILS002","ILF016","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340021-03","POS 5000a Methodist Bronze","Limited Cost Sharing Plan Variation",,"0.611072798631118","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$60","$5,000","$20","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20.00%",,,,,"$12,700","$12700 per person","$25400 per group","$17,700","$17700 per person","$38100 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_5000A_METHODIST_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_5000A_METHODIST_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340018","POS 5000a Elite Bronze","20129IL034","7740283974","ILN001","ILS004","ILF016","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340018-00","POS 5000a Elite Bronze","Standard Bronze Off Exchange Plan",,"0.611072798631118","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$60","$5,000","$20","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20.00%",,,,,"$12,700","$12700 per person","$25400 per group","$17,700","$17700 per person","$38100 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_5000A_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_5000A_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300027","POS HSA 6000 Elite Bronze","20129IL030","7740283974","ILN001","ILS004","ILF020","New","POS","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300027-00","POS HSA 6000 Elite Bronze","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_HSA_6000_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_HSA_6000_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310117","POS 4000 Methodist Silver","20129IL031","7740283974","ILN002","ILS002","ILF011","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310117-00","POS 4000 Methodist Silver","Standard Silver Off Exchange Plan",,"0.719988761848844","No","Yes","No","100%",,"$3,400","$300","$1,700","$60","$2,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$18,000","$18000 per person","$36000 per group","$25,350","$25350 per person","$50700 per group","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_4000_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_4000_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310117","POS 4000 Methodist Silver","20129IL031","7740283974","ILN002","ILS002","ILF011","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310117-01","POS 4000 Methodist Silver","Standard Silver On Exchange Plan",,"0.719988761848844","No","Yes","No","100%",,"$3,400","$300","$1,700","$60","$2,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$18,000","$18000 per person","$36000 per group","$25,350","$25350 per person","$50700 per group","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_4000_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_4000_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310112","POS 3000 Methodist Gold","20129IL031","7740283974","ILN002","ILS002","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310112-00","POS 3000 Methodist Gold","Standard Gold Off Exchange Plan",,"0.784910983015652","No","Yes","No","100%",,"$3,000","$30","$900","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$14,000","$14000 per person","$28000 per group","$20,000","$20000 per person","$40000 per group","$3,000","$3000 per person","$6000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_3000_METHODIST_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_3000_METHODIST_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310112","POS 3000 Methodist Gold","20129IL031","7740283974","ILN002","ILS002","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310112-01","POS 3000 Methodist Gold","Standard Gold On Exchange Plan",,"0.784910983015652","No","Yes","No","100%",,"$3,000","$30","$900","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$14,000","$14000 per person","$28000 per group","$20,000","$20000 per person","$40000 per group","$3,000","$3000 per person","$6000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_3000_METHODIST_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_3000_METHODIST_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340018","POS 5000a Elite Bronze","20129IL034","7740283974","ILN001","ILS004","ILF016","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340018-01","POS 5000a Elite Bronze","Standard Bronze On Exchange Plan",,"0.611072798631118","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$60","$5,000","$20","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20.00%",,,,,"$12,700","$12700 per person","$25400 per group","$17,700","$17700 per person","$38100 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_5000A_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_5000A_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340018","POS 5000a Elite Bronze","20129IL034","7740283974","ILN001","ILS004","ILF016","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340018-02","POS 5000a Elite Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_5000A_ELITE_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_5000A_ELITE_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340018","POS 5000a Elite Bronze","20129IL034","7740283974","ILN001","ILS004","ILF016","Existing","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340018-03","POS 5000a Elite Bronze","Limited Cost Sharing Plan Variation",,"0.611072798631118","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$60","$5,000","$20","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20.00%",,,,,"$12,700","$12700 per person","$25400 per group","$17,700","$17700 per person","$38100 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_5000A_ELITE_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_5000A_ELITE_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340039","POS 3750c Elite Bronze","20129IL034","7740283974","ILN001","ILS004","ILF015","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340039-00","POS 3750c Elite Bronze","Standard Bronze Off Exchange Plan",,"0.615128434612749","Yes","Yes","No","100%",,"$3,750","$0","$2,913","$60","$3,750","$20","$1,500","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$56300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","45.00%",,,,,"$7,500","$7500 per person","$15000 per group","$11,250","$11250 per person","$22500 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_3750C_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_3750C_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310114","POS 3000 OSF Gold","20129IL031","7740283974","ILN001","ILS002","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310114-00","POS 3000 OSF Gold","Standard Gold Off Exchange Plan",,"0.784910983015652","No","Yes","No","100%",,"$3,000","$30","$900","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$14,000","$14000 per person","$28000 per group","$20,000","$20000 per person","$40000 per group","$3,000","$3000 per person","$6000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_POS_3000_OSF_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_POS_3000_OSF_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310114","POS 3000 OSF Gold","20129IL031","7740283974","ILN001","ILS002","ILF007","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310114-01","POS 3000 OSF Gold","Standard Gold On Exchange Plan",,"0.784910983015652","No","Yes","No","100%",,"$3,000","$30","$900","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$14,000","$14000 per person","$28000 per group","$20,000","$20000 per person","$40000 per group","$3,000","$3000 per person","$6000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_3000_OSF_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_3000_OSF_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340039","POS 3750c Elite Bronze","20129IL034","7740283974","ILN001","ILS004","ILF015","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340039-01","POS 3750c Elite Bronze","Standard Bronze On Exchange Plan",,"0.615128434612749","Yes","Yes","No","100%",,"$3,750","$0","$2,913","$60","$3,750","$20","$1,500","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$56300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","45.00%",,,,,"$7,500","$7500 per person","$15000 per group","$11,250","$11250 per person","$22500 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3750C_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3750C_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340039","POS 3750c Elite Bronze","20129IL034","7740283974","ILN001","ILS004","ILF015","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340039-02","POS 3750c Elite Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3750C_ELITE_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3750C_ELITE_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340039","POS 3750c Elite Bronze","20129IL034","7740283974","ILN001","ILS004","ILF015","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340039-03","POS 3750c Elite Bronze","Limited Cost Sharing Plan Variation",,"0.615128434612749","Yes","Yes","No","100%",,"$3,750","$0","$2,913","$60","$3,750","$20","$1,500","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$56300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","45.00%",,,,,"$7,500","$7500 per person","$15000 per group","$11,250","$11250 per person","$22500 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3750C_ELITE_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3750C_ELITE_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340035","POS 6650a Elite Bronze","20129IL034","7740283974","ILN001","ILS004","ILF018","New","POS","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340035-02","POS 6650a Elite Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6650A_ELITE_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6650A_ELITE_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340035","POS 6650a Elite Bronze","20129IL034","7740283974","ILN001","ILS004","ILF018","New","POS","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340035-03","POS 6650a Elite Bronze","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,800","$700","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6650A_ELITE_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6650A_ELITE_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300027","POS HSA 6000 Elite Bronze","20129IL030","7740283974","ILN001","ILS004","ILF020","New","POS","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300027-01","POS HSA 6000 Elite Bronze","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_HSA_6000_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_HSA_6000_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300027","POS HSA 6000 Elite Bronze","20129IL030","7740283974","ILN001","ILS004","ILF020","New","POS","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300027-02","POS HSA 6000 Elite Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_HSA_6000_ELITE_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_HSA_6000_ELITE_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300027","POS HSA 6000 Elite Bronze","20129IL030","7740283974","ILN001","ILS004","ILF020","New","POS","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300027-03","POS HSA 6000 Elite Bronze","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_HSA_6000_ELITE_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_HSA_6000_ELITE_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340040","POS 3750c Methodist Bronze","20129IL034","7740283974","ILN002","ILS002","ILF015","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340040-00","POS 3750c Methodist Bronze","Standard Bronze Off Exchange Plan",,"0.615128431687168","Yes","Yes","No","100%",,"$3,750","$0","$2,913","$60","$3,750","$20","$1,500","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","45.00%",,,,,"$7,500","$7500 per person","$15000 per group","$11,250","$11250 per person","$22500 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_3750C_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_3750C_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310127","POS 6500 Elite Silver","20129IL031","7740283974","ILN001","ILS001","ILF011","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310127-00","POS 6500 Elite Silver","Standard Silver Off Exchange Plan",,"0.715367003195067","No","Yes","No","100%",,"$3,400","$300","$0","$60","$2,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$19,000","$19000 per person","$38000 per group","$26,350","$26350 per person","$52700 per group","$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","$18,500","$18500 per person","$39000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_6500_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_6500_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310127","POS 6500 Elite Silver","20129IL031","7740283974","ILN001","ILS001","ILF011","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310127-01","POS 6500 Elite Silver","Standard Silver On Exchange Plan",,"0.715367003195067","No","Yes","No","100%",,"$3,400","$300","$0","$60","$2,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$19,000","$19000 per person","$38000 per group","$26,350","$26350 per person","$52700 per group","$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","$18,500","$18500 per person","$39000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_6500_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_6500_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300029","POS HSA 6000 OSF Bronze","20129IL030","7740283974","ILN001","ILS002","ILF020","New","POS","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300029-01","POS HSA 6000 OSF Bronze","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_HSA_6000_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_HSA_6000_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300029","POS HSA 6000 OSF Bronze","20129IL030","7740283974","ILN001","ILS002","ILF020","New","POS","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300029-02","POS HSA 6000 OSF Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_HSA_6000_OSF_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_HSA_6000_OSF_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300029","POS HSA 6000 OSF Bronze","20129IL030","7740283974","ILN001","ILS002","ILF020","New","POS","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300029-03","POS HSA 6000 OSF Bronze","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_HSA_6000_OSF_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_HSA_6000_OSF_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340049","POS 6650a Methodist Bronze","20129IL034","7740283974","ILN002","ILS002","ILF018","New","POS","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340049-00","POS 6650a Methodist Bronze","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,800","$700","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_6650A_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_6650A_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310119","POS 4000 OSF Silver","20129IL031","7740283974","ILN001","ILS002","ILF011","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310119-00","POS 4000 OSF Silver","Standard Silver Off Exchange Plan",,"0.719988761848844","No","Yes","No","100%",,"$3,400","$300","$1,700","$60","$2,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$18,000","$18000 per person","$36000 per group","$25,350","$25350 per person","$50700 per group","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_4000_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_4000_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310119","POS 4000 OSF Silver","20129IL031","7740283974","ILN001","ILS002","ILF011","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310119-01","POS 4000 OSF Silver","Standard Silver On Exchange Plan",,"0.719988761848844","No","Yes","No","100%",,"$3,400","$300","$1,700","$60","$2,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$18,000","$18000 per person","$36000 per group","$25,350","$25350 per person","$50700 per group","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_4000_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_4000_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340040","POS 3750c Methodist Bronze","20129IL034","7740283974","ILN002","ILS002","ILF015","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340040-01","POS 3750c Methodist Bronze","Standard Bronze On Exchange Plan",,"0.615128431687168","Yes","Yes","No","100%",,"$3,750","$0","$2,913","$60","$3,750","$20","$1,500","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","45.00%",,,,,"$7,500","$7500 per person","$15000 per group","$11,250","$11250 per person","$22500 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3750C_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3750C_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340040","POS 3750c Methodist Bronze","20129IL034","7740283974","ILN002","ILS002","ILF015","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340040-02","POS 3750c Methodist Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3750C_METHODIST_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3750C_METHODIST_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340040","POS 3750c Methodist Bronze","20129IL034","7740283974","ILN002","ILS002","ILF015","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340040-03","POS 3750c Methodist Bronze","Limited Cost Sharing Plan Variation",,"0.615128431687168","Yes","Yes","No","100%",,"$3,750","$0","$2,913","$60","$3,750","$20","$1,500","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","45.00%",,,,,"$7,500","$7500 per person","$15000 per group","$11,250","$11250 per person","$22500 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3750C_METHODIST_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3750C_METHODIST_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340041","POS 3750c OSF Bronze","20129IL034","7740283974","ILN001","ILS002","ILF015","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340041-00","POS 3750c OSF Bronze","Standard Bronze Off Exchange Plan",,"0.615128431687168","Yes","Yes","No","100%",,"$3,750","$0","$2,913","$60","$3,750","$20","$1,500","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","45.00%",,,,,"$7,500","$7500 per person","$15000 per group","$11,250","$11250 per person","$22500 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_3750C_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_3750C_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300029","POS HSA 6000 OSF Bronze","20129IL030","7740283974","ILN001","ILS002","ILF020","New","POS","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300029-00","POS HSA 6000 OSF Bronze","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_HSA_6000_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_HSA_6000_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310129","POS 6500 Methodist Silver","20129IL031","7740283974","ILN002","ILS002","ILF011","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310129-00","POS 6500 Methodist Silver","Standard Silver Off Exchange Plan",,"0.715367003195067","No","Yes","No","100%",,"$3,400","$300","$0","$60","$2,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$19,000","$19000 per person","$38000 per group","$26,350","$26350 per person","$52700 per group","$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_6500_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_6500_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310121","POS 5000 Elite Silver","20129IL031","7740283974","ILN001","ILS001","ILF011","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310121-00","POS 5000 Elite Silver","Standard Silver Off Exchange Plan",,"0.706975349515835","No","Yes","No","100%",,"$5,000","$30","$1,500","$60","$2,300","$1,200","$0","$0","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$20,000","$20000 per person","$40000 per group","$27,350","$27350 per person","$54700 per group","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_5000_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_5000_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310121","POS 5000 Elite Silver","20129IL031","7740283974","ILN001","ILS001","ILF011","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310121-01","POS 5000 Elite Silver","Standard Silver On Exchange Plan",,"0.706975349515835","No","Yes","No","100%",,"$5,000","$30","$1,500","$60","$2,300","$1,200","$0","$0","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$20,000","$20000 per person","$40000 per group","$27,350","$27350 per person","$54700 per group","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_5000_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_5000_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340041","POS 3750c OSF Bronze","20129IL034","7740283974","ILN001","ILS002","ILF015","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340041-01","POS 3750c OSF Bronze","Standard Bronze On Exchange Plan",,"0.615128431687168","Yes","Yes","No","100%",,"$3,750","$0","$2,913","$60","$3,750","$20","$1,500","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","45.00%",,,,,"$7,500","$7500 per person","$15000 per group","$11,250","$11250 per person","$22500 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3750C_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3750C_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340041","POS 3750c OSF Bronze","20129IL034","7740283974","ILN001","ILS002","ILF015","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340041-02","POS 3750c OSF Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3750C_OSF_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3750C_OSF_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340041","POS 3750c OSF Bronze","20129IL034","7740283974","ILN001","ILS002","ILF015","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340041-03","POS 3750c OSF Bronze","Limited Cost Sharing Plan Variation",,"0.615128431687168","Yes","Yes","No","100%",,"$3,750","$0","$2,913","$60","$3,750","$20","$1,500","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","45.00%",,,,,"$7,500","$7500 per person","$15000 per group","$11,250","$11250 per person","$22500 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3750C_OSF_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3750C_OSF_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340042","POS 5000a OSF Bronze","20129IL034","7740283974","ILN001","ILS002","ILF016","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340042-00","POS 5000a OSF Bronze","Standard Bronze Off Exchange Plan",,"0.611109570881387","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$60","$5,000","$20","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20.00%",,,,,"$12,700","$12700 per person","$25400 per group","$17,700","$17700 per person","$38100 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_5000A_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_5000A_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310123","POS 5000 Methodist Silver","20129IL031","7740283974","ILN002","ILS002","ILF011","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Benefits Available","Yes","Out of Network Benefits Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310123-00","POS 5000 Methodist Silver","Standard Silver Off Exchange Plan",,"0.706975349515835","No","Yes","No","100%",,"$5,000","$30","$1,500","$60","$2,300","$1,200","$0","$0","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$20,000","$20000 per person","$40000 per group","$27,350","$27350 per person","$54700 per group","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_5000_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_5000_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310123","POS 5000 Methodist Silver","20129IL031","7740283974","ILN002","ILS002","ILF011","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Benefits Available","Yes","Out of Network Benefits Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310123-01","POS 5000 Methodist Silver","Standard Silver On Exchange Plan",,"0.706975349515835","No","Yes","No","100%",,"$5,000","$30","$1,500","$60","$2,300","$1,200","$0","$0","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$20,000","$20000 per person","$40000 per group","$27,350","$27350 per person","$54700 per group","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_5000_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_5000_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340042","POS 5000a OSF Bronze","20129IL034","7740283974","ILN001","ILS002","ILF016","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340042-01","POS 5000a OSF Bronze","Standard Bronze On Exchange Plan",,"0.611109570881387","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$60","$5,000","$20","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20.00%",,,,,"$12,700","$12700 per person","$25400 per group","$17,700","$17700 per person","$38100 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_5000A_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_5000A_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340042","POS 5000a OSF Bronze","20129IL034","7740283974","ILN001","ILS002","ILF016","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340042-02","POS 5000a OSF Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_5000A_OSF_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_5000A_OSF_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340042","POS 5000a OSF Bronze","20129IL034","7740283974","ILN001","ILS002","ILF016","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340042-03","POS 5000a OSF Bronze","Limited Cost Sharing Plan Variation",,"0.611109570881387","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$60","$5,000","$20","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$42900 per group","$21,450","$21450 per person","$57200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20.00%",,,,,"$12,700","$12700 per person","$25400 per group","$17,700","$17700 per person","$38100 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_5000A_OSF_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_5000A_OSF_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300028","POS HSA 6000 Methodist Bronze","20129IL030","7740283974","ILN002","ILS002","ILF020","New","POS","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300028-00","POS HSA 6000 Methodist Bronze","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_HSA_6000_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_HSA_6000_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310125","POS 5000 OSF Silver","20129IL031","7740283974","ILN001","ILS002","ILF011","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310125-00","POS 5000 OSF Silver","Standard Silver Off Exchange Plan",,"0.706975349515835","No","Yes","No","100%",,"$5,000","$30","$1,500","$60","$2,300","$1,200","$0","$0","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$20,000","$20000 per person","$40000 per group","$27,350","$27350 per person","$54700 per group","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_5000_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_5000_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310125","POS 5000 OSF Silver","20129IL031","7740283974","ILN001","ILS002","ILF011","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310125-01","POS 5000 OSF Silver","Standard Silver On Exchange Plan",,"0.706975349515835","No","Yes","No","100%",,"$5,000","$30","$1,500","$60","$2,300","$1,200","$0","$0","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$20,000","$20000 per person","$40000 per group","$27,350","$27350 per person","$54700 per group","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_5000_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_5000_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300028","POS HSA 6000 Methodist Bronze","20129IL030","7740283974","ILN002","ILS002","ILF020","New","POS","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300028-01","POS HSA 6000 Methodist Bronze","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_HSA_6000_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_HSA_6000_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300028","POS HSA 6000 Methodist Bronze","20129IL030","7740283974","ILN002","ILS002","ILF020","New","POS","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300028-02","POS HSA 6000 Methodist Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_HSA_6000_METHODIST_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_HSA_6000_METHODIST_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300028","POS HSA 6000 Methodist Bronze","20129IL030","7740283974","ILN002","ILS002","ILF020","New","POS","Expanded Bronze","Design 3","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300028-03","POS HSA 6000 Methodist Bronze","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_HSA_6000_METHODIST_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_HSA_6000_METHODIST_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310129","POS 6500 Methodist Silver","20129IL031","7740283974","ILN002","ILS002","ILF011","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310129-01","POS 6500 Methodist Silver","Standard Silver On Exchange Plan",,"0.715367003195067","No","Yes","No","100%",,"$3,400","$300","$0","$60","$2,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$19,000","$19000 per person","$38000 per group","$26,350","$26350 per person","$52700 per group","$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_6500_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_6500_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340049","POS 6650a Methodist Bronze","20129IL034","7740283974","ILN002","ILS002","ILF018","New","POS","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340049-01","POS 6650a Methodist Bronze","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,800","$700","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6650A_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6650A_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340049","POS 6650a Methodist Bronze","20129IL034","7740283974","ILN002","ILS002","ILF018","New","POS","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340049-02","POS 6650a Methodist Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6650A_METHODIST_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6650A_METHODIST_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340049","POS 6650a Methodist Bronze","20129IL034","7740283974","ILN002","ILS002","ILF018","New","POS","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340049-03","POS 6650a Methodist Bronze","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,800","$700","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6650A_METHODIST_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6650A_METHODIST_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280049","POS HSA 2000 Elite Gold","20129IL028","7740283974","ILN001","ILS001","ILF013","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280049-00","POS HSA 2000 Elite Gold","Standard Gold Off Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$60","$2,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"$4,000","per person not applicable","$8000 per group","$6,000","per person not applicable","$12000 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_HSA_2000_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_HSA_2000_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280049","POS HSA 2000 Elite Gold","20129IL028","7740283974","ILN001","ILS001","ILF013","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280049-01","POS HSA 2000 Elite Gold","Standard Gold On Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$60","$2,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"$4,000","per person not applicable","$8000 per group","$6,000","per person not applicable","$12000 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_HSA_2000_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_HSA_2000_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300032","POS HSA 6550 OSF Bronze","20129IL030","7740283974","ILN001","ILS002","ILF020","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300032-02","POS HSA 6550 OSF Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_HSA_6550_OSF_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_HSA_6550_OSF_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300032","POS HSA 6550 OSF Bronze","20129IL030","7740283974","ILN001","ILS002","ILF020","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300032-03","POS HSA 6550 OSF Bronze","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","$22,925","$22925 per person","$45850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_HSA_6550_OSF_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_HSA_6550_OSF_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330015","HMO 5000c Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF007","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330015-00","HMO 5000c Elite Silver","Standard Silver Off Exchange Plan",,"0.717400452952087","No","Yes","No","100%",,"$5,000","$0","$784","$60","$1,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_5000C_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_5000C_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280052","POS HSA 2000 Methodist Gold","20129IL028","7740283974","ILN002","ILS002","ILF013","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280052-00","POS HSA 2000 Methodist Gold","Standard Gold Off Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$60","$2,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"$4,000","per person not applicable","$8000 per group","$6,000","per person not applicable","$12000 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_HSA_2000_METHODIST_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_HSA_2000_METHODIST_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340050","POS 6650a OSF Bronze","20129IL034","7740283974","ILN001","ILS002","ILF018","New","POS","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340050-00","POS 6650a OSF Bronze","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,800","$700","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_6650A_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_6650A_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310131","POS 6500 OSF Silver","20129IL031","7740283974","ILN001","ILS002","ILF011","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310131-00","POS 6500 OSF Silver","Standard Silver Off Exchange Plan",,"0.715367003195067","No","Yes","No","100%",,"$3,400","$300","$0","$60","$2,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$19,000","$19000 per person","$38000 per group","$26,350","$26350 per person","$52700 per group","$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_6500_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_6500_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0310131","POS 6500 OSF Silver","20129IL031","7740283974","ILN001","ILS002","ILF011","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0310131-01","POS 6500 OSF Silver","Standard Silver On Exchange Plan",,"0.715367003195067","No","Yes","No","100%",,"$3,400","$300","$0","$60","$2,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$19,000","$19000 per person","$38000 per group","$26,350","$26350 per person","$52700 per group","$6,500","$6500 per person","$13000 per group","0.00%",,,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_6500_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_6500_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340050","POS 6650a OSF Bronze","20129IL034","7740283974","ILN001","ILS002","ILF018","New","POS","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340050-01","POS 6650a OSF Bronze","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,800","$700","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6650A_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6650A_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340050","POS 6650a OSF Bronze","20129IL034","7740283974","ILN001","ILS002","ILF018","New","POS","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340050-02","POS 6650a OSF Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6650A_OSF_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6650A_OSF_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340050","POS 6650a OSF Bronze","20129IL034","7740283974","ILN001","ILS002","ILF018","New","POS","Expanded Bronze","Design 1","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340050-03","POS 6650a OSF Bronze","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,800","$700","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6650A_OSF_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6650A_OSF_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300032","POS HSA 6550 OSF Bronze","20129IL030","7740283974","ILN001","ILS002","ILF020","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300032-01","POS HSA 6550 OSF Bronze","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","$22,925","$22925 per person","$45850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_HSA_6550_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_HSA_6550_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330059","HMO 3500a Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330059-01","HMO 3500a Methodist Silver","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$30","$1,800","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3500A_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3500A_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330059","HMO 3500a Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330059-02","HMO 3500a Methodist Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3500A_METHODIST_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3500A_METHODIST_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330059","HMO 3500a Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330059-03","HMO 3500a Methodist Silver","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$30","$1,800","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3500A_METHODIST_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3500A_METHODIST_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330059","HMO 3500a Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330059-04","HMO 3500a Methodist Silver","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$30","$1,900","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3500A_METHODIST_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3500A_METHODIST_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330057","HMO 3100 Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330057-01","HMO 3100 Methodist Silver","Standard Silver On Exchange Plan",,"0.719233110825319","No","Yes","No","100%",,"$3,100","$30","$2,800","$60","$2,200","$1,100","$0","$60","$300","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3100_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3100_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300030","POS HSA 6550 Elite Bronze","20129IL030","7740283974","ILN001","ILS004","ILF020","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300030-00","POS HSA 6550 Elite Bronze","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$22,925","$22925 per person","$45850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_HSA_6550_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_HSA_6550_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0350035","PPO 3500 Elite Gold","20129IL035","7740283974","ILN001","ILS001","ILF010","New","PPO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0350035-00","PPO 3500 Elite Gold","Standard Gold Off Exchange Plan",,"0.79497705205282","No","Yes","No","100%",,"$3,500","$30","$0","$60","$2,200","$1,000","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$13,000","$13000 per person","$26000 per group","$18,000","$18000 per person","$36000 per group","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_PPO_3500_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_PPO_3500_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0350035","PPO 3500 Elite Gold","20129IL035","7740283974","ILN001","ILS001","ILF010","New","PPO","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0350035-01","PPO 3500 Elite Gold","Standard Gold On Exchange Plan",,"0.79497705205282","No","Yes","No","100%",,"$3,500","$30","$0","$60","$2,200","$1,000","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$13,000","$13000 per person","$26000 per group","$18,000","$18000 per person","$36000 per group","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_PPO_3500_ELITE_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_PPO_3500_ELITE_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300030","POS HSA 6550 Elite Bronze","20129IL030","7740283974","ILN001","ILS004","ILF020","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300030-01","POS HSA 6550 Elite Bronze","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$22,925","$22925 per person","$45850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_HSA_6550_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_HSA_6550_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300030","POS HSA 6550 Elite Bronze","20129IL030","7740283974","ILN001","ILS004","ILF020","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300030-02","POS HSA 6550 Elite Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_HSA_6550_ELITE_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_HSA_6550_ELITE_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300030","POS HSA 6550 Elite Bronze","20129IL030","7740283974","ILN001","ILS004","ILF020","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300030-03","POS HSA 6550 Elite Bronze","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$22,925","$22925 per person","$45850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_HSA_6550_ELITE_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_HSA_6550_ELITE_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300031","POS HSA 6550 Methodist Bronze","20129IL030","7740283974","ILN002","ILS002","ILF020","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300031-00","POS HSA 6550 Methodist Bronze","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","$22,925","$22925 per person","$45850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_HSA_6550_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_HSA_6550_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0350033","PPO 3250 Elite Silver","20129IL035","7740283974","ILN001","ILS003","ILF011","New","PPO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0350033-00","PPO 3250 Elite Silver","Standard Silver Off Exchange Plan",,"0.719566380826397","No","Yes","No","100%",,"$1,000","$500","$3,000","$60","$2,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$16,500","$16500 per person","$33000 per group","$23,850","$23850 per person","$47700 per group","$3,250","$3250 per person","$6500 per group","30.00%",,,,,"$6,500","$6500 per person","$13000 per group","$9,750","$9750 per person","$19500 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_PPO_3250_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_PPO_3250_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0350033","PPO 3250 Elite Silver","20129IL035","7740283974","ILN001","ILS003","ILF011","New","PPO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0350033-01","PPO 3250 Elite Silver","Standard Silver On Exchange Plan",,"0.719566380826397","No","Yes","No","100%",,"$1,000","$500","$3,000","$60","$2,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$16,500","$16500 per person","$33000 per group","$23,850","$23850 per person","$47700 per group","$3,250","$3250 per person","$6500 per group","30.00%",,,,,"$6,500","$6500 per person","$13000 per group","$9,750","$9750 per person","$19500 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_PPO_3250_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_PPO_3250_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300031","POS HSA 6550 Methodist Bronze","20129IL030","7740283974","ILN002","ILS002","ILF020","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300031-01","POS HSA 6550 Methodist Bronze","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","$22,925","$22925 per person","$45850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_HSA_6550_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_HSA_6550_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300031","POS HSA 6550 Methodist Bronze","20129IL030","7740283974","ILN002","ILS002","ILF020","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300031-02","POS HSA 6550 Methodist Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_HSA_6550_METHODIST_BRONZE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_HSA_6550_METHODIST_BRONZE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300031","POS HSA 6550 Methodist Bronze","20129IL030","7740283974","ILN002","ILS002","ILF020","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300031-03","POS HSA 6550 Methodist Bronze","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","$22,925","$22925 per person","$45850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_HSA_6550_METHODIST_BRONZE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_HSA_6550_METHODIST_BRONZE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0300032","POS HSA 6550 OSF Bronze","20129IL030","7740283974","ILN001","ILS002","ILF020","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0300032-00","POS HSA 6550 OSF Bronze","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","$22,925","$22925 per person","$45850 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_HSA_6550_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_HSA_6550_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280052","POS HSA 2000 Methodist Gold","20129IL028","7740283974","ILN002","ILS002","ILF013","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280052-01","POS HSA 2000 Methodist Gold","Standard Gold On Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$60","$2,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"$4,000","per person not applicable","$8000 per group","$6,000","per person not applicable","$12000 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_HSA_2000_METHODIST_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_HSA_2000_METHODIST_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330015","HMO 5000c Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF007","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330015-01","HMO 5000c Elite Silver","Standard Silver On Exchange Plan",,"0.717400452952087","No","Yes","No","100%",,"$5,000","$0","$784","$60","$1,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_5000C_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_5000C_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330015","HMO 5000c Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF007","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330015-02","HMO 5000c Elite Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_5000C_ELITE_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_5000C_ELITE_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330015","HMO 5000c Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF007","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330015-03","HMO 5000c Elite Silver","Limited Cost Sharing Plan Variation",,"0.717400452952087","No","Yes","No","100%",,"$5,000","$0","$784","$60","$1,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_5000C_ELITE_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_5000C_ELITE_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330015","HMO 5000c Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF007","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330015-04","HMO 5000c Elite Silver","73% AV Level Silver Plan",,"0.737720862726305","No","Yes","No","100%",,"$4,000","$0","$1,034","$60","$1,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_5000C_ELITE_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_5000C_ELITE_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330015","HMO 5000c Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF007","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330015-05","HMO 5000c Elite Silver","87% AV Level Silver Plan",,"0.879605018216582","No","Yes","No","100%",,"$450","$30","$1,200","$60","$450","$1,300","$70","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_5000C_ELITE_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_5000C_ELITE_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330015","HMO 5000c Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF007","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330015-06","HMO 5000c Elite Silver","94% AV Level Silver Plan",,"0.94702564047848","No","Yes","No","100%",,"$0","$30","$200","$60","$0","$1,200","$20","$60","$0","$30","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","2.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_5000C_ELITE_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_5000C_ELITE_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290014","HMO HSA 3250 Elite Silver","20129IL029","7740283974","ILN001","ILS004","ILF011","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290014-00","HMO HSA 3250 Elite Silver","Standard Silver Off Exchange Plan",,"0.688503485139974","Yes","Yes","No","100%",,"$3,250","$0","$1,800","$60","$3,250","$0","$800","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_HSA_3250_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_HSA_3250_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280054","POS HSA 2000 OSF Gold","20129IL028","7740283974","ILN001","ILS002","ILF013","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280054-00","POS HSA 2000 OSF Gold","Standard Gold Off Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$60","$2,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"$4,000","per person not applicable","$8000 per group","$6,000","per person not applicable","$12000 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_POS_HSA_2000_OSF_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_POS_HSA_2000_OSF_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280054","POS HSA 2000 OSF Gold","20129IL028","7740283974","ILN001","ILS002","ILF013","New","POS","Gold","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280054-01","POS HSA 2000 OSF Gold","Standard Gold On Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$60","$2,000","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"$4,000","per person not applicable","$8000 per group","$6,000","per person not applicable","$12000 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_HSA_2000_OSF_GOLD.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_HSA_2000_OSF_GOLD.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290014","HMO HSA 3250 Elite Silver","20129IL029","7740283974","ILN001","ILS004","ILF011","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290014-01","HMO HSA 3250 Elite Silver","Standard Silver On Exchange Plan",,"0.688503485139974","Yes","Yes","No","100%",,"$3,250","$0","$1,800","$60","$3,250","$0","$800","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_3250_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_3250_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290014","HMO HSA 3250 Elite Silver","20129IL029","7740283974","ILN001","ILS004","ILF011","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290014-02","HMO HSA 3250 Elite Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_3250_ELITE_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_3250_ELITE_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290014","HMO HSA 3250 Elite Silver","20129IL029","7740283974","ILN001","ILS004","ILF011","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290014-03","HMO HSA 3250 Elite Silver","Limited Cost Sharing Plan Variation",,"0.688503485139974","Yes","Yes","No","100%",,"$3,250","$0","$1,800","$60","$3,250","$0","$800","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_3250_ELITE_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_3250_ELITE_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290014","HMO HSA 3250 Elite Silver","20129IL029","7740283974","ILN001","ILS004","ILF011","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290014-04","HMO HSA 3250 Elite Silver","73% AV Level Silver Plan",,"0.723884568341668","Yes","Yes","No","100%",,"$3,250","$0","$300","$60","$3,250","$0","$300","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_3250_ELITE_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_3250_ELITE_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290014","HMO HSA 3250 Elite Silver","20129IL029","7740283974","ILN001","ILS004","ILF011","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290014-05","HMO HSA 3250 Elite Silver","87% AV Level Silver Plan",,"0.869761452528119","Yes","Yes","No","100%",,"$500","$0","$1,300","$60","$500","$20","$1,200","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_3250_ELITE_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_3250_ELITE_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290014","HMO HSA 3250 Elite Silver","20129IL029","7740283974","ILN001","ILS004","ILF011","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290014-06","HMO HSA 3250 Elite Silver","94% AV Level Silver Plan",,"0.942923840446537","Yes","Yes","No","100%",,"$0","$0","$1,200","$60","$0","$20","$700","$60","$0","$0","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_3250_ELITE_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_3250_ELITE_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330054","HMO 3500a Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330054-00","HMO 3500a Elite Silver","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$30","$1,800","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_3500A_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_3500A_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0270042","HMO HSA 1350 Elite Silver","20129IL027","7740283974","ILN001","ILS001","ILF008","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0270042-00","HMO HSA 1350 Elite Silver","Standard Silver Off Exchange Plan",,"0.718645760902802","Yes","Yes","No","100%",,"$1,350","$0","$3,400","$60","$1,350","$100","$1,700","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_HMO_HSA_1350_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_HMO_HSA_1350_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0270042","HMO HSA 1350 Elite Silver","20129IL027","7740283974","ILN001","ILS001","ILF008","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0270042-01","HMO HSA 1350 Elite Silver","Standard Silver On Exchange Plan",,"0.718645760902802","Yes","Yes","No","100%",,"$1,350","$0","$3,400","$60","$1,350","$100","$1,700","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_HSA_1350_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_HSA_1350_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330054","HMO 3500a Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330054-01","HMO 3500a Elite Silver","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$30","$1,800","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3500A_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3500A_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330054","HMO 3500a Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330054-02","HMO 3500a Elite Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3500A_ELITE_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3500A_ELITE_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330054","HMO 3500a Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330054-03","HMO 3500a Elite Silver","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$30","$1,800","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3500A_ELITE_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3500A_ELITE_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330054","HMO 3500a Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330054-04","HMO 3500a Elite Silver","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$30","$1,900","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3500A_ELITE_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3500A_ELITE_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330054","HMO 3500a Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330054-05","HMO 3500a Elite Silver","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,800","$60","$700","$800","$100","$60","$300","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3500A_ELITE_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3500A_ELITE_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330054","HMO 3500a Elite Silver","20129IL033","7740283974","ILN001","ILS004","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330054-06","HMO 3500a Elite Silver","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$10","$600","$60","$250","$200","$50","$60","$250","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3500A_ELITE_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3500A_ELITE_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330059","HMO 3500a Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330059-00","HMO 3500a Methodist Silver","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$30","$1,800","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_3500A_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_3500A_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0270044","HMO HSA 1350 Methodist Silver","20129IL027","7740283974","ILN002","ILS002","ILF008","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0270044-00","HMO HSA 1350 Methodist Silver","Standard Silver Off Exchange Plan",,"0.718645760902802","Yes","Yes","No","100%",,"$1,350","$0","$3,400","$60","$1,350","$100","$1,700","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_HMO_HSA_1350_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_HMO_HSA_1350_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0270044","HMO HSA 1350 Methodist Silver","20129IL027","7740283974","ILN002","ILS002","ILF008","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0270044-01","HMO HSA 1350 Methodist Silver","Standard Silver On Exchange Plan",,"0.718645760902802","Yes","Yes","No","100%",,"$1,350","$0","$3,400","$60","$1,350","$100","$1,700","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_HSA_1350_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_HSA_1350_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330059","HMO 3500a Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330059-05","HMO 3500a Methodist Silver","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,800","$60","$700","$800","$100","$60","$300","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3500A_METHODIST_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3500A_METHODIST_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330059","HMO 3500a Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330059-06","HMO 3500a Methodist Silver","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$10","$600","$60","$250","$200","$50","$60","$250","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3500A_METHODIST_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3500A_METHODIST_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330060","HMO 3500a OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330060-00","HMO 3500a OSF Silver","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$30","$1,800","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_3500A_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_3500A_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0270046","HMO HSA 1350 OSF Silver","20129IL027","7740283974","ILN001","ILS002","ILF008","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0270046-00","HMO HSA 1350 OSF Silver","Standard Silver Off Exchange Plan",,"0.718645760902802","Yes","Yes","No","100%",,"$1,350","$0","$3,400","$60","$1,350","$100","$1,700","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_HMO_HSA_1350_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_HMO_HSA_1350_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0270046","HMO HSA 1350 OSF Silver","20129IL027","7740283974","ILN001","ILS002","ILF008","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0270046-01","HMO HSA 1350 OSF Silver","Standard Silver On Exchange Plan",,"0.718645760902802","Yes","Yes","No","100%",,"$1,350","$0","$3,400","$60","$1,350","$100","$1,700","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_HSA_1350_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_HSA_1350_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330060","HMO 3500a OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330060-01","HMO 3500a OSF Silver","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$30","$1,800","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3500A_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3500A_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330060","HMO 3500a OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330060-02","HMO 3500a OSF Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3500A_OSF_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3500A_OSF_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330060","HMO 3500a OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330060-03","HMO 3500a OSF Silver","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$30","$1,800","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3500A_OSF_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3500A_OSF_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330060","HMO 3500a OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330060-04","HMO 3500a OSF Silver","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$30","$1,900","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3500A_OSF_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3500A_OSF_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330060","HMO 3500a OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330060-05","HMO 3500a OSF Silver","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,800","$60","$700","$800","$100","$60","$300","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3500A_OSF_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3500A_OSF_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330060","HMO 3500a OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF002","New","HMO","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330060-06","HMO 3500a OSF Silver","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$10","$600","$60","$250","$200","$50","$60","$250","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3500A_OSF_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3500A_OSF_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290019","HMO HSA 3250 Methodist Silver","20129IL029","7740283974","ILN002","ILS002","ILF011","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290019-00","HMO HSA 3250 Methodist Silver","Standard Silver Off Exchange Plan",,"0.688503485139974","Yes","Yes","No","100%",,"$3,250","$0","$1,800","$60","$3,250","$0","$800","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_HSA_3250_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_HSA_3250_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0270048","HMO HSA 1900 Elite Silver","20129IL027","7740283974","ILN001","ILS001","ILF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0270048-00","HMO HSA 1900 Elite Silver","Standard Silver Off Exchange Plan",,"0.719512713496803","Yes","Yes","No","100%",,"$1,900","$0","$2,100","$60","$1,900","$0","$1,100","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","per person not applicable","$3800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_HMO_HSA_1900_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_HMO_HSA_1900_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0270048","HMO HSA 1900 Elite Silver","20129IL027","7740283974","ILN001","ILS001","ILF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0270048-01","HMO HSA 1900 Elite Silver","Standard Silver On Exchange Plan",,"0.719512713496803","Yes","Yes","No","100%",,"$1,900","$0","$2,100","$60","$1,900","$0","$1,100","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","per person not applicable","$3800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_HSA_1900_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_HSA_1900_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290019","HMO HSA 3250 Methodist Silver","20129IL029","7740283974","ILN002","ILS002","ILF011","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290019-01","HMO HSA 3250 Methodist Silver","Standard Silver On Exchange Plan",,"0.688503485139974","Yes","Yes","No","100%",,"$3,250","$0","$1,800","$60","$3,250","$0","$800","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_3250_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_3250_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290019","HMO HSA 3250 Methodist Silver","20129IL029","7740283974","ILN002","ILS002","ILF011","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290019-02","HMO HSA 3250 Methodist Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_3250_METHODIST_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_3250_METHODIST_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290019","HMO HSA 3250 Methodist Silver","20129IL029","7740283974","ILN002","ILS002","ILF011","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290019-03","HMO HSA 3250 Methodist Silver","Limited Cost Sharing Plan Variation",,"0.688503485139974","Yes","Yes","No","100%",,"$3,250","$0","$1,800","$60","$3,250","$0","$800","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_3250_METHODIST_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_3250_METHODIST_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290019","HMO HSA 3250 Methodist Silver","20129IL029","7740283974","ILN002","ILS002","ILF011","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290019-04","HMO HSA 3250 Methodist Silver","73% AV Level Silver Plan",,"0.723884568341668","Yes","Yes","No","100%",,"$3,250","$0","$300","$60","$3,250","$0","$300","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_3250_METHODIST_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_3250_METHODIST_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290019","HMO HSA 3250 Methodist Silver","20129IL029","7740283974","ILN002","ILS002","ILF011","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290019-05","HMO HSA 3250 Methodist Silver","87% AV Level Silver Plan",,"0.869761452528119","Yes","Yes","No","100%",,"$500","$0","$1,300","$60","$500","$20","$1,200","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_3250_METHODIST_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_3250_METHODIST_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290019","HMO HSA 3250 Methodist Silver","20129IL029","7740283974","ILN002","ILS002","ILF011","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290019-06","HMO HSA 3250 Methodist Silver","94% AV Level Silver Plan",,"0.942923840446537","Yes","Yes","No","100%",,"$0","$0","$1,200","$60","$0","$20","$700","$60","$0","$0","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_3250_METHODIST_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_3250_METHODIST_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290020","HMO HSA 3250 OSF Silver","20129IL029","7740283974","ILN001","ILS002","ILF011","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290020-00","HMO HSA 3250 OSF Silver","Standard Silver Off Exchange Plan",,"0.688503485139974","Yes","Yes","No","100%",,"$3,250","$0","$1,800","$60","$3,250","$0","$800","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_HSA_3250_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_HSA_3250_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280055","POS HSA 2700 Elite Silver","20129IL028","7740283974","ILN001","ILS001","ILF004","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280055-00","POS HSA 2700 Elite Silver","Standard Silver Off Exchange Plan",,"0.686089904738914","Yes","Yes","No","100%",,"$2,700","$0","$1,900","$60","$2,700","$20","$900","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$15,400","$15400 per person","$30800 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$8100 per person","$16200 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_POS_HSA_2700_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_POS_HSA_2700_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280055","POS HSA 2700 Elite Silver","20129IL028","7740283974","ILN001","ILS001","ILF004","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280055-01","POS HSA 2700 Elite Silver","Standard Silver On Exchange Plan",,"0.686089904738914","Yes","Yes","No","100%",,"$2,700","$0","$1,900","$60","$2,700","$20","$900","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$15,400","$15400 per person","$30800 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$8100 per person","$16200 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_HSA_2700_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_HSA_2700_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290020","HMO HSA 3250 OSF Silver","20129IL029","7740283974","ILN001","ILS002","ILF011","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290020-01","HMO HSA 3250 OSF Silver","Standard Silver On Exchange Plan",,"0.688503485139974","Yes","Yes","No","100%",,"$3,250","$0","$1,800","$60","$3,250","$0","$800","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_3250_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_3250_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290020","HMO HSA 3250 OSF Silver","20129IL029","7740283974","ILN001","ILS002","ILF011","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290020-02","HMO HSA 3250 OSF Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_3250_OSF_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_3250_OSF_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290020","HMO HSA 3250 OSF Silver","20129IL029","7740283974","ILN001","ILS002","ILF011","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290020-03","HMO HSA 3250 OSF Silver","Limited Cost Sharing Plan Variation",,"0.688503485139974","Yes","Yes","No","100%",,"$3,250","$0","$1,800","$60","$3,250","$0","$800","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_3250_OSF_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_3250_OSF_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290020","HMO HSA 3250 OSF Silver","20129IL029","7740283974","ILN001","ILS002","ILF011","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290020-04","HMO HSA 3250 OSF Silver","73% AV Level Silver Plan",,"0.723884568341668","Yes","Yes","No","100%",,"$3,250","$0","$300","$60","$3,250","$0","$300","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_3250_OSF_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_3250_OSF_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290020","HMO HSA 3250 OSF Silver","20129IL029","7740283974","ILN001","ILS002","ILF011","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290020-05","HMO HSA 3250 OSF Silver","87% AV Level Silver Plan",,"0.869761452528119","Yes","Yes","No","100%",,"$500","$0","$1,300","$60","$500","$20","$1,200","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_3250_OSF_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_3250_OSF_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0290020","HMO HSA 3250 OSF Silver","20129IL029","7740283974","ILN001","ILS002","ILF011","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0290020-06","HMO HSA 3250 OSF Silver","94% AV Level Silver Plan",,"0.942923840446537","Yes","Yes","No","100%",,"$0","$0","$1,200","$60","$0","$20","$700","$60","$0","$0","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_HSA_3250_OSF_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_HSA_3250_OSF_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330057","HMO 3100 Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330057-00","HMO 3100 Methodist Silver","Standard Silver Off Exchange Plan",,"0.719233110825319","No","Yes","No","100%",,"$3,100","$30","$2,800","$60","$2,200","$1,100","$0","$60","$300","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_3100_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_3100_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280057","POS HSA 2700 Methodist Silver","20129IL028","7740283974","ILN002","ILS002","ILF004","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No",,"0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280057-00","POS HSA 2700 Methodist Silver","Standard Silver Off Exchange Plan",,"0.686089904738914","Yes","Yes","No","100%",,"$2,700","$0","$1,900","$60","$2,700","$20","$900","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$15,400","$15400 per person","$30800 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$8100 per person","$16200 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_POS_HSA_2700_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_POS_HSA_2700_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280057","POS HSA 2700 Methodist Silver","20129IL028","7740283974","ILN002","ILS002","ILF004","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No",,"0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280057-01","POS HSA 2700 Methodist Silver","Standard Silver On Exchange Plan",,"0.686089904738914","Yes","Yes","No","100%",,"$2,700","$0","$1,900","$60","$2,700","$20","$900","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$15,400","$15400 per person","$30800 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$8100 per person","$16200 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_HSA_2700_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_HSA_2700_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330057","HMO 3100 Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330057-02","HMO 3100 Methodist Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3100_METHODIST_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3100_METHODIST_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330057","HMO 3100 Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330057-03","HMO 3100 Methodist Silver","Limited Cost Sharing Plan Variation",,"0.719233110825319","No","Yes","No","100%",,"$3,100","$30","$2,800","$60","$2,200","$1,100","$0","$60","$300","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3100_METHODIST_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3100_METHODIST_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330057","HMO 3100 Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330057-04","HMO 3100 Methodist Silver","73% AV Level Silver Plan",,"0.739507085147661","No","Yes","No","100%",,"$3,100","$30","$2,800","$60","$2,200","$1,100","$0","$60","$300","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3100_METHODIST_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3100_METHODIST_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280065","POS HSA 3600 OSF Silver","20129IL028","7740283974","ILN001","ILS002","ILF013","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280065-01","POS HSA 3600 OSF Silver","Standard Silver On Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,600","$0","$0","$60","$3,600","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$13,200","$13200 per person","$26400 per group","$16,800","$16800 per person","$33600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_HSA_3600_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_HSA_3600_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330057","HMO 3100 Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330057-05","HMO 3100 Methodist Silver","87% AV Level Silver Plan",,"0.877439210785406","No","Yes","No","100%",,"$3,100","$30","$900","$60","$2,200","$1,000","$0","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3100_METHODIST_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3100_METHODIST_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330057","HMO 3100 Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330057-06","HMO 3100 Methodist Silver","94% AV Level Silver Plan",,"0.944845243227994","No","Yes","No","100%",,"$250","$30","$0","$60","$250","$500","$0","$60","$250","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","2.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3100_METHODIST_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3100_METHODIST_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330058","HMO 3100 OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330058-00","HMO 3100 OSF Silver","Standard Silver Off Exchange Plan",,"0.719233110825319","No","Yes","No","100%",,"$3,100","$30","$2,800","$60","$2,200","$1,100","$0","$60","$300","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_3100_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_3100_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330070","HMO 4000b OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330070-04","HMO 4000b OSF Silver","73% AV Level Silver Plan",,"0.736436203183915","No","Yes","No","100%",,"$2,400","$1,200","$0","$60","$1,100","$1,000","$0","$60","$200","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000B_OSF_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000B_OSF_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330070","HMO 4000b OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330070-05","HMO 4000b OSF Silver","87% AV Level Silver Plan",,"0.87906917337977","No","Yes","No","100%",,"$200","$600","$40","$60","$200","$1,000","$20","$60","$200","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","2.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000B_OSF_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000B_OSF_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280059","POS HSA 2700 OSF Silver","20129IL028","7740283974","ILN001","ILS002","ILF004","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280059-00","POS HSA 2700 OSF Silver","Standard Silver Off Exchange Plan",,"0.686089904738914","Yes","Yes","No","100%",,"$2,700","$0","$1,900","$60","$2,700","$20","$900","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$15,400","$15400 per person","$30800 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$8100 per person","$16200 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_POS_HSA_2700_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_POS_HSA_2700_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280059","POS HSA 2700 OSF Silver","20129IL028","7740283974","ILN001","ILS002","ILF004","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280059-01","POS HSA 2700 OSF Silver","Standard Silver On Exchange Plan",,"0.686089904738914","Yes","Yes","No","100%",,"$2,700","$0","$1,900","$60","$2,700","$20","$900","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$15,400","$15400 per person","$30800 per group","$22,050","$22050 per person","$44100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$8100 per person","$16200 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_HSA_2700_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_HSA_2700_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330058","HMO 3100 OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330058-01","HMO 3100 OSF Silver","Standard Silver On Exchange Plan",,"0.719233110825319","No","Yes","No","100%",,"$3,100","$30","$2,800","$60","$2,200","$1,100","$0","$60","$300","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3100_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3100_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330058","HMO 3100 OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330058-02","HMO 3100 OSF Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3100_OSF_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3100_OSF_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330058","HMO 3100 OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330058-03","HMO 3100 OSF Silver","Limited Cost Sharing Plan Variation",,"0.719233110825319","No","Yes","No","100%",,"$3,100","$30","$2,800","$60","$2,200","$1,100","$0","$60","$300","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3100_OSF_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3100_OSF_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330058","HMO 3100 OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330058-04","HMO 3100 OSF Silver","73% AV Level Silver Plan",,"0.739507085147661","No","Yes","No","100%",,"$3,100","$30","$2,800","$60","$2,200","$1,100","$0","$60","$300","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3100_OSF_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3100_OSF_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330058","HMO 3100 OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330058-05","HMO 3100 OSF Silver","87% AV Level Silver Plan",,"0.877439210785406","No","Yes","No","100%",,"$3,100","$30","$900","$60","$2,200","$1,000","$0","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3100_OSF_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3100_OSF_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330058","HMO 3100 OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330058-06","HMO 3100 OSF Silver","94% AV Level Silver Plan",,"0.944845243227994","No","Yes","No","100%",,"$250","$30","$0","$60","$250","$500","$0","$60","$250","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$600 per group","2.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_3100_OSF_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_3100_OSF_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330069","HMO 4000b Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330069-00","HMO 4000b Methodist Silver","Standard Silver Off Exchange Plan",,"0.712523423704602","No","Yes","No","100%",,"$2,400","$1,200","$0","$60","$1,100","$1,000","$0","$60","$200","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_4000B_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_4000B_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280061","POS HSA 3600 Elite Silver","20129IL028","7740283974","ILN001","ILS001","ILF013","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280061-00","POS HSA 3600 Elite Silver","Standard Silver Off Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,600","$0","$0","$60","$3,600","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$13,200","$13200 per person","$26400 per group","$16,800","$16800 per person","$33600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_POS_HSA_3600_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_POS_HSA_3600_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280061","POS HSA 3600 Elite Silver","20129IL028","7740283974","ILN001","ILS001","ILF013","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280061-01","POS HSA 3600 Elite Silver","Standard Silver On Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,600","$0","$0","$60","$3,600","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$13,200","$13200 per person","$26400 per group","$16,800","$16800 per person","$33600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","No","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_HSA_3600_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_HSA_3600_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330069","HMO 4000b Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330069-01","HMO 4000b Methodist Silver","Standard Silver On Exchange Plan",,"0.712523423704602","No","Yes","No","100%",,"$2,400","$1,200","$0","$60","$1,100","$1,000","$0","$60","$200","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000B_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000B_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330069","HMO 4000b Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330069-02","HMO 4000b Methodist Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000B_METHODIST_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000B_METHODIST_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330069","HMO 4000b Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330069-03","HMO 4000b Methodist Silver","Limited Cost Sharing Plan Variation",,"0.712523423704602","No","Yes","No","100%",,"$2,400","$1,200","$0","$60","$1,100","$1,000","$0","$60","$200","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000B_METHODIST_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000B_METHODIST_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330069","HMO 4000b Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330069-04","HMO 4000b Methodist Silver","73% AV Level Silver Plan",,"0.736436203183915","No","Yes","No","100%",,"$2,400","$1,200","$0","$60","$1,100","$1,000","$0","$60","$200","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000B_METHODIST_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000B_METHODIST_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330069","HMO 4000b Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330069-05","HMO 4000b Methodist Silver","87% AV Level Silver Plan",,"0.87906917337977","No","Yes","No","100%",,"$200","$600","$40","$60","$200","$1,000","$20","$60","$200","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","2.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000B_METHODIST_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000B_METHODIST_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330069","HMO 4000b Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330069-06","HMO 4000b Methodist Silver","94% AV Level Silver Plan",,"0.932123027987302","No","Yes","No","100%",,"$0","$300","$50","$60","$0","$1,000","$20","$60","$0","$100","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","2.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000B_METHODIST_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000B_METHODIST_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330070","HMO 4000b OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330070-00","HMO 4000b OSF Silver","Standard Silver Off Exchange Plan",,"0.712523423704602","No","Yes","No","100%",,"$2,400","$1,200","$0","$60","$1,100","$1,000","$0","$60","$200","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_4000B_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_4000B_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280063","POS HSA 3600 Methodist Silver","20129IL028","7740283974","ILN002","ILS002","ILF013","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280063-00","POS HSA 3600 Methodist Silver","Standard Silver Off Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,600","$0","$0","$60","$3,600","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$13,200","$13200 per person","$26400 per group","$16,800","$16800 per person","$33600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_POS_HSA_3600_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_POS_HSA_3600_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280063","POS HSA 3600 Methodist Silver","20129IL028","7740283974","ILN002","ILS002","ILF013","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280063-01","POS HSA 3600 Methodist Silver","Standard Silver On Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,600","$0","$0","$60","$3,600","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$13,200","$13200 per person","$26400 per group","$16,800","$16800 per person","$33600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_HSA_3600_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_HSA_3600_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330070","HMO 4000b OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330070-01","HMO 4000b OSF Silver","Standard Silver On Exchange Plan",,"0.712523423704602","No","Yes","No","100%",,"$2,400","$1,200","$0","$60","$1,100","$1,000","$0","$60","$200","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000B_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000B_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330070","HMO 4000b OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330070-02","HMO 4000b OSF Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000B_OSF_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000B_OSF_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330070","HMO 4000b OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330070-03","HMO 4000b OSF Silver","Limited Cost Sharing Plan Variation",,"0.712523423704602","No","Yes","No","100%",,"$2,400","$1,200","$0","$60","$1,100","$1,000","$0","$60","$200","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000B_OSF_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000B_OSF_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330070","HMO 4000b OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF005","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330070-06","HMO 4000b OSF Silver","94% AV Level Silver Plan",,"0.932123027987302","No","Yes","No","100%",,"$0","$300","$50","$60","$0","$1,000","$20","$60","$0","$100","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","2.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_4000B_OSF_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_4000B_OSF_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330076","HMO 5000c Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330076-00","HMO 5000c Methodist Silver","Standard Silver Off Exchange Plan",,"0.717400452952087","No","Yes","No","100%",,"$5,000","$0","$784","$60","$1,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_5000C_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_5000C_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280065","POS HSA 3600 OSF Silver","20129IL028","7740283974","ILN001","ILS002","ILF013","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280065-00","POS HSA 3600 OSF Silver","Standard Silver Off Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,600","$0","$0","$60","$3,600","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$13,200","$13200 per person","$26400 per group","$16,800","$16800 per person","$33600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_POS_HSA_3600_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_POS_HSA_3600_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330076","HMO 5000c Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330076-01","HMO 5000c Methodist Silver","Standard Silver On Exchange Plan",,"0.717400452952087","No","Yes","No","100%",,"$5,000","$0","$784","$60","$1,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_5000C_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_5000C_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330076","HMO 5000c Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330076-02","HMO 5000c Methodist Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_5000C_METHODIST_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_5000C_METHODIST_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330076","HMO 5000c Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330076-03","HMO 5000c Methodist Silver","Limited Cost Sharing Plan Variation",,"0.717400452952087","No","Yes","No","100%",,"$5,000","$0","$784","$60","$1,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_5000C_METHODIST_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_5000C_METHODIST_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330076","HMO 5000c Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330076-04","HMO 5000c Methodist Silver","73% AV Level Silver Plan",,"0.737720862726305","No","Yes","No","100%",,"$4,000","$0","$1,034","$60","$1,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_5000C_METHODIST_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_5000C_METHODIST_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330076","HMO 5000c Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330076-05","HMO 5000c Methodist Silver","87% AV Level Silver Plan",,"0.879605018216582","No","Yes","No","100%",,"$450","$30","$1,200","$60","$450","$1,300","$70","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_5000C_METHODIST_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_5000C_METHODIST_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330076","HMO 5000c Methodist Silver","20129IL033","7740283974","ILN002","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330076-06","HMO 5000c Methodist Silver","94% AV Level Silver Plan",,"0.94702564047848","No","Yes","No","100%",,"$0","$30","$200","$60","$0","$1,200","$20","$60","$0","$30","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","2.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_5000C_METHODIST_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_5000C_METHODIST_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330077","HMO 5000c OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330077-00","HMO 5000c OSF Silver","Standard Silver Off Exchange Plan",,"0.717400452952087","No","Yes","No","100%",,"$5,000","$0","$784","$60","$1,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_5000C_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_5000C_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340012","POS 6300 Elite Silver","20129IL034","7740283974","ILN001","ILS001","ILF017","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340012-03","POS 6300 Elite Silver","Limited Cost Sharing Plan Variation",,"0.717413441049738","No","Yes","No","100%",,"$3,400","$300","$0","$60","$1,200","$800","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$6,300","$6300 per person","$12600 per group","10.00%",,,,,"$12,600","$12600 per person","$37800 per group","$18,900","$18900 per person","$50400 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_ELITE_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_ELITE_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0360006","PPO HSA 5000 Elite Bronze","20129IL036","7740283974","ILN001","ILS003","ILF004","New","PPO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0360006-00","PPO HSA 5000 Elite Bronze","Standard Bronze Off Exchange Plan",,"0.617423208673523","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$60","$5,000","$20","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$20,000","$20000 per person","$40000 per group","$26,650","$26650 per person","$53300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_PPO_HSA_5000_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_PPO_HSA_5000_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0360006","PPO HSA 5000 Elite Bronze","20129IL036","7740283974","ILN001","ILS003","ILF004","New","PPO","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0360006-01","PPO HSA 5000 Elite Bronze","Standard Bronze On Exchange Plan",,"0.617423208673523","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$60","$5,000","$20","$400","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$20,000","$20000 per person","$40000 per group","$26,650","$26650 per person","$53300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_PPO_HSA_5000_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_PPO_HSA_5000_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330077","HMO 5000c OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330077-01","HMO 5000c OSF Silver","Standard Silver On Exchange Plan",,"0.717400452952087","No","Yes","No","100%",,"$5,000","$0","$784","$60","$1,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_5000C_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_5000C_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280070","POS HSA 6650 Methodist Bronze","20129IL028","7740283974","ILN002","ILS002","ILF013","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280070-00","POS HSA 6650 Methodist Bronze","Standard Bronze Off Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,300","$19300 per person","$38600 per group","$25,950","$25950 per person","$51900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_POS_HSA_6650_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_POS_HSA_6650_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280070","POS HSA 6650 Methodist Bronze","20129IL028","7740283974","ILN002","ILS002","ILF013","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280070-01","POS HSA 6650 Methodist Bronze","Standard Bronze On Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,300","$19300 per person","$38600 per group","$25,950","$25950 per person","$51900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_HSA_6650_METHODIST_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_HSA_6650_METHODIST_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330077","HMO 5000c OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330077-02","HMO 5000c OSF Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_5000C_OSF_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_5000C_OSF_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330077","HMO 5000c OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330077-03","HMO 5000c OSF Silver","Limited Cost Sharing Plan Variation",,"0.717400452952087","No","Yes","No","100%",,"$5,000","$0","$784","$60","$1,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_5000C_OSF_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_5000C_OSF_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330077","HMO 5000c OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330077-04","HMO 5000c OSF Silver","73% AV Level Silver Plan",,"0.737720862726305","No","Yes","No","100%",,"$4,000","$0","$1,034","$60","$1,200","$1,300","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_5000C_OSF_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_5000C_OSF_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330077","HMO 5000c OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330077-05","HMO 5000c OSF Silver","87% AV Level Silver Plan",,"0.879605018216582","No","Yes","No","100%",,"$450","$30","$1,200","$60","$450","$1,300","$70","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_5000C_OSF_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_5000C_OSF_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330077","HMO 5000c OSF Silver","20129IL033","7740283974","ILN001","ILS002","ILF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330077-06","HMO 5000c OSF Silver","94% AV Level Silver Plan",,"0.94702564047848","No","Yes","No","100%",,"$0","$30","$200","$60","$0","$1,200","$20","$60","$0","$30","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","2.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_5000C_OSF_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_5000C_OSF_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330083","HMO 7350 Riverside Silver","20129IL033","7740283974","ILN001","ILS003","ILF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330083-00","HMO 7350 Riverside Silver","Standard Silver Off Exchange Plan",,"0.709553251098679","No","Yes","No","100%",,"$7,350","$0","$0","$60","$2,200","$900","$0","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_HMO_7350_RIVERSIDE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_HMO_7350_RIVERSIDE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280068","POS HSA 6650 Elite Bronze","20129IL028","7740283974","ILN001","ILS001","ILF013","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280068-00","POS HSA 6650 Elite Bronze","Standard Bronze Off Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,300","$19300 per person","$38600 per group","$25,950","$25950 per person","$51900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_POS_HSA_6650_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_POS_HSA_6650_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280068","POS HSA 6650 Elite Bronze","20129IL028","7740283974","ILN001","ILS001","ILF013","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280068-01","POS HSA 6650 Elite Bronze","Standard Bronze On Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,300","$19300 per person","$38600 per group","$25,950","$25950 per person","$51900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_HSA_6650_ELITE_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_HSA_6650_ELITE_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330083","HMO 7350 Riverside Silver","20129IL033","7740283974","ILN001","ILS003","ILF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330083-01","HMO 7350 Riverside Silver","Standard Silver On Exchange Plan",,"0.709553251098679","No","Yes","No","100%",,"$7,350","$0","$0","$60","$2,200","$900","$0","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_7350_RIVERSIDE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_7350_RIVERSIDE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330083","HMO 7350 Riverside Silver","20129IL033","7740283974","ILN001","ILS003","ILF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330083-02","HMO 7350 Riverside Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_7350_RIVERSIDE_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_7350_RIVERSIDE_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330083","HMO 7350 Riverside Silver","20129IL033","7740283974","ILN001","ILS003","ILF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330083-03","HMO 7350 Riverside Silver","Limited Cost Sharing Plan Variation",,"0.709553251098679","No","Yes","No","100%",,"$7,350","$0","$0","$60","$2,200","$900","$0","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_7350_RIVERSIDE_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_7350_RIVERSIDE_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330083","HMO 7350 Riverside Silver","20129IL033","7740283974","ILN001","ILS003","ILF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330083-04","HMO 7350 Riverside Silver","73% AV Level Silver Plan",,"0.736372579308593","No","Yes","No","100%",,"$5,850","$0","$0","$60","$2,200","$900","$0","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_7350_RIVERSIDE_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_7350_RIVERSIDE_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330083","HMO 7350 Riverside Silver","20129IL033","7740283974","ILN001","ILS003","ILF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330083-05","HMO 7350 Riverside Silver","87% AV Level Silver Plan",,"0.871520664573296","No","Yes","No","100%",,"$1,750","$0","$0","$60","$1,100","$598","$0","$60","$300","$40","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_7350_RIVERSIDE_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_7350_RIVERSIDE_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0330083","HMO 7350 Riverside Silver","20129IL033","7740283974","ILN001","ILS003","ILF010","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0330083-06","HMO 7350 Riverside Silver","94% AV Level Silver Plan",,"0.932298745661496","No","Yes","No","100%",,"$750","$0","$0","$60","$500","$200","$0","$60","$300","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_HMO_7350_RIVERSIDE_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_HMO_7350_RIVERSIDE_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340012","POS 6300 Elite Silver","20129IL034","7740283974","ILN001","ILS001","ILF017","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340012-00","POS 6300 Elite Silver","Standard Silver Off Exchange Plan",,"0.717413441049738","No","Yes","No","100%",,"$3,400","$300","$0","$60","$1,200","$800","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$6,300","$6300 per person","$12600 per group","10.00%",,,,,"$12,600","$12600 per person","$37800 per group","$18,900","$18900 per person","$50400 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_6300_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_6300_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340012","POS 6300 Elite Silver","20129IL034","7740283974","ILN001","ILS001","ILF017","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340012-01","POS 6300 Elite Silver","Standard Silver On Exchange Plan",,"0.717413441049738","No","Yes","No","100%",,"$3,400","$300","$0","$60","$1,200","$800","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$6,300","$6300 per person","$12600 per group","10.00%",,,,,"$12,600","$12600 per person","$37800 per group","$18,900","$18900 per person","$50400 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340012","POS 6300 Elite Silver","20129IL034","7740283974","ILN001","ILS001","ILF017","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340012-02","POS 6300 Elite Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_ELITE_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_ELITE_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340012","POS 6300 Elite Silver","20129IL034","7740283974","ILN001","ILS001","ILF017","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340012-04","POS 6300 Elite Silver","73% AV Level Silver Plan",,"0.738810451574341","No","Yes","No","100%",,"$3,400","$300","$0","$60","$1,200","$800","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$33000 per group","$16,500","$16500 per person","$44000 per group","$5,500","$5500 per person","$11000 per group","10.00%",,,,,"$11,000","$11000 per person","$33000 per group","$16,500","$16500 per person","$44000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_ELITE_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_ELITE_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340012","POS 6300 Elite Silver","20129IL034","7740283974","ILN001","ILS001","ILF017","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340012-05","POS 6300 Elite Silver","87% AV Level Silver Plan",,"0.870483117150397","No","Yes","No","100%",,"$1,000","$30","$600","$60","$1,000","$800","$60","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$4,900","$4900 per person","$9800 per group","$7,350","$7350 per person","$14700 per group","$1,000","$1000 per person","$2000 per group","5.00%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$8000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_ELITE_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_ELITE_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340012","POS 6300 Elite Silver","20129IL034","7740283974","ILN001","ILS001","ILF017","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340012-06","POS 6300 Elite Silver","94% AV Level Silver Plan",,"0.948178892934799","No","Yes","No","100%",,"$250","$100","$0","$60","$250","$500","$0","$60","$250","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,500","$1500 per person","$4500 per group","$2,250","$2250 per person","$6000 per group","$250","$250 per person","$500 per group","0.00%",,,,,"$500","$500 per person","$1500 per group","$750","$750 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_ELITE_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_ELITE_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340022","POS 6300 Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF017","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340022-00","POS 6300 Methodist Silver","Standard Silver Off Exchange Plan",,"0.717413441049738","No","Yes","No","100%",,"$3,400","$300","$0","$60","$1,200","$800","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$6,300","$6300 per person","$12600 per group","10.00%",,,,,"$12,600","$12600 per person","$37800 per group","$18,900","$18900 per person","$50400 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_6300_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_6300_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280072","POS HSA 6650 OSF Bronze","20129IL028","7740283974","ILN001","ILS002","ILF013","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280072-00","POS HSA 6650 OSF Bronze","Standard Bronze Off Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,300","$19300 per person","$38600 per group","$25,950","$25950 per person","$51900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_POS_HSA_6650_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_POS_HSA_6650_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0280072","POS HSA 6650 OSF Bronze","20129IL028","7740283974","ILN001","ILS002","ILF013","New","POS","Bronze","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0280072-01","POS HSA 6650 OSF Bronze","Standard Bronze On Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,300","$19300 per person","$38600 per group","$25,950","$25950 per person","$51900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$13,300","$13300 per person","$26600 per group","$19,950","$19950 per person","$39900 per group","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_POS_HSA_6650_OSF_BRONZE.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_POS_HSA_6650_OSF_BRONZE.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340022","POS 6300 Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF017","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340022-01","POS 6300 Methodist Silver","Standard Silver On Exchange Plan",,"0.717413441049738","No","Yes","No","100%",,"$3,400","$300","$0","$60","$1,200","$800","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$6,300","$6300 per person","$12600 per group","10.00%",,,,,"$12,600","$12600 per person","$37800 per group","$18,900","$18900 per person","$50400 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340022","POS 6300 Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF017","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340022-02","POS 6300 Methodist Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_METHODIST_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_METHODIST_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340022","POS 6300 Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF017","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340022-03","POS 6300 Methodist Silver","Limited Cost Sharing Plan Variation",,"0.717413441049738","No","Yes","No","100%",,"$3,400","$300","$0","$60","$1,200","$800","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$6,300","$6300 per person","$12600 per group","10.00%",,,,,"$12,600","$12600 per person","$37800 per group","$18,900","$18900 per person","$50400 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_METHODIST_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_METHODIST_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340022","POS 6300 Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF017","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340022-04","POS 6300 Methodist Silver","73% AV Level Silver Plan",,"0.738810451574341","No","Yes","No","100%",,"$3,400","$300","$0","$60","$1,200","$800","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$33000 per group","$16,500","$16500 per person","$44000 per group","$5,500","$5500 per person","$11000 per group","10.00%",,,,,"$11,000","$11000 per person","$33000 per group","$16,500","$16500 per person","$44000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_METHODIST_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_METHODIST_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340022","POS 6300 Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF017","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340022-05","POS 6300 Methodist Silver","87% AV Level Silver Plan",,"0.870483117150397","No","Yes","No","100%",,"$1,000","$30","$600","$60","$1,000","$800","$60","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$4,900","$4900 per person","$9800 per group","$7,350","$7350 per person","$14700 per group","$1,000","$1000 per person","$2000 per group","5.00%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$8000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_METHODIST_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_METHODIST_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340022","POS 6300 Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF017","Existing","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340022-06","POS 6300 Methodist Silver","94% AV Level Silver Plan",,"0.948178892934799","No","Yes","No","100%",,"$250","$100","$0","$60","$250","$500","$0","$60","$250","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,500","$1500 per person","$4500 per group","$2,250","$2250 per person","$6000 per group","$250","$250 per person","$500 per group","0.00%",,,,,"$500","$500 per person","$1500 per group","$750","$750 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_METHODIST_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_METHODIST_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340036","POS 3500a Elite Silver","20129IL034","7740283974","ILN001","ILS004","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340036-00","POS 3500a Elite Silver","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$30","$1,800","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_3500A_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_3500A_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0270050","HMO HSA 1900 Methodist Silver","20129IL027","7740283974","ILN002","ILS002","ILF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0270050-00","HMO HSA 1900 Methodist Silver","Standard Silver Off Exchange Plan",,"0.719512713496803","Yes","Yes","No","100%",,"$1,900","$0","$2,100","$60","$1,900","$0","$1,100","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","per person not applicable","$3800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_HMO_HSA_1900_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_HMO_HSA_1900_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0270050","HMO HSA 1900 Methodist Silver","20129IL027","7740283974","ILN002","ILS002","ILF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0270050-01","HMO HSA 1900 Methodist Silver","Standard Silver On Exchange Plan",,"0.719512713496803","Yes","Yes","No","100%",,"$1,900","$0","$2,100","$60","$1,900","$0","$1,100","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","per person not applicable","$3800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_HSA_1900_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_HSA_1900_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340036","POS 3500a Elite Silver","20129IL034","7740283974","ILN001","ILS004","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340036-01","POS 3500a Elite Silver","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$30","$1,800","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3500A_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3500A_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340036","POS 3500a Elite Silver","20129IL034","7740283974","ILN001","ILS004","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340036-02","POS 3500a Elite Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3500A_ELITE_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3500A_ELITE_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340036","POS 3500a Elite Silver","20129IL034","7740283974","ILN001","ILS004","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340036-03","POS 3500a Elite Silver","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$30","$1,800","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3500A_ELITE_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3500A_ELITE_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340036","POS 3500a Elite Silver","20129IL034","7740283974","ILN001","ILS004","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340036-04","POS 3500a Elite Silver","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$30","$1,900","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$11,700","$11700 per person","$23400 per group","$17,550","$17550 per person","$35100 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$200","$200 per person","$400 per group","40.00%",,,,,"$400","$400 per person","$800 per group","$600","$600 per person","$1200 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3500A_ELITE_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3500A_ELITE_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340037","POS 3500a Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340037-03","POS 3500a Methodist Silver","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$30","$1,800","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3500A_METHODIST_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3500A_METHODIST_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340037","POS 3500a Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340037-04","POS 3500a Methodist Silver","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$30","$1,900","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$11,700","$11700 per person","$23400 per group","$17,550","$17550 per person","$35100 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$200","$200 per person","$400 per group","40.00%",,,,,"$400","$400 per person","$800 per group","$600","$600 per person","$1200 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3500A_METHODIST_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3500A_METHODIST_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340036","POS 3500a Elite Silver","20129IL034","7740283974","ILN001","ILS004","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340036-05","POS 3500a Elite Silver","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,800","$60","$700","$800","$100","$60","$300","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$4,900","$4900 per person","$9800 per group","$7,350","$7350 per person","$14700 per group","$700","$700 per person","$1400 per group","20.00%",,,,,"$1,400","$1400 per person","$2800 per group","$2,000","$2000 per person","$4200 per group","$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3500A_ELITE_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3500A_ELITE_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340036","POS 3500a Elite Silver","20129IL034","7740283974","ILN001","ILS004","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340036-06","POS 3500a Elite Silver","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$20","$600","$60","$250","$400","$50","$60","$250","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$2,500","$2500 per person","$5000 per group","$3,750","$3750 per person","$7500 per group","$250","$250 per person","$500 per group","5.00%",,,,,"$500","$500 per person","$1000 per group","$750","$750 per person","$1500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3500A_ELITE_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3500A_ELITE_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340037","POS 3500a Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340037-00","POS 3500a Methodist Silver","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$30","$1,800","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_3500A_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_3500A_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0270052","HMO HSA 1900 OSF Silver","20129IL027","7740283974","ILN001","ILS002","ILF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Available","Yes","Emergency Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0270052-00","HMO HSA 1900 OSF Silver","Standard Silver Off Exchange Plan",,"0.719512713496803","Yes","Yes","No","100%",,"$1,900","$0","$2,100","$60","$1,900","$0","$1,100","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","per person not applicable","$3800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SBC_HMO_HSA_1900_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_DIR_SOB_HMO_HSA_1900_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","37-1260731","20129IL0270052","HMO HSA 1900 OSF Silver","20129IL027","7740283974","ILN001","ILS002","ILF009","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9955",,,"2018-01-01",,"Yes","Emergency Coverage Available","Yes","Emergency Coverage Available","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0270052-01","HMO HSA 1900 OSF Silver","Standard Silver On Exchange Plan",,"0.719512713496803","Yes","Yes","No","100%",,"$1,900","$0","$2,100","$60","$1,900","$0","$1,100","$60","$400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","per person not applicable","$3800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SBC_HMO_HSA_1900_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_GRP_PUB_SOB_HMO_HSA_1900_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340037","POS 3500a Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340037-01","POS 3500a Methodist Silver","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$30","$1,800","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3500A_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3500A_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340037","POS 3500a Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340037-02","POS 3500a Methodist Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3500A_METHODIST_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3500A_METHODIST_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340037","POS 3500a Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340037-05","POS 3500a Methodist Silver","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,800","$60","$700","$800","$100","$60","$300","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$4,900","$4900 per person","$9800 per group","$7,350","$7350 per person","$14700 per group","$700","$700 per person","$1400 per group","20.00%",,,,,"$1,400","$1400 per person","$2800 per group","$2,100","$2100 per person","$4200 per group","$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3500A_METHODIST_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3500A_METHODIST_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340037","POS 3500a Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340037-06","POS 3500a Methodist Silver","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$20","$600","$60","$250","$400","$50","$60","$250","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$2,500","$2500 per person","$5000 per group","$3,750","$3750 per person","$7500 per group","$250","$250 per person","$500 per group","5.00%",,,,,"$500","$500 per person","$1000 per group","$750","$750 per person","$1500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3500A_METHODIST_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3500A_METHODIST_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340038","POS 3500a OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340038-00","POS 3500a OSF Silver","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$30","$1,800","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_3500A_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_3500A_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340038","POS 3500a OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340038-01","POS 3500a OSF Silver","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$30","$1,800","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3500A_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3500A_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340038","POS 3500a OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340038-02","POS 3500a OSF Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3500A_OSF_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3500A_OSF_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340038","POS 3500a OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340038-03","POS 3500a OSF Silver","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$30","$1,800","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$22,050","$22050 per person","$44100 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3500A_OSF_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3500A_OSF_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340038","POS 3500a OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340038-04","POS 3500a OSF Silver","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$30","$1,900","$60","$1,200","$1,600","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$11,700","$11700 per person","$23400 per group","$17,550","$17550 per person","$35100 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$200","$200 per person","$400 per group","40.00%",,,,,"$400","$400 per person","$800 per group","$600","$600 per person","$1200 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3500A_OSF_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3500A_OSF_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340038","POS 3500a OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340038-05","POS 3500a OSF Silver","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,800","$60","$700","$800","$100","$60","$300","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$4,900","$4900 per person","$9800 per group","$7,350","$7350 per person","$14700 per group","$700","$700 per person","$1400 per group","20.00%",,,,,"$1,400","$1400 per person","$2800 per group","$2,100","$2100 per person","$4200 per group","$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3500A_OSF_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3500A_OSF_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340038","POS 3500a OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF014","New","POS","Silver","Design 2","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340038-06","POS 3500a OSF Silver","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$20","$600","$60","$250","$400","$50","$60","$250","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$2,500","$2500 per person","$5000 per group","$3,750","$3750 per person","$7500 per group","$250","$250 per person","$500 per group","5.00%",,,,,"$500","$500 per person","$1000 per group","$750","$750 per person","$1500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_3500A_OSF_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_3500A_OSF_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340043","POS 6300 OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF017","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340043-00","POS 6300 OSF Silver","Standard Silver Off Exchange Plan",,"0.717413441049738","No","Yes","No","100%",,"$3,400","$300","$0","$60","$1,200","$800","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$6,300","$6300 per person","$12600 per group","10.00%",,,,,"$12,600","$12600 per person","$37800 per group","$18,900","$18900 per person","$50400 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_6300_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_6300_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340043","POS 6300 OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF017","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340043-01","POS 6300 OSF Silver","Standard Silver On Exchange Plan",,"0.717413441049738","No","Yes","No","100%",,"$3,400","$300","$0","$60","$1,200","$800","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$6,300","$6300 per person","$12600 per group","10.00%",,,,,"$12,600","$12600 per person","$37800 per group","$18,900","$18900 per person","$50400 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340043","POS 6300 OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF017","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340043-02","POS 6300 OSF Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_OSF_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_OSF_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340043","POS 6300 OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF017","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340043-03","POS 6300 OSF Silver","Limited Cost Sharing Plan Variation",,"0.717413441049738","No","Yes","No","100%",,"$3,400","$300","$0","$60","$1,200","$800","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$6,300","$6300 per person","$12600 per group","10.00%",,,,,"$12,600","$12600 per person","$37800 per group","$18,900","$18900 per person","$50400 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_OSF_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_OSF_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340043","POS 6300 OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF017","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340043-04","POS 6300 OSF Silver","73% AV Level Silver Plan",,"0.738810451574341","No","Yes","No","100%",,"$3,400","$300","$0","$60","$1,200","$800","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$33000 per group","$16,500","$16500 per person","$44000 per group","$5,500","$5500 per person","$11000 per group","10.00%",,,,,"$11,000","$11000 per person","$33000 per group","$16,500","$16500 per person","$44000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_OSF_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_OSF_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340043","POS 6300 OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF017","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340043-05","POS 6300 OSF Silver","87% AV Level Silver Plan",,"0.870483117150397","No","Yes","No","100%",,"$1,000","$30","$600","$60","$1,000","$800","$60","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$4,900","$4900 per person","$9800 per group","$7,350","$7350 per person","$14700 per group","$1,000","$1000 per person","$2000 per group","5.00%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$8000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_OSF_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_OSF_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340043","POS 6300 OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF017","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340043-06","POS 6300 OSF Silver","94% AV Level Silver Plan",,"0.948178892934799","No","Yes","No","100%",,"$250","$100","$0","$60","$250","$500","$0","$60","$250","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,500","$1500 per person","$4500 per group","$2,250","$2250 per person","$6000 per group","$250","$250 per person","$500 per group","0.00%",,,,,"$500","$500 per person","$1500 per group","$750","$750 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_OSF_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_OSF_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340044","POS 6300 Riverside Silver","20129IL034","7740283974","ILN001","ILS003","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340044-00","POS 6300 Riverside Silver","Standard Silver Off Exchange Plan",,"0.717413441049738","No","Yes","No","100%",,"$3,400","$300","$0","$60","$1,200","$800","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$6,300","$6300 per person","$12600 per group","10.00%",,,,,"$12,600","$12600 per person","$37800 per group","$18,900","$18900 per person","$50400 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_6300_RIVERSIDE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_6300_RIVERSIDE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340044","POS 6300 Riverside Silver","20129IL034","7740283974","ILN001","ILS003","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340044-01","POS 6300 Riverside Silver","Standard Silver On Exchange Plan",,"0.717413441049738","No","Yes","No","100%",,"$3,400","$300","$0","$60","$1,200","$800","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$6,300","$6300 per person","$12600 per group","10.00%",,,,,"$12,600","$12600 per person","$37800 per group","$18,900","$18900 per person","$50400 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_RIVERSIDE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_RIVERSIDE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340044","POS 6300 Riverside Silver","20129IL034","7740283974","ILN001","ILS003","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340044-02","POS 6300 Riverside Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_RIVERSIDE_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_RIVERSIDE_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340044","POS 6300 Riverside Silver","20129IL034","7740283974","ILN001","ILS003","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340044-03","POS 6300 Riverside Silver","Limited Cost Sharing Plan Variation",,"0.717413441049738","No","Yes","No","100%",,"$3,400","$300","$0","$60","$1,200","$800","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$6,300","$6300 per person","$12600 per group","10.00%",,,,,"$12,600","$12600 per person","$37800 per group","$18,900","$18900 per person","$50400 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_RIVERSIDE_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_RIVERSIDE_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340044","POS 6300 Riverside Silver","20129IL034","7740283974","ILN001","ILS003","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340044-04","POS 6300 Riverside Silver","73% AV Level Silver Plan",,"0.738810451574341","No","Yes","No","100%",,"$3,400","$300","$0","$60","$1,200","$800","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$33000 per group","$16,500","$16500 per person","$44000 per group","$5,500","$5500 per person","$11000 per group","10.00%",,,,,"$11,000","$11000 per person","$33000 per group","$16,500","$16500 per person","$44000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_RIVERSIDE_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_RIVERSIDE_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340044","POS 6300 Riverside Silver","20129IL034","7740283974","ILN001","ILS003","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340044-05","POS 6300 Riverside Silver","87% AV Level Silver Plan",,"0.870483117150397","No","Yes","No","100%",,"$1,000","$30","$600","$60","$1,000","$800","$60","$60","$300","$80","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$4,900","$4900 per person","$9800 per group","$7,350","$7350 per person","$14700 per group","$1,000","$1000 per person","$2000 per group","5.00%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$8000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_RIVERSIDE_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_RIVERSIDE_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340044","POS 6300 Riverside Silver","20129IL034","7740283974","ILN001","ILS003","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340044-06","POS 6300 Riverside Silver","94% AV Level Silver Plan",,"0.948178892934799","No","Yes","No","100%",,"$250","$100","$0","$60","$250","$500","$0","$60","$250","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,500","$1500 per person","$4500 per group","$2,250","$2250 per person","$6000 per group","$250","$250 per person","$500 per group","0.00%",,,,,"$500","$500 per person","$1500 per group","$750","$750 per person","$2000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_6300_RIVERSIDE_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_6300_RIVERSIDE_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340045","POS 7350 Elite Silver","20129IL034","7740283974","ILN001","ILS001","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340045-00","POS 7350 Elite Silver","Standard Silver Off Exchange Plan",,"0.706607047162704","No","Yes","No","100%",,"$7,350","$0","$0","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$7,350","$7350 per person","$14700 per group","5.00%",,,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_7350_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_7350_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340045","POS 7350 Elite Silver","20129IL034","7740283974","ILN001","ILS001","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340045-01","POS 7350 Elite Silver","Standard Silver On Exchange Plan",,"0.706607047162704","No","Yes","No","100%",,"$7,350","$0","$0","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$7,350","$7350 per person","$14700 per group","5.00%",,,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_ELITE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_ELITE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340045","POS 7350 Elite Silver","20129IL034","7740283974","ILN001","ILS001","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340045-02","POS 7350 Elite Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_ELITE_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_ELITE_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340045","POS 7350 Elite Silver","20129IL034","7740283974","ILN001","ILS001","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340045-03","POS 7350 Elite Silver","Limited Cost Sharing Plan Variation",,"0.706607047162704","No","Yes","No","100%",,"$7,350","$0","$0","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$7,350","$7350 per person","$14700 per group","5.00%",,,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_ELITE_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_ELITE_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340045","POS 7350 Elite Silver","20129IL034","7740283974","ILN001","ILS001","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340045-04","POS 7350 Elite Silver","73% AV Level Silver Plan",,"0.733037703743769","No","Yes","No","100%",,"$5,850","$0","$0","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$11,700","$11700 per person","$23400 per group","$17,550","$17550 per person","$35100 per group","$5,850","$5850 per person","$11700 per group","5.00%",,,,,"$11,700","$11700 per person","$23400 per group","$17,550","$17550 per person","$35100 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_ELITE_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_ELITE_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340045","POS 7350 Elite Silver","20129IL034","7740283974","ILN001","ILS001","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340045-05","POS 7350 Elite Silver","87% AV Level Silver Plan",,"0.868246021959291","No","Yes","No","100%",,"$1,750","$0","$0","$60","$1,000","$800","$0","$60","$300","$70","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$3,500","$3500 per person","$7000 per group","$5,250","$5250 per person","$10500 per group","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"$3,500","$3500 per person","$7000 per group","$5,250","$5250 per person","$10500 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_ELITE_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_ELITE_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340045","POS 7350 Elite Silver","20129IL034","7740283974","ILN001","ILS001","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340045-06","POS 7350 Elite Silver","94% AV Level Silver Plan",,"0.948719362638529","No","Yes","No","100%",,"$500","$0","$0","$60","$400","$100","$0","$60","$0","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_ELITE_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_ELITE_SILVER_CSR_94.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140002-06","Ambetter Balanced Care 1 (2018): IlliniCare Health Network","94% AV Level Silver Plan",,"0.949528260595198","Yes","Yes","No","100%",,"$0","$0","$950","$60","$0","$300","$400","$60","$0","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140002-06.pdf","https://api.centene.com/Brochures/2018/27833IL0140002-06.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140003-00","Ambetter Balanced Care 2 (2018): IlliniCare Health Network","Standard Silver Off Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140003-00.pdf","https://api.centene.com/Brochures/2018/27833IL0140003-00.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340046","POS 7350 Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340046-00","POS 7350 Methodist Silver","Standard Silver Off Exchange Plan",,"0.706607047162704","No","Yes","No","100%",,"$7,350","$0","$0","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$7,350","$7350 per person","$14700 per group","5.00%",,,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_7350_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_7350_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340046","POS 7350 Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340046-01","POS 7350 Methodist Silver","Standard Silver On Exchange Plan",,"0.706607047162704","No","Yes","No","100%",,"$7,350","$0","$0","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$7,350","$7350 per person","$14700 per group","5.00%",,,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_METHODIST_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_METHODIST_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340046","POS 7350 Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340046-02","POS 7350 Methodist Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_METHODIST_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_METHODIST_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340046","POS 7350 Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340046-03","POS 7350 Methodist Silver","Limited Cost Sharing Plan Variation",,"0.706607047162704","No","Yes","No","100%",,"$7,350","$0","$0","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$7,350","$7350 per person","$14700 per group","5.00%",,,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_METHODIST_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_METHODIST_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340046","POS 7350 Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340046-04","POS 7350 Methodist Silver","73% AV Level Silver Plan",,"0.733037703743769","No","Yes","No","100%",,"$5,850","$0","$0","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$11,700","$11700 per person","$23400 per group","$17,550","$17550 per person","$35100 per group","$5,850","$5850 per person","$11700 per group","5.00%",,,,,"$11,700","$11700 per person","$23400 per group","$17,550","$17550 per person","$35100 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_METHODIST_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_METHODIST_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340046","POS 7350 Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340046-05","POS 7350 Methodist Silver","87% AV Level Silver Plan",,"0.868246021959291","No","Yes","No","100%",,"$1,750","$0","$0","$60","$1,000","$800","$0","$60","$300","$70","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$3,500","$3500 per person","$7000 per group","$5,250","$5250 per person","$10500 per group","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"$3,500","$3500 per person","$7000 per group","$5,250","$5250 per person","$10500 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_METHODIST_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_METHODIST_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340046","POS 7350 Methodist Silver","20129IL034","7740283974","ILN002","ILS002","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340046-06","POS 7350 Methodist Silver","94% AV Level Silver Plan",,"0.948719362638529","No","Yes","No","100%",,"$500","$0","$0","$60","$400","$100","$0","$60","$0","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_METHODIST_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_METHODIST_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340047","POS 7350 OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340047-00","POS 7350 OSF Silver","Standard Silver Off Exchange Plan",,"0.706607047162704","No","Yes","No","100%",,"$7,350","$0","$0","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$7,350","$7350 per person","$14700 per group","5.00%",,,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_7350_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_7350_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340047","POS 7350 OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340047-01","POS 7350 OSF Silver","Standard Silver On Exchange Plan",,"0.706607047162704","No","Yes","No","100%",,"$7,350","$0","$0","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$7,350","$7350 per person","$14700 per group","5.00%",,,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_OSF_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_OSF_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340047","POS 7350 OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340047-02","POS 7350 OSF Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_OSF_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_OSF_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340047","POS 7350 OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340047-03","POS 7350 OSF Silver","Limited Cost Sharing Plan Variation",,"0.706607047162704","No","Yes","No","100%",,"$7,350","$0","$0","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$7,350","$7350 per person","$14700 per group","5.00%",,,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_OSF_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_OSF_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340047","POS 7350 OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340047-04","POS 7350 OSF Silver","73% AV Level Silver Plan",,"0.733037703743769","No","Yes","No","100%",,"$5,850","$0","$0","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$11,700","$11700 per person","$23400 per group","$17,550","$17550 per person","$35100 per group","$5,850","$5850 per person","$11700 per group","5.00%",,,,,"$11,700","$11700 per person","$23400 per group","$17,550","$17550 per person","$35100 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_OSF_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_OSF_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340047","POS 7350 OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340047-05","POS 7350 OSF Silver","87% AV Level Silver Plan",,"0.868246021959291","No","Yes","No","100%",,"$1,750","$0","$0","$60","$1,000","$800","$0","$60","$300","$70","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$3,500","$3500 per person","$7000 per group","$5,250","$5250 per person","$10500 per group","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"$3,500","$3500 per person","$7000 per group","$5,250","$5250 per person","$10500 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_OSF_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_OSF_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340047","POS 7350 OSF Silver","20129IL034","7740283974","ILN001","ILS002","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340047-06","POS 7350 OSF Silver","94% AV Level Silver Plan",,"0.948719362638529","No","Yes","No","100%",,"$500","$0","$0","$60","$400","$100","$0","$60","$0","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_OSF_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_OSF_SILVER_CSR_94.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340048","POS 7350 Riverside Silver","20129IL034","7740283974","ILN001","ILS003","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340048-00","POS 7350 Riverside Silver","Standard Silver Off Exchange Plan",,"0.706607047162704","No","Yes","No","100%",,"$7,350","$0","$0","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$7,350","$7350 per person","$14700 per group","5.00%",,,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_DIR_SBC_POS_7350_RIVERSIDE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_DIR_SOB_POS_7350_RIVERSIDE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340048","POS 7350 Riverside Silver","20129IL034","7740283974","ILN001","ILS003","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340048-01","POS 7350 Riverside Silver","Standard Silver On Exchange Plan",,"0.706607047162704","No","Yes","No","100%",,"$7,350","$0","$0","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$7,350","$7350 per person","$14700 per group","5.00%",,,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_RIVERSIDE_SILVER.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_RIVERSIDE_SILVER.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340048","POS 7350 Riverside Silver","20129IL034","7740283974","ILN001","ILS003","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340048-02","POS 7350 Riverside Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_RIVERSIDE_SILVER_IND_CSR_0.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_RIVERSIDE_SILVER_IND_CSR_0.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340048","POS 7350 Riverside Silver","20129IL034","7740283974","ILN001","ILS003","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340048-03","POS 7350 Riverside Silver","Limited Cost Sharing Plan Variation",,"0.706607047162704","No","Yes","No","100%",,"$7,350","$0","$0","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$7,350","$7350 per person","$14700 per group","5.00%",,,,,"$14,700","$14700 per person","$44100 per group","$22,050","$22050 per person","$58800 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_RIVERSIDE_SILVER_IND_CSR.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_RIVERSIDE_SILVER_IND_CSR.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340048","POS 7350 Riverside Silver","20129IL034","7740283974","ILN001","ILS003","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340048-04","POS 7350 Riverside Silver","73% AV Level Silver Plan",,"0.733037703743769","No","Yes","No","100%",,"$5,850","$0","$0","$60","$2,200","$900","$0","$60","$300","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$11,700","$11700 per person","$23400 per group","$17,550","$17550 per person","$35100 per group","$5,850","$5850 per person","$11700 per group","5.00%",,,,,"$11,700","$11700 per person","$23400 per group","$17,550","$17550 per person","$35100 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_RIVERSIDE_SILVER_CSR_73.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_RIVERSIDE_SILVER_CSR_73.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340048","POS 7350 Riverside Silver","20129IL034","7740283974","ILN001","ILS003","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340048-05","POS 7350 Riverside Silver","87% AV Level Silver Plan",,"0.868246021959291","No","Yes","No","100%",,"$1,750","$0","$0","$60","$1,000","$800","$0","$60","$300","$70","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$3,500","$3500 per person","$7000 per group","$5,250","$5250 per person","$10500 per group","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"$3,500","$3500 per person","$7000 per group","$5,250","$5250 per person","$10500 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_RIVERSIDE_SILVER_CSR_87.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_RIVERSIDE_SILVER_CSR_87.pdf"
"2018","IL","20129","SERFF","2017-10-31 20:15:29","Individual","No","37-1260731","20129IL0340048","POS 7350 Riverside Silver","20129IL034","7740283974","ILN001","ILS003","ILF019","New","POS","Silver","Not Applicable","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol","0.9956",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No",,"https://www.healthalliance.org/media/Resources/Health-Alliance-Comprehensive-Formulary-Public-2018.pdf","20129IL0340048-06","POS 7350 Riverside Silver","94% AV Level Silver Plan",,"0.948719362638529","No","Yes","No","100%",,"$500","$0","$0","$60","$400","$100","$0","$60","$0","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2018_IL_IND_PUB_SBC_POS_7350_RIVERSIDE_SILVER_CSR_94.pdf","https://www.healthalliance.org/docs/2018_IL_IND_PUB_SOB_POS_7350_RIVERSIDE_SILVER_CSR_94.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits: IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140001-00","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits: IlliniCare Health Network","Standard Gold Off Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/27833IL0140001-00.pdf","https://api.centene.com/Brochures/2018/27833IL0140001-00.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits: IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140001-01","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits: IlliniCare Health Network","Standard Gold On Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/27833IL0140001-01.pdf","https://api.centene.com/Brochures/2018/27833IL0140001-01.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits: IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140001-02","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits: IlliniCare Health Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/27833IL0140001-02.pdf","https://api.centene.com/Brochures/2018/27833IL0140001-02.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits: IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140001-03","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits: IlliniCare Health Network","Limited Cost Sharing Plan Variation",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/27833IL0140001-03.pdf","https://api.centene.com/Brochures/2018/27833IL0140001-03.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140002-00","Ambetter Balanced Care 1 (2018): IlliniCare Health Network","Standard Silver Off Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140002-00.pdf","https://api.centene.com/Brochures/2018/27833IL0140002-00.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140002-01","Ambetter Balanced Care 1 (2018): IlliniCare Health Network","Standard Silver On Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140002-01.pdf","https://api.centene.com/Brochures/2018/27833IL0140002-01.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140002-02","Ambetter Balanced Care 1 (2018): IlliniCare Health Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140002-02.pdf","https://api.centene.com/Brochures/2018/27833IL0140002-02.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140002-03","Ambetter Balanced Care 1 (2018): IlliniCare Health Network","Limited Cost Sharing Plan Variation",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140002-03.pdf","https://api.centene.com/Brochures/2018/27833IL0140002-03.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140002-04","Ambetter Balanced Care 1 (2018): IlliniCare Health Network","73% AV Level Silver Plan",,"0.739812128349422","Yes","Yes","No","100%",,"$3,000","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140002-04.pdf","https://api.centene.com/Brochures/2018/27833IL0140002-04.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140002-05","Ambetter Balanced Care 1 (2018): IlliniCare Health Network","87% AV Level Silver Plan",,"0.87931537568396","Yes","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$300","$400","$60","$750","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140002-05.pdf","https://api.centene.com/Brochures/2018/27833IL0140002-05.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140003-01","Ambetter Balanced Care 2 (2018): IlliniCare Health Network","Standard Silver On Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140003-01.pdf","https://api.centene.com/Brochures/2018/27833IL0140003-01.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140003-02","Ambetter Balanced Care 2 (2018): IlliniCare Health Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140003-02.pdf","https://api.centene.com/Brochures/2018/27833IL0140003-02.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140003-03","Ambetter Balanced Care 2 (2018): IlliniCare Health Network","Limited Cost Sharing Plan Variation",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140003-03.pdf","https://api.centene.com/Brochures/2018/27833IL0140003-03.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140003-04","Ambetter Balanced Care 2 (2018): IlliniCare Health Network","73% AV Level Silver Plan",,"0.729896135538709","Yes","Yes","No","100%",,"$4,600","$400","$0","$60","$1,900","$1,400","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140003-04.pdf","https://api.centene.com/Brochures/2018/27833IL0140003-04.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140003-05","Ambetter Balanced Care 2 (2018): IlliniCare Health Network","87% AV Level Silver Plan",,"0.867181007012531","Yes","Yes","No","100%",,"$1,700","$10","$0","$60","$1,500","$250","$0","$60","$1,600","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140003-05.pdf","https://api.centene.com/Brochures/2018/27833IL0140003-05.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140003-06","Ambetter Balanced Care 2 (2018): IlliniCare Health Network","94% AV Level Silver Plan",,"0.942313720589882","Yes","Yes","No","100%",,"$572","$3","$0","$60","$500","$70","$0","$60","$575","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140003-06.pdf","https://api.centene.com/Brochures/2018/27833IL0140003-06.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140007","Ambetter Balanced Care 3 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140007-00","Ambetter Balanced Care 3 (2018): IlliniCare Health Network","Standard Silver Off Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140007-00.pdf","https://api.centene.com/Brochures/2018/27833IL0140007-00.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140007","Ambetter Balanced Care 3 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140007-01","Ambetter Balanced Care 3 (2018): IlliniCare Health Network","Standard Silver On Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140007-01.pdf","https://api.centene.com/Brochures/2018/27833IL0140007-01.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140007","Ambetter Balanced Care 3 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140007-02","Ambetter Balanced Care 3 (2018): IlliniCare Health Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140007-02.pdf","https://api.centene.com/Brochures/2018/27833IL0140007-02.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140007","Ambetter Balanced Care 3 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140007-03","Ambetter Balanced Care 3 (2018): IlliniCare Health Network","Limited Cost Sharing Plan Variation",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140007-03.pdf","https://api.centene.com/Brochures/2018/27833IL0140007-03.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140007","Ambetter Balanced Care 3 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140007-04","Ambetter Balanced Care 3 (2018): IlliniCare Health Network","73% AV Level Silver Plan",,"0.739635889295605","Yes","Yes","No","100%",,"$1,950","$1,300","$300","$60","$1,300","$1,700","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140007-04.pdf","https://api.centene.com/Brochures/2018/27833IL0140007-04.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140007","Ambetter Balanced Care 3 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140007-05","Ambetter Balanced Care 3 (2018): IlliniCare Health Network","87% AV Level Silver Plan",,"0.879959544313859","Yes","Yes","No","100%",,"$675","$200","$300","$60","$675","$300","$600","$60","$675","$20","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140007-05.pdf","https://api.centene.com/Brochures/2018/27833IL0140007-05.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140007","Ambetter Balanced Care 3 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140007-06","Ambetter Balanced Care 3 (2018): IlliniCare Health Network","94% AV Level Silver Plan",,"0.949879112635725","Yes","Yes","No","100%",,"$200","$90","$300","$60","$200","$200","$200","$60","$200","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140007-06.pdf","https://api.centene.com/Brochures/2018/27833IL0140007-06.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140008","Ambetter Balanced Care 12 Standardized (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140008-00","Ambetter Balanced Care 12 Standardized (2018): IlliniCare Health Network","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/27833IL0140008-00.pdf","https://api.centene.com/Brochures/2018/27833IL0140008-00.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140008","Ambetter Balanced Care 12 Standardized (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140008-01","Ambetter Balanced Care 12 Standardized (2018): IlliniCare Health Network","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/27833IL0140008-01.pdf","https://api.centene.com/Brochures/2018/27833IL0140008-01.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140008","Ambetter Balanced Care 12 Standardized (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140008-02","Ambetter Balanced Care 12 Standardized (2018): IlliniCare Health Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/27833IL0140008-02.pdf","https://api.centene.com/Brochures/2018/27833IL0140008-02.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140008","Ambetter Balanced Care 12 Standardized (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140008-03","Ambetter Balanced Care 12 Standardized (2018): IlliniCare Health Network","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/27833IL0140008-03.pdf","https://api.centene.com/Brochures/2018/27833IL0140008-03.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140008","Ambetter Balanced Care 12 Standardized (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140008-04","Ambetter Balanced Care 12 Standardized (2018): IlliniCare Health Network","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/27833IL0140008-04.pdf","https://api.centene.com/Brochures/2018/27833IL0140008-04.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140008","Ambetter Balanced Care 12 Standardized (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140008-05","Ambetter Balanced Care 12 Standardized (2018): IlliniCare Health Network","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$100","$1,600","$60","$700","$600","$400","$60","$700","$80","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/27833IL0140008-05.pdf","https://api.centene.com/Brochures/2018/27833IL0140008-05.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140008","Ambetter Balanced Care 12 Standardized (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140008-06","Ambetter Balanced Care 12 Standardized (2018): IlliniCare Health Network","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$100","$500","$60","$250","$200","$90","$60","$250","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/27833IL0140008-06.pdf","https://api.centene.com/Brochures/2018/27833IL0140008-06.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140009","Ambetter Balanced Care 4 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140009-00","Ambetter Balanced Care 4 (2018): IlliniCare Health Network","Standard Silver Off Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140009-00.pdf","https://api.centene.com/Brochures/2018/27833IL0140009-00.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140009","Ambetter Balanced Care 4 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140009-01","Ambetter Balanced Care 4 (2018): IlliniCare Health Network","Standard Silver On Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140009-01.pdf","https://api.centene.com/Brochures/2018/27833IL0140009-01.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140009","Ambetter Balanced Care 4 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140009-02","Ambetter Balanced Care 4 (2018): IlliniCare Health Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140009-02.pdf","https://api.centene.com/Brochures/2018/27833IL0140009-02.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140009","Ambetter Balanced Care 4 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140009-03","Ambetter Balanced Care 4 (2018): IlliniCare Health Network","Limited Cost Sharing Plan Variation",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140009-03.pdf","https://api.centene.com/Brochures/2018/27833IL0140009-03.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140009","Ambetter Balanced Care 4 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140009-04","Ambetter Balanced Care 4 (2018): IlliniCare Health Network","73% AV Level Silver Plan",,"0.727430168333116","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$1,800","$1,300","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140009-04.pdf","https://api.centene.com/Brochures/2018/27833IL0140009-04.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140009","Ambetter Balanced Care 4 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140009-05","Ambetter Balanced Care 4 (2018): IlliniCare Health Network","87% AV Level Silver Plan",,"0.863154651499334","Yes","Yes","No","100%",,"$1,850","$0","$0","$60","$1,850","$0","$0","$60","$1,630","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140009-05.pdf","https://api.centene.com/Brochures/2018/27833IL0140009-05.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0140009","Ambetter Balanced Care 4 (2018): IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0140009-06","Ambetter Balanced Care 4 (2018): IlliniCare Health Network","94% AV Level Silver Plan",,"0.940719200046497","Yes","Yes","No","100%",,"$600","$0","$0","$60","$600","$0","$0","$60","$600","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0140009-06.pdf","https://api.centene.com/Brochures/2018/27833IL0140009-06.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150001-00","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental: IlliniCare Health Network","Standard Silver Off Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150001-00.pdf","https://api.centene.com/Brochures/2018/27833IL0150001-00.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150001-01","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental: IlliniCare Health Network","Standard Silver On Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150001-01.pdf","https://api.centene.com/Brochures/2018/27833IL0150001-01.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150001-02","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental: IlliniCare Health Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150001-02.pdf","https://api.centene.com/Brochures/2018/27833IL0150001-02.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150001-03","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental: IlliniCare Health Network","Limited Cost Sharing Plan Variation",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150001-03.pdf","https://api.centene.com/Brochures/2018/27833IL0150001-03.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150001-04","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental: IlliniCare Health Network","73% AV Level Silver Plan",,"0.739812128349422","Yes","Yes","No","100%",,"$3,000","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150001-04.pdf","https://api.centene.com/Brochures/2018/27833IL0150001-04.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150001-05","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental: IlliniCare Health Network","87% AV Level Silver Plan",,"0.87931537568396","Yes","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$300","$400","$60","$750","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150001-05.pdf","https://api.centene.com/Brochures/2018/27833IL0150001-05.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150001-06","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental: IlliniCare Health Network","94% AV Level Silver Plan",,"0.949528260595198","Yes","Yes","No","100%",,"$0","$0","$950","$60","$0","$300","$400","$60","$0","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150001-06.pdf","https://api.centene.com/Brochures/2018/27833IL0150001-06.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150002-00","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental: IlliniCare Health Network","Standard Silver Off Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150002-00.pdf","https://api.centene.com/Brochures/2018/27833IL0150002-00.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150002-01","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental: IlliniCare Health Network","Standard Silver On Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150002-01.pdf","https://api.centene.com/Brochures/2018/27833IL0150002-01.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150002-02","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental: IlliniCare Health Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150002-02.pdf","https://api.centene.com/Brochures/2018/27833IL0150002-02.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150002-03","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental: IlliniCare Health Network","Limited Cost Sharing Plan Variation",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150002-03.pdf","https://api.centene.com/Brochures/2018/27833IL0150002-03.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150002-04","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental: IlliniCare Health Network","73% AV Level Silver Plan",,"0.729896135538709","Yes","Yes","No","100%",,"$4,600","$400","$0","$60","$1,900","$1,400","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150002-04.pdf","https://api.centene.com/Brochures/2018/27833IL0150002-04.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150002-05","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental: IlliniCare Health Network","87% AV Level Silver Plan",,"0.867181007012531","Yes","Yes","No","100%",,"$1,700","$10","$0","$60","$1,500","$250","$0","$60","$1,600","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150002-05.pdf","https://api.centene.com/Brochures/2018/27833IL0150002-05.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150002-06","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental: IlliniCare Health Network","94% AV Level Silver Plan",,"0.942313720589882","Yes","Yes","No","100%",,"$572","$3","$0","$60","$500","$70","$0","$60","$575","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150002-06.pdf","https://api.centene.com/Brochures/2018/27833IL0150002-06.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150004","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150004-00","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental: IlliniCare Health Network","Standard Silver Off Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150004-00.pdf","https://api.centene.com/Brochures/2018/27833IL0150004-00.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150004","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150004-01","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental: IlliniCare Health Network","Standard Silver On Exchange Plan",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150004-01.pdf","https://api.centene.com/Brochures/2018/27833IL0150004-01.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150004","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150004-02","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental: IlliniCare Health Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150004-02.pdf","https://api.centene.com/Brochures/2018/27833IL0150004-02.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150004","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150004-03","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental: IlliniCare Health Network","Limited Cost Sharing Plan Variation",,"0.707657754179468","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150004-03.pdf","https://api.centene.com/Brochures/2018/27833IL0150004-03.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150004","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150004-04","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental: IlliniCare Health Network","73% AV Level Silver Plan",,"0.739635889295605","Yes","Yes","No","100%",,"$1,950","$1,300","$300","$60","$1,300","$1,700","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150004-04.pdf","https://api.centene.com/Brochures/2018/27833IL0150004-04.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150004","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150004-05","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental: IlliniCare Health Network","87% AV Level Silver Plan",,"0.879959544313859","Yes","Yes","No","100%",,"$675","$200","$300","$60","$675","$300","$600","$60","$675","$20","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150004-05.pdf","https://api.centene.com/Brochures/2018/27833IL0150004-05.pdf"
"2018","IL","27833","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","27833IL0150004","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental: IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9534",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","https://ambetter.illinicare.com/resources/pharmacy-resources.html","27833IL0150004-06","Ambetter Balanced Care 3 (2018) + Vision + Adult Dental: IlliniCare Health Network","94% AV Level Silver Plan",,"0.949879112635725","Yes","Yes","No","100%",,"$200","$90","$300","$60","$200","$200","$200","$60","$200","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/27833IL0150004-06.pdf","https://api.centene.com/Brochures/2018/27833IL0150004-06.pdf"
"2018","IL","30680","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","93-0242990","30680IL0040002","EHB High PPO","30680IL004",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","30680IL0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2018","IL","30680","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","93-0242990","30680IL0040001","EHB Low PPO","30680IL004",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","30680IL0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950019","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS023","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950019-03","BlueCare Direct Silver? 212 with Advocate","Limited Cost Sharing Plan Variation",,"0.714827355042273","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950019","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS023","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950019-04","BlueCare Direct Silver? 212 with Advocate","73% AV Level Silver Plan",,"0.735946150820262","Yes","Yes","No","100%",,"$2,100","$900","$2,800","$60","$2,100","$500","$1,000","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950018","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS013","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950018-02","BlueCare Direct Silver? 212 with Advocate","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950018","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS013","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950018-03","BlueCare Direct Silver? 212 with Advocate","Limited Cost Sharing Plan Variation",,"0.714827355042273","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950018","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS013","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950018-04","BlueCare Direct Silver? 212 with Advocate","73% AV Level Silver Plan",,"0.735946150820262","Yes","Yes","No","100%",,"$2,100","$900","$2,800","$60","$2,100","$500","$1,000","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950018","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS013","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950018-05","BlueCare Direct Silver? 212 with Advocate","87% AV Level Silver Plan",,"0.87424871081585","Yes","Yes","No","100%",,"$200","$900","$1,400","$60","$200","$200","$1,500","$60","$200","$200","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950018","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS013","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950018-06","BlueCare Direct Silver? 212 with Advocate","94% AV Level Silver Plan",,"0.93794339877856","Yes","Yes","No","100%",,"$0","$200","$1,800","$60","$0","$0","$1,100","$60","$0","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950019","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS023","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950019-00","BlueCare Direct Silver? 212 with Advocate","Standard Silver Off Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL1000008","Blue FocusCare Silver? 210","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.999",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL1000008-02","Blue FocusCare Silver? 210","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL1000008-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","30680","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","93-0242990","30680IL0030002","EHB High Passive","30680IL003",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","30680IL0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2018","IL","30680","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","93-0242990","30680IL0030001","EHB Low Passive","30680IL003",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","30680IL0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950018","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS013","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950018-00","BlueCare Direct Silver? 212 with Advocate","Standard Silver Off Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","Yes","36-1236610","36096IL0830001","BlueCare Dental? 1A","36096IL083",,"ILN005","ILS005",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830001-00","BlueCare Dental? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsil.com/static/il/pdf/dental/2018/bluecare-dental-individuals-and-families-il2018.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","Yes","36-1236610","36096IL0830001","BlueCare Dental? 1A","36096IL083",,"ILN005","ILS005",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830001-01","BlueCare Dental? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsil.com/static/il/pdf/dental/2018/bluecare-dental-individuals-and-families-il2018.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950018","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS013","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950018-01","BlueCare Direct Silver? 212 with Advocate","Standard Silver On Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950019","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS023","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950019-01","BlueCare Direct Silver? 212 with Advocate","Standard Silver On Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950019","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS023","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950019-02","BlueCare Direct Silver? 212 with Advocate","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950019","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS023","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950019-05","BlueCare Direct Silver? 212 with Advocate","87% AV Level Silver Plan",,"0.87424871081585","Yes","Yes","No","100%",,"$200","$900","$1,400","$60","$200","$200","$1,500","$60","$200","$200","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950019","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS023","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950019-06","BlueCare Direct Silver? 212 with Advocate","94% AV Level Silver Plan",,"0.93794339877856","Yes","Yes","No","100%",,"$0","$200","$1,800","$60","$0","$0","$1,100","$60","$0","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950020","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS033","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950020-00","BlueCare Direct Silver? 212 with Advocate","Standard Silver Off Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950020","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS033","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950020-01","BlueCare Direct Silver? 212 with Advocate","Standard Silver On Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950020","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS033","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950020-02","BlueCare Direct Silver? 212 with Advocate","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950020","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS033","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950020-03","BlueCare Direct Silver? 212 with Advocate","Limited Cost Sharing Plan Variation",,"0.714827355042273","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950020","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS033","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950020-04","BlueCare Direct Silver? 212 with Advocate","73% AV Level Silver Plan",,"0.735946150820262","Yes","Yes","No","100%",,"$2,100","$900","$2,800","$60","$2,100","$500","$1,000","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950020","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS033","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950020-05","BlueCare Direct Silver? 212 with Advocate","87% AV Level Silver Plan",,"0.87424871081585","Yes","Yes","No","100%",,"$200","$900","$1,400","$60","$200","$200","$1,500","$60","$200","$200","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950020","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS033","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950020-06","BlueCare Direct Silver? 212 with Advocate","94% AV Level Silver Plan",,"0.93794339877856","Yes","Yes","No","100%",,"$0","$200","$1,800","$60","$0","$0","$1,100","$60","$0","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950021","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS043","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950021-00","BlueCare Direct Silver? 212 with Advocate","Standard Silver Off Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950021","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS043","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950021-01","BlueCare Direct Silver? 212 with Advocate","Standard Silver On Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950021","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS043","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950021-02","BlueCare Direct Silver? 212 with Advocate","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950021","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS043","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950021-03","BlueCare Direct Silver? 212 with Advocate","Limited Cost Sharing Plan Variation",,"0.714827355042273","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950021","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS043","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950021-04","BlueCare Direct Silver? 212 with Advocate","73% AV Level Silver Plan",,"0.735946150820262","Yes","Yes","No","100%",,"$2,100","$900","$2,800","$60","$2,100","$500","$1,000","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950021","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS043","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950021-05","BlueCare Direct Silver? 212 with Advocate","87% AV Level Silver Plan",,"0.87424871081585","Yes","Yes","No","100%",,"$200","$900","$1,400","$60","$200","$200","$1,500","$60","$200","$200","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0950021","BlueCare Direct Silver? 212 with Advocate","36096IL095",,"ILN003","ILS043","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0950021-06","BlueCare Direct Silver? 212 with Advocate","94% AV Level Silver Plan",,"0.93794339877856","Yes","Yes","No","100%",,"$0","$200","$1,800","$60","$0","$0","$1,100","$60","$0","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0950018-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL1000005","Blue FocusCare Gold? 211","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.999",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL1000005-00","Blue FocusCare Gold? 211","Standard Gold Off Exchange Plan",,"0.8092047781528","Yes","Yes","No","100%",,"$500","$1,000","$600","$60","$500","$300","$1,200","$60","$500","$400","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL1000005-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","Yes","36-1236610","36096IL0830003","BlueCare Dental 4 Kids? 1A","36096IL083",,"ILN005","ILS005",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830003-00","BlueCare Dental 4 Kids? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsil.com/static/il/pdf/dental/2018/bluecare-dental-individuals-and-families-il2018.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","Yes","36-1236610","36096IL0830003","BlueCare Dental 4 Kids? 1A","36096IL083",,"ILN005","ILS005",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830003-01","BlueCare Dental 4 Kids? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsil.com/static/il/pdf/dental/2018/bluecare-dental-individuals-and-families-il2018.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL1000005","Blue FocusCare Gold? 211","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.999",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL1000005-01","Blue FocusCare Gold? 211","Standard Gold On Exchange Plan",,"0.8092047781528","Yes","Yes","No","100%",,"$500","$1,000","$600","$60","$500","$300","$1,200","$60","$500","$400","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL1000005-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL1000005","Blue FocusCare Gold? 211","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.999",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL1000005-02","Blue FocusCare Gold? 211","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL1000005-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL1000005","Blue FocusCare Gold? 211","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.999",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL1000005-03","Blue FocusCare Gold? 211","Limited Cost Sharing Plan Variation",,"0.8092047781528","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL1000005-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL1000008","Blue FocusCare Silver? 210","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.999",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL1000008-00","Blue FocusCare Silver? 210","Standard Silver Off Exchange Plan",,"0.665001038008449","Yes","Yes","No","100%",,"$2,400","$1,300","$0","$60","$3,750","$500","$500","$60","$1,400","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL1000008-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL1000008","Blue FocusCare Silver? 210","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.999",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL1000008-01","Blue FocusCare Silver? 210","Standard Silver On Exchange Plan",,"0.665001038008449","Yes","Yes","No","100%",,"$2,400","$1,300","$0","$60","$3,750","$500","$500","$60","$1,400","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL1000008-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL1000008","Blue FocusCare Silver? 210","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.999",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL1000008-03","Blue FocusCare Silver? 210","Limited Cost Sharing Plan Variation",,"0.665001038008449","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL1000008-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810092","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS042","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810092-00","Blue Precision Gold HMO? 207","Standard Gold Off Exchange Plan",,"0.8092047781528","Yes","Yes","No","100%",,"$500","$1,000","$600","$60","$500","$200","$1,200","$60","$500","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810092","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS042","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810092-01","Blue Precision Gold HMO? 207","Standard Gold On Exchange Plan",,"0.8092047781528","Yes","Yes","No","100%",,"$500","$1,000","$600","$60","$500","$200","$1,200","$60","$500","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810092","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS042","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810092-02","Blue Precision Gold HMO? 207","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810110","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS042","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810110-00","Blue Precision Bronze HMO? 205","Standard Bronze Off Exchange Plan",,"0.610657506831782","Yes","Yes","No","100%",,"$2,400","$1,600","$0","$60","$6,000","$700","$0","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810110","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS042","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810110-01","Blue Precision Bronze HMO? 205","Standard Bronze On Exchange Plan",,"0.610657506831782","Yes","Yes","No","100%",,"$2,400","$1,600","$0","$60","$6,000","$700","$0","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810096","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS022","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810096-05","Blue Precision Silver HMO? 206","87% AV Level Silver Plan",,"0.87424871081585","Yes","Yes","No","100%",,"$200","$900","$1,400","$60","$200","$200","$1,500","$60","$200","$200","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810096","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS022","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810096-06","Blue Precision Silver HMO? 206","94% AV Level Silver Plan",,"0.93794339877856","Yes","Yes","No","100%",,"$0","$200","$1,800","$60","$0","$0","$1,100","$60","$0","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL1000008","Blue FocusCare Silver? 210","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.999",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL1000008-04","Blue FocusCare Silver? 210","73% AV Level Silver Plan",,"0.731275197564619","Yes","Yes","No","100%",,"$1,600","$1,300","$200","$60","$1,600","$500","$1,000","$60","$1,400","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$4800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL1000008-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL1000008","Blue FocusCare Silver? 210","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.999",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL1000008-05","Blue FocusCare Silver? 210","87% AV Level Silver Plan",,"0.870626889075179","Yes","Yes","No","100%",,"$250","$800","$600","$60","$250","$200","$1,200","$60","$250","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$750 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL1000008-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL1000008","Blue FocusCare Silver? 210","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.999",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL1000008-06","Blue FocusCare Silver? 210","94% AV Level Silver Plan",,"0.93794040480513","Yes","Yes","No","100%",,"$0","$400","$400","$60","$0","$100","$1,000","$60","$0","$40","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL1000008-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL1000009","Blue FocusCare Bronze? 209","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.999",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL1000009-00","Blue FocusCare Bronze? 209","Standard Bronze Off Exchange Plan",,"0.610657506831782","Yes","Yes","No","100%",,"$2,400","$1,500","$0","$60","$6,000","$700","$0","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL1000009-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL1000009","Blue FocusCare Bronze? 209","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.999",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL1000009-01","Blue FocusCare Bronze? 209","Standard Bronze On Exchange Plan",,"0.610657506831782","Yes","Yes","No","100%",,"$2,400","$1,500","$0","$60","$6,000","$700","$0","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL1000009-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL1000009","Blue FocusCare Bronze? 209","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.999",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL1000009-02","Blue FocusCare Bronze? 209","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL1000009-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL1000009","Blue FocusCare Bronze? 209","36096IL100",,"ILN007","ILS017","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.999",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL1000009-03","Blue FocusCare Bronze? 209","Limited Cost Sharing Plan Variation",,"0.610657506831782","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL1000009-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810080","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS012","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810080-00","Blue Precision Gold HMO? 207","Standard Gold Off Exchange Plan",,"0.8092047781528","Yes","Yes","No","100%",,"$500","$1,000","$600","$60","$500","$200","$1,200","$60","$500","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","Yes","36-1236610","36096IL0830002","BlueCare Dental? 1B","36096IL083",,"ILN005","ILS005",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830002-00","BlueCare Dental? 1B","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsil.com/static/il/pdf/dental/2018/bluecare-dental-individuals-and-families-il2018.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","Yes","36-1236610","36096IL0830002","BlueCare Dental? 1B","36096IL083",,"ILN005","ILS005",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830002-01","BlueCare Dental? 1B","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsil.com/static/il/pdf/dental/2018/bluecare-dental-individuals-and-families-il2018.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810080","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS012","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810080-01","Blue Precision Gold HMO? 207","Standard Gold On Exchange Plan",,"0.8092047781528","Yes","Yes","No","100%",,"$500","$1,000","$600","$60","$500","$200","$1,200","$60","$500","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810080","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS012","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810080-02","Blue Precision Gold HMO? 207","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810080","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS012","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810080-03","Blue Precision Gold HMO? 207","Limited Cost Sharing Plan Variation",,"0.8092047781528","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810090","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS022","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810090-00","Blue Precision Gold HMO? 207","Standard Gold Off Exchange Plan",,"0.8092047781528","Yes","Yes","No","100%",,"$500","$1,000","$600","$60","$500","$200","$1,200","$60","$500","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810090","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS022","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810090-01","Blue Precision Gold HMO? 207","Standard Gold On Exchange Plan",,"0.8092047781528","Yes","Yes","No","100%",,"$500","$1,000","$600","$60","$500","$200","$1,200","$60","$500","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810090","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS022","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810090-02","Blue Precision Gold HMO? 207","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810090","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS022","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810090-03","Blue Precision Gold HMO? 207","Limited Cost Sharing Plan Variation",,"0.8092047781528","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810091","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS032","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810091-00","Blue Precision Gold HMO? 207","Standard Gold Off Exchange Plan",,"0.8092047781528","Yes","Yes","No","100%",,"$500","$1,000","$600","$60","$500","$200","$1,200","$60","$500","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810091","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS032","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810091-01","Blue Precision Gold HMO? 207","Standard Gold On Exchange Plan",,"0.8092047781528","Yes","Yes","No","100%",,"$500","$1,000","$600","$60","$500","$200","$1,200","$60","$500","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810091","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS032","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810091-02","Blue Precision Gold HMO? 207","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810091","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS032","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810091-03","Blue Precision Gold HMO? 207","Limited Cost Sharing Plan Variation",,"0.8092047781528","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810092","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS042","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810092-03","Blue Precision Gold HMO? 207","Limited Cost Sharing Plan Variation",,"0.8092047781528","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810093","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS052","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9996",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810093-00","Blue Precision Gold HMO? 207","Standard Gold Off Exchange Plan",,"0.8092047781528","Yes","Yes","No","100%",,"$500","$1,000","$600","$60","$500","$200","$1,200","$60","$500","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810108","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS022","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810108-03","Blue Precision Bronze HMO? 205","Limited Cost Sharing Plan Variation",,"0.610657506831782","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810109","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS032","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810109-00","Blue Precision Bronze HMO? 205","Standard Bronze Off Exchange Plan",,"0.610657506831782","Yes","Yes","No","100%",,"$2,400","$1,600","$0","$60","$6,000","$700","$0","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810109","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS032","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810109-01","Blue Precision Bronze HMO? 205","Standard Bronze On Exchange Plan",,"0.610657506831782","Yes","Yes","No","100%",,"$2,400","$1,600","$0","$60","$6,000","$700","$0","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810109","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS032","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810109-02","Blue Precision Bronze HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810096","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS022","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810096-04","Blue Precision Silver HMO? 206","73% AV Level Silver Plan",,"0.735946150820262","Yes","Yes","No","100%",,"$2,100","$900","$2,800","$60","$2,100","$500","$1,000","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810097","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS032","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810097-00","Blue Precision Silver HMO? 206","Standard Silver Off Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810100","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS072","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810100-00","Blue Precision Silver HMO? 206","Standard Silver Off Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810093","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS052","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9996",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810093-01","Blue Precision Gold HMO? 207","Standard Gold On Exchange Plan",,"0.8092047781528","Yes","Yes","No","100%",,"$500","$1,000","$600","$60","$500","$200","$1,200","$60","$500","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810093","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS052","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9996",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810093-02","Blue Precision Gold HMO? 207","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810093","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS052","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9996",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810093-03","Blue Precision Gold HMO? 207","Limited Cost Sharing Plan Variation",,"0.8092047781528","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810094","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS072","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810094-00","Blue Precision Gold HMO? 207","Standard Gold Off Exchange Plan",,"0.8092047781528","Yes","Yes","No","100%",,"$500","$1,000","$600","$60","$500","$200","$1,200","$60","$500","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810094","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS072","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810094-01","Blue Precision Gold HMO? 207","Standard Gold On Exchange Plan",,"0.8092047781528","Yes","Yes","No","100%",,"$500","$1,000","$600","$60","$500","$200","$1,200","$60","$500","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810094","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS072","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810094-02","Blue Precision Gold HMO? 207","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810094","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS072","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810094-03","Blue Precision Gold HMO? 207","Limited Cost Sharing Plan Variation",,"0.8092047781528","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810095","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS082","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810095-00","Blue Precision Gold HMO? 207","Standard Gold Off Exchange Plan",,"0.8092047781528","Yes","Yes","No","100%",,"$500","$1,000","$600","$60","$500","$200","$1,200","$60","$500","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810095","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS082","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810095-01","Blue Precision Gold HMO? 207","Standard Gold On Exchange Plan",,"0.8092047781528","Yes","Yes","No","100%",,"$500","$1,000","$600","$60","$500","$200","$1,200","$60","$500","$300","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810095","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS082","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810095-02","Blue Precision Gold HMO? 207","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810095","Blue Precision Gold HMO? 207","36096IL081",,"ILN002","ILS082","ILF003","New","HMO","Gold","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810095-03","Blue Precision Gold HMO? 207","Limited Cost Sharing Plan Variation",,"0.8092047781528","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810080-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810083","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS012","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810083-00","Blue Precision Bronze HMO? 205","Standard Bronze Off Exchange Plan",,"0.610657506831782","Yes","Yes","No","100%",,"$2,400","$1,600","$0","$60","$6,000","$700","$0","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","Yes","36-1236610","36096IL0830004","BlueCare Dental 4 Kids? 1B","36096IL083",,"ILN005","ILS005",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830004-00","BlueCare Dental 4 Kids? 1B","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsil.com/static/il/pdf/dental/2018/bluecare-dental-individuals-and-families-il2018.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","Yes","36-1236610","36096IL0830004","BlueCare Dental 4 Kids? 1B","36096IL083",,"ILN005","ILS005",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830004-01","BlueCare Dental 4 Kids? 1B","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsil.com/static/il/pdf/dental/2018/bluecare-dental-individuals-and-families-il2018.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810083","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS012","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810083-01","Blue Precision Bronze HMO? 205","Standard Bronze On Exchange Plan",,"0.610657506831782","Yes","Yes","No","100%",,"$2,400","$1,600","$0","$60","$6,000","$700","$0","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810083","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS012","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810083-02","Blue Precision Bronze HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810083","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS012","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810083-03","Blue Precision Bronze HMO? 205","Limited Cost Sharing Plan Variation",,"0.610657506831782","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810108","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS022","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810108-00","Blue Precision Bronze HMO? 205","Standard Bronze Off Exchange Plan",,"0.610657506831782","Yes","Yes","No","100%",,"$2,400","$1,600","$0","$60","$6,000","$700","$0","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810108","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS022","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810108-01","Blue Precision Bronze HMO? 205","Standard Bronze On Exchange Plan",,"0.610657506831782","Yes","Yes","No","100%",,"$2,400","$1,600","$0","$60","$6,000","$700","$0","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810108","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS022","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810108-02","Blue Precision Bronze HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810109","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS032","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810109-03","Blue Precision Bronze HMO? 205","Limited Cost Sharing Plan Variation",,"0.610657506831782","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810110","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS042","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810110-02","Blue Precision Bronze HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810110","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS042","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810110-03","Blue Precision Bronze HMO? 205","Limited Cost Sharing Plan Variation",,"0.610657506831782","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810111","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS052","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810111-00","Blue Precision Bronze HMO? 205","Standard Bronze Off Exchange Plan",,"0.610657506831782","Yes","Yes","No","100%",,"$2,400","$1,600","$0","$60","$6,000","$700","$0","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810111","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS052","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810111-01","Blue Precision Bronze HMO? 205","Standard Bronze On Exchange Plan",,"0.610657506831782","Yes","Yes","No","100%",,"$2,400","$1,600","$0","$60","$6,000","$700","$0","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810111","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS052","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810111-02","Blue Precision Bronze HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810111","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS052","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810111-03","Blue Precision Bronze HMO? 205","Limited Cost Sharing Plan Variation",,"0.610657506831782","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810112","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS072","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810112-00","Blue Precision Bronze HMO? 205","Standard Bronze Off Exchange Plan",,"0.610657506831782","Yes","Yes","No","100%",,"$2,400","$1,600","$0","$60","$6,000","$700","$0","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810112","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS072","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810112-01","Blue Precision Bronze HMO? 205","Standard Bronze On Exchange Plan",,"0.610657506831782","Yes","Yes","No","100%",,"$2,400","$1,600","$0","$60","$6,000","$700","$0","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810112","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS072","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810112-02","Blue Precision Bronze HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810112","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS072","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9994",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810112-03","Blue Precision Bronze HMO? 205","Limited Cost Sharing Plan Variation",,"0.610657506831782","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810113","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS082","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810113-00","Blue Precision Bronze HMO? 205","Standard Bronze Off Exchange Plan",,"0.610657506831782","Yes","Yes","No","100%",,"$2,400","$1,600","$0","$60","$6,000","$700","$0","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810113","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS082","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810113-01","Blue Precision Bronze HMO? 205","Standard Bronze On Exchange Plan",,"0.610657506831782","Yes","Yes","No","100%",,"$2,400","$1,600","$0","$60","$6,000","$700","$0","$60","$1,400","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810113","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS082","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810113-02","Blue Precision Bronze HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810113","Blue Precision Bronze HMO? 205","36096IL081",,"ILN002","ILS082","ILF003","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9993",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810113-03","Blue Precision Bronze HMO? 205","Limited Cost Sharing Plan Variation",,"0.610657506831782","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$14700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810083-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810081","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS012","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810081-00","Blue Precision Silver HMO? 206","Standard Silver Off Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810081","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS012","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810081-01","Blue Precision Silver HMO? 206","Standard Silver On Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810081","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS012","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810081-02","Blue Precision Silver HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810081","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS012","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810081-03","Blue Precision Silver HMO? 206","Limited Cost Sharing Plan Variation",,"0.714827355042273","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810081","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS012","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810081-04","Blue Precision Silver HMO? 206","73% AV Level Silver Plan",,"0.735946150820262","Yes","Yes","No","100%",,"$2,100","$900","$2,800","$60","$2,100","$500","$1,000","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810081","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS012","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810081-05","Blue Precision Silver HMO? 206","87% AV Level Silver Plan",,"0.87424871081585","Yes","Yes","No","100%",,"$200","$900","$1,400","$60","$200","$200","$1,500","$60","$200","$200","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810081","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS012","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810081-06","Blue Precision Silver HMO? 206","94% AV Level Silver Plan",,"0.93794339877856","Yes","Yes","No","100%",,"$0","$200","$1,800","$60","$0","$0","$1,100","$60","$0","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810096","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS022","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810096-00","Blue Precision Silver HMO? 206","Standard Silver Off Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810096","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS022","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810096-01","Blue Precision Silver HMO? 206","Standard Silver On Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810096","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS022","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810096-02","Blue Precision Silver HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810096","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS022","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810096-03","Blue Precision Silver HMO? 206","Limited Cost Sharing Plan Variation",,"0.714827355042273","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990166","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS041","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990166-00","Blue Choice Preferred Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990166","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS041","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990166-01","Blue Choice Preferred Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990166","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS041","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990166-02","Blue Choice Preferred Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990166","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS041","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990166-03","Blue Choice Preferred Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990173","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS111","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990173-01","Blue Choice Preferred Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990190","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS041","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990190-02","Blue Choice Preferred Bronze PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810097","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS032","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810097-01","Blue Precision Silver HMO? 206","Standard Silver On Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810097","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS032","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810097-02","Blue Precision Silver HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810097","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS032","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810097-03","Blue Precision Silver HMO? 206","Limited Cost Sharing Plan Variation",,"0.714827355042273","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810097","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS032","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810097-04","Blue Precision Silver HMO? 206","73% AV Level Silver Plan",,"0.735946150820262","Yes","Yes","No","100%",,"$2,100","$900","$2,800","$60","$2,100","$500","$1,000","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810097","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS032","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810097-05","Blue Precision Silver HMO? 206","87% AV Level Silver Plan",,"0.87424871081585","Yes","Yes","No","100%",,"$200","$900","$1,400","$60","$200","$200","$1,500","$60","$200","$200","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810097","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS032","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810097-06","Blue Precision Silver HMO? 206","94% AV Level Silver Plan",,"0.93794339877856","Yes","Yes","No","100%",,"$0","$200","$1,800","$60","$0","$0","$1,100","$60","$0","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810098","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS042","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810098-00","Blue Precision Silver HMO? 206","Standard Silver Off Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810098","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS042","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810098-01","Blue Precision Silver HMO? 206","Standard Silver On Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810098","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS042","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810098-02","Blue Precision Silver HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810098","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS042","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810098-03","Blue Precision Silver HMO? 206","Limited Cost Sharing Plan Variation",,"0.714827355042273","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810098","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS042","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810098-04","Blue Precision Silver HMO? 206","73% AV Level Silver Plan",,"0.735946150820262","Yes","Yes","No","100%",,"$2,100","$900","$2,800","$60","$2,100","$500","$1,000","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810098","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS042","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810098-05","Blue Precision Silver HMO? 206","87% AV Level Silver Plan",,"0.87424871081585","Yes","Yes","No","100%",,"$200","$900","$1,400","$60","$200","$200","$1,500","$60","$200","$200","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810098","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS042","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810098-06","Blue Precision Silver HMO? 206","94% AV Level Silver Plan",,"0.93794339877856","Yes","Yes","No","100%",,"$0","$200","$1,800","$60","$0","$0","$1,100","$60","$0","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810099","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS052","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810099-00","Blue Precision Silver HMO? 206","Standard Silver Off Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810099","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS052","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810099-01","Blue Precision Silver HMO? 206","Standard Silver On Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810099","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS052","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810099-02","Blue Precision Silver HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810099","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS052","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810099-03","Blue Precision Silver HMO? 206","Limited Cost Sharing Plan Variation",,"0.714827355042273","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810099","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS052","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810099-04","Blue Precision Silver HMO? 206","73% AV Level Silver Plan",,"0.735946150820262","Yes","Yes","No","100%",,"$2,100","$900","$2,800","$60","$2,100","$500","$1,000","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810099","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS052","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810099-05","Blue Precision Silver HMO? 206","87% AV Level Silver Plan",,"0.87424871081585","Yes","Yes","No","100%",,"$200","$900","$1,400","$60","$200","$200","$1,500","$60","$200","$200","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810099","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS052","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810099-06","Blue Precision Silver HMO? 206","94% AV Level Silver Plan",,"0.93794339877856","Yes","Yes","No","100%",,"$0","$200","$1,800","$60","$0","$0","$1,100","$60","$0","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810100","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS072","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810100-01","Blue Precision Silver HMO? 206","Standard Silver On Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990164","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS021","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990164-03","Blue Choice Preferred Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990165","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS031","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990165-00","Blue Choice Preferred Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990165","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS031","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990165-01","Blue Choice Preferred Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990172","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS101","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990172-02","Blue Choice Preferred Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990172","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS101","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990172-03","Blue Choice Preferred Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990173","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS111","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990173-00","Blue Choice Preferred Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990173","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS111","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990173-02","Blue Choice Preferred Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810100","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS072","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810100-02","Blue Precision Silver HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810100","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS072","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810100-03","Blue Precision Silver HMO? 206","Limited Cost Sharing Plan Variation",,"0.714827355042273","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810100","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS072","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810100-04","Blue Precision Silver HMO? 206","73% AV Level Silver Plan",,"0.735946150820262","Yes","Yes","No","100%",,"$2,100","$900","$2,800","$60","$2,100","$500","$1,000","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810100","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS072","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810100-05","Blue Precision Silver HMO? 206","87% AV Level Silver Plan",,"0.87424871081585","Yes","Yes","No","100%",,"$200","$900","$1,400","$60","$200","$200","$1,500","$60","$200","$200","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810100","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS072","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810100-06","Blue Precision Silver HMO? 206","94% AV Level Silver Plan",,"0.93794339877856","Yes","Yes","No","100%",,"$0","$200","$1,800","$60","$0","$0","$1,100","$60","$0","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810101","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS082","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810101-00","Blue Precision Silver HMO? 206","Standard Silver Off Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810101","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS082","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810101-01","Blue Precision Silver HMO? 206","Standard Silver On Exchange Plan",,"0.714827355042273","Yes","Yes","No","100%",,"$2,250","$900","$4,200","$60","$2,250","$500","$900","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810101","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS082","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810101-02","Blue Precision Silver HMO? 206","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810101","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS082","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810101-03","Blue Precision Silver HMO? 206","Limited Cost Sharing Plan Variation",,"0.714827355042273","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$6750 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810101","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS082","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810101-04","Blue Precision Silver HMO? 206","73% AV Level Silver Plan",,"0.735946150820262","Yes","Yes","No","100%",,"$2,100","$900","$2,800","$60","$2,100","$500","$1,000","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$6300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810101","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS082","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810101-05","Blue Precision Silver HMO? 206","87% AV Level Silver Plan",,"0.87424871081585","Yes","Yes","No","100%",,"$200","$900","$1,400","$60","$200","$200","$1,500","$60","$200","$200","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0810101","Blue Precision Silver HMO? 206","36096IL081",,"ILN002","ILS082","ILF002","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9995",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0810101-06","Blue Precision Silver HMO? 206","94% AV Level Silver Plan",,"0.93794339877856","Yes","Yes","No","100%",,"$0","$200","$1,800","$60","$0","$0","$1,100","$60","$0","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0810081-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990125","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS011","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990125-00","Blue Choice Preferred Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990125","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS011","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990125-01","Blue Choice Preferred Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990125","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS011","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990125-02","Blue Choice Preferred Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990125","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS011","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990125-03","Blue Choice Preferred Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990164","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS021","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990164-00","Blue Choice Preferred Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990164","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS021","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990164-01","Blue Choice Preferred Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990164","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS021","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990164-02","Blue Choice Preferred Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990165","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS031","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990165-02","Blue Choice Preferred Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990165","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS031","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990165-03","Blue Choice Preferred Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990167","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS051","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990167-00","Blue Choice Preferred Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990167","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS051","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990167-01","Blue Choice Preferred Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990167","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS051","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990167-02","Blue Choice Preferred Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990167","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS051","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990167-03","Blue Choice Preferred Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990168","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS061","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990168-00","Blue Choice Preferred Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990168","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS061","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990168-01","Blue Choice Preferred Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990168","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS061","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990168-02","Blue Choice Preferred Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990168","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS061","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990168-03","Blue Choice Preferred Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990169","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS071","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990169-00","Blue Choice Preferred Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990169","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS071","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990169-01","Blue Choice Preferred Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990169","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS071","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990169-02","Blue Choice Preferred Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990169","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS071","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990169-03","Blue Choice Preferred Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990170","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS081","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990170-00","Blue Choice Preferred Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990170","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS081","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990170-01","Blue Choice Preferred Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990170","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS081","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990170-02","Blue Choice Preferred Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990170","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS081","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990170-03","Blue Choice Preferred Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990171","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS091","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990171-00","Blue Choice Preferred Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990171","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS091","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990171-01","Blue Choice Preferred Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990171","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS091","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990171-02","Blue Choice Preferred Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990171","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS091","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990171-03","Blue Choice Preferred Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990172","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS101","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990172-00","Blue Choice Preferred Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990172","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS101","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990172-01","Blue Choice Preferred Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990173","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS111","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990173-03","Blue Choice Preferred Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990174","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS121","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990174-00","Blue Choice Preferred Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990189","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS031","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990189-03","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990190","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS041","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990190-00","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990195","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS091","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990195-02","Blue Choice Preferred Bronze PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990195","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS091","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990195-03","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990129","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS031","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990129-01","Blue Choice Preferred Gold PPO? 204","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990130","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS041","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990130-00","Blue Choice Preferred Gold PPO? 204","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990174","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS121","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990174-01","Blue Choice Preferred Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990174","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS121","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990174-02","Blue Choice Preferred Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990174","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS121","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990174-03","Blue Choice Preferred Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990175","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS131","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990175-00","Blue Choice Preferred Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990175","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS131","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990175-01","Blue Choice Preferred Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/sbc/2018/IL0990125-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990175","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS131","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990175-02","Blue Choice Preferred Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990175","Blue Choice Preferred Bronze PPO? 202","36096IL099",,"ILN001","ILS131","ILF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990175-03","Blue Choice Preferred Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990125-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990127","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS011","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990127-00","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990127","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS011","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990127-01","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990127","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS011","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990127-02","Blue Choice Preferred Bronze PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990127","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS011","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990127-03","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990188","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS021","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990188-00","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990188","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS021","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990188-01","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990188","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS021","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990188-02","Blue Choice Preferred Bronze PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990188","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS021","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990188-03","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990189","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS031","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990189-00","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990189","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS031","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990189-01","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990189","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS031","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990189-02","Blue Choice Preferred Bronze PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990190","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS041","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990190-01","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990190","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS041","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990190-03","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990191","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS051","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990191-00","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990191","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS051","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990191-01","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990196","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS101","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990196-00","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990196","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS101","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990196-01","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990129","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS031","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990129-02","Blue Choice Preferred Gold PPO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990129","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS031","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990129-03","Blue Choice Preferred Gold PPO? 204","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990136","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS101","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990136-01","Blue Choice Preferred Gold PPO? 204","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990191","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS051","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990191-02","Blue Choice Preferred Bronze PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990191","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS051","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990191-03","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990192","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS061","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990192-00","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990192","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS061","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990192-01","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990192","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS061","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990192-02","Blue Choice Preferred Bronze PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990192","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS061","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990192-03","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990193","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS071","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990193-00","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990193","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS071","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990193-01","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990193","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS071","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990193-02","Blue Choice Preferred Bronze PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990193","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS071","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990193-03","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990194","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS081","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990194-00","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990194","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS081","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990194-01","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990194","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS081","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990194-02","Blue Choice Preferred Bronze PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990194","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS081","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990194-03","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990195","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS091","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990195-00","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990195","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS091","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990195-01","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990196","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS101","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990196-02","Blue Choice Preferred Bronze PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990196","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS101","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990196-03","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990197","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS111","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990197-00","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990197","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS111","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990197-01","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990197","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS111","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990197-02","Blue Choice Preferred Bronze PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990197","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS111","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990197-03","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990198","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS121","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990198-00","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990198","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS121","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990198-01","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990198","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS121","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990198-02","Blue Choice Preferred Bronze PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990198","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS121","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990198-03","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990199","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS131","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990199-00","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990199","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS131","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990199-01","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990199","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS131","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990199-02","Blue Choice Preferred Bronze PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990199","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","36096IL099",,"ILN001","ILS131","ILF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990199-03","Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990127-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990126","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS011","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990126-00","Blue Choice Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990126","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS011","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990126-01","Blue Choice Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990176","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS021","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990176-00","Blue Choice Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990176","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS021","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990176-01","Blue Choice Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990177","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS031","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990177-00","Blue Choice Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990177","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS031","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990177-01","Blue Choice Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990178","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS041","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990178-00","Blue Choice Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990178","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS041","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990178-01","Blue Choice Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990179","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS051","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990179-00","Blue Choice Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990179","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS051","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990179-01","Blue Choice Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990180","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS061","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990180-00","Blue Choice Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990180","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS061","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990180-01","Blue Choice Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990181","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS071","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990181-00","Blue Choice Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990181","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS071","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990181-01","Blue Choice Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990182","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS081","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990182-00","Blue Choice Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990182","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS081","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990182-01","Blue Choice Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990183","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS091","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990183-00","Blue Choice Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990183","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS091","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990183-01","Blue Choice Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990184","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS101","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990184-00","Blue Choice Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990184","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS101","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990184-01","Blue Choice Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990185","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS111","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990185-00","Blue Choice Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990185","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS111","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990185-01","Blue Choice Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990186","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS121","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990186-00","Blue Choice Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990186","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS121","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990186-01","Blue Choice Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990187","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS131","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990187-00","Blue Choice Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990187","Blue Choice Preferred Security PPO? 200","36096IL099",,"ILN001","ILS131","ILF004","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990187-01","Blue Choice Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$2,100","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990126-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990122","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS011","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990122-00","Blue Choice Preferred Gold PPO? 204","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990122","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS011","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990122-01","Blue Choice Preferred Gold PPO? 204","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990122","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS011","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990122-02","Blue Choice Preferred Gold PPO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990122","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS011","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990122-03","Blue Choice Preferred Gold PPO? 204","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990128","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS021","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990128-00","Blue Choice Preferred Gold PPO? 204","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990128","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS021","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990128-01","Blue Choice Preferred Gold PPO? 204","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990128","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS021","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990128-02","Blue Choice Preferred Gold PPO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990128","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS021","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990128-03","Blue Choice Preferred Gold PPO? 204","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990129","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS031","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990129-00","Blue Choice Preferred Gold PPO? 204","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990130","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS041","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990130-01","Blue Choice Preferred Gold PPO? 204","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990130","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS041","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990130-02","Blue Choice Preferred Gold PPO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990130","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS041","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990130-03","Blue Choice Preferred Gold PPO? 204","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990135","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS091","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990135-02","Blue Choice Preferred Gold PPO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990140","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS021","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990140-02","Blue Choice Preferred Silver PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990143","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS051","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990143-03","Blue Choice Preferred Silver PPO? 203","Limited Cost Sharing Plan Variation",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990143","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS051","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990143-06","Blue Choice Preferred Silver PPO? 203","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990151","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS131","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990151-02","Blue Choice Preferred Silver PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990131","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS051","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990131-00","Blue Choice Preferred Gold PPO? 204","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990131","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS051","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990131-01","Blue Choice Preferred Gold PPO? 204","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990131","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS051","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990131-02","Blue Choice Preferred Gold PPO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990131","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS051","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990131-03","Blue Choice Preferred Gold PPO? 204","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990132","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS061","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990132-00","Blue Choice Preferred Gold PPO? 204","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990132","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS061","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990132-01","Blue Choice Preferred Gold PPO? 204","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990132","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS061","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990132-02","Blue Choice Preferred Gold PPO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990132","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS061","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990132-03","Blue Choice Preferred Gold PPO? 204","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990133","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS071","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990133-00","Blue Choice Preferred Gold PPO? 204","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990133","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS071","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990133-01","Blue Choice Preferred Gold PPO? 204","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990133","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS071","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990133-02","Blue Choice Preferred Gold PPO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990133","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS071","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990133-03","Blue Choice Preferred Gold PPO? 204","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990134","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS081","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990134-00","Blue Choice Preferred Gold PPO? 204","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990134","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS081","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990134-01","Blue Choice Preferred Gold PPO? 204","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990134","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS081","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990134-02","Blue Choice Preferred Gold PPO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990134","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS081","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990134-03","Blue Choice Preferred Gold PPO? 204","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990135","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS091","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990135-00","Blue Choice Preferred Gold PPO? 204","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990135","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS091","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990135-01","Blue Choice Preferred Gold PPO? 204","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990135","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS091","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990135-03","Blue Choice Preferred Gold PPO? 204","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990136","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS101","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990136-00","Blue Choice Preferred Gold PPO? 204","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990136","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS101","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990136-02","Blue Choice Preferred Gold PPO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990136","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS101","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990136-03","Blue Choice Preferred Gold PPO? 204","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990137","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS111","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990137-00","Blue Choice Preferred Gold PPO? 204","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990137","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS111","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990137-01","Blue Choice Preferred Gold PPO? 204","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990137","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS111","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990137-02","Blue Choice Preferred Gold PPO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990137","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS111","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990137-03","Blue Choice Preferred Gold PPO? 204","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990138","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS121","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990138-00","Blue Choice Preferred Gold PPO? 204","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990138","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS121","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990138-01","Blue Choice Preferred Gold PPO? 204","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990138","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS121","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990138-02","Blue Choice Preferred Gold PPO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990138","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS121","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990138-03","Blue Choice Preferred Gold PPO? 204","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990139","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS131","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990139-00","Blue Choice Preferred Gold PPO? 204","Standard Gold Off Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990139","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS131","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990139-01","Blue Choice Preferred Gold PPO? 204","Standard Gold On Exchange Plan",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$750","$900","$3,100","$60","$750","$200","$1,100","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990139","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS131","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990139-02","Blue Choice Preferred Gold PPO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990139","Blue Choice Preferred Gold PPO? 204","36096IL099",,"ILN001","ILS131","ILF006","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990139-03","Blue Choice Preferred Gold PPO? 204","Limited Cost Sharing Plan Variation",,"0.787241497082104","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","30.00%","$750","$750 per person","$2250 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990122-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990123","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS011","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990123-00","Blue Choice Preferred Silver PPO? 203","Standard Silver Off Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990123","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS011","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990123-01","Blue Choice Preferred Silver PPO? 203","Standard Silver On Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990123","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS011","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990123-02","Blue Choice Preferred Silver PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990123","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS011","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990123-03","Blue Choice Preferred Silver PPO? 203","Limited Cost Sharing Plan Variation",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990123","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS011","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990123-04","Blue Choice Preferred Silver PPO? 203","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990123","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS011","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990123-05","Blue Choice Preferred Silver PPO? 203","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990123","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS011","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990123-06","Blue Choice Preferred Silver PPO? 203","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990140","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS021","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990140-00","Blue Choice Preferred Silver PPO? 203","Standard Silver Off Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990140","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS021","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990140-01","Blue Choice Preferred Silver PPO? 203","Standard Silver On Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990140","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS021","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990140-03","Blue Choice Preferred Silver PPO? 203","Limited Cost Sharing Plan Variation",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990140","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS021","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990140-04","Blue Choice Preferred Silver PPO? 203","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990140","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS021","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990140-05","Blue Choice Preferred Silver PPO? 203","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990140","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS021","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990140-06","Blue Choice Preferred Silver PPO? 203","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990143","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS051","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990143-04","Blue Choice Preferred Silver PPO? 203","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990143","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS051","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990143-05","Blue Choice Preferred Silver PPO? 203","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990151","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS131","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990151-00","Blue Choice Preferred Silver PPO? 203","Standard Silver Off Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990151","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS131","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990151-01","Blue Choice Preferred Silver PPO? 203","Standard Silver On Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990141","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS031","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990141-00","Blue Choice Preferred Silver PPO? 203","Standard Silver Off Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990141","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS031","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990141-01","Blue Choice Preferred Silver PPO? 203","Standard Silver On Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990141","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS031","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990141-02","Blue Choice Preferred Silver PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990141","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS031","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990141-03","Blue Choice Preferred Silver PPO? 203","Limited Cost Sharing Plan Variation",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990141","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS031","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990141-04","Blue Choice Preferred Silver PPO? 203","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990141","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS031","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990141-05","Blue Choice Preferred Silver PPO? 203","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990141","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS031","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990141-06","Blue Choice Preferred Silver PPO? 203","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990142","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS041","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990142-00","Blue Choice Preferred Silver PPO? 203","Standard Silver Off Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990142","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS041","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990142-01","Blue Choice Preferred Silver PPO? 203","Standard Silver On Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990142","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS041","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990142-02","Blue Choice Preferred Silver PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990142","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS041","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990142-03","Blue Choice Preferred Silver PPO? 203","Limited Cost Sharing Plan Variation",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990142","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS041","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990142-04","Blue Choice Preferred Silver PPO? 203","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990142","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS041","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990142-05","Blue Choice Preferred Silver PPO? 203","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990142","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS041","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990142-06","Blue Choice Preferred Silver PPO? 203","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990143","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS051","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990143-00","Blue Choice Preferred Silver PPO? 203","Standard Silver Off Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990143","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS051","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990143-01","Blue Choice Preferred Silver PPO? 203","Standard Silver On Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990143","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS051","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990143-02","Blue Choice Preferred Silver PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990144","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS061","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990144-00","Blue Choice Preferred Silver PPO? 203","Standard Silver Off Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990144","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS061","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990144-01","Blue Choice Preferred Silver PPO? 203","Standard Silver On Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990144","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS061","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990144-02","Blue Choice Preferred Silver PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990144","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS061","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990144-03","Blue Choice Preferred Silver PPO? 203","Limited Cost Sharing Plan Variation",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990144","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS061","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990144-04","Blue Choice Preferred Silver PPO? 203","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990144","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS061","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990144-05","Blue Choice Preferred Silver PPO? 203","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990144","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS061","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990144-06","Blue Choice Preferred Silver PPO? 203","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990145","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS071","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990145-00","Blue Choice Preferred Silver PPO? 203","Standard Silver Off Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990145","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS071","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990145-01","Blue Choice Preferred Silver PPO? 203","Standard Silver On Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990145","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS071","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990145-02","Blue Choice Preferred Silver PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990145","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS071","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990145-03","Blue Choice Preferred Silver PPO? 203","Limited Cost Sharing Plan Variation",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990145","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS071","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990145-04","Blue Choice Preferred Silver PPO? 203","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990145","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS071","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990145-05","Blue Choice Preferred Silver PPO? 203","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990145","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS071","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990145-06","Blue Choice Preferred Silver PPO? 203","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990146","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS081","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990146-00","Blue Choice Preferred Silver PPO? 203","Standard Silver Off Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990146","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS081","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990146-01","Blue Choice Preferred Silver PPO? 203","Standard Silver On Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990146","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS081","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990146-02","Blue Choice Preferred Silver PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990146","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS081","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990146-03","Blue Choice Preferred Silver PPO? 203","Limited Cost Sharing Plan Variation",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990146","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS081","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990146-04","Blue Choice Preferred Silver PPO? 203","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990146","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS081","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990146-05","Blue Choice Preferred Silver PPO? 203","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990146","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS081","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990146-06","Blue Choice Preferred Silver PPO? 203","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990147","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS091","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990147-00","Blue Choice Preferred Silver PPO? 203","Standard Silver Off Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990147","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS091","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990147-01","Blue Choice Preferred Silver PPO? 203","Standard Silver On Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990147","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS091","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990147-02","Blue Choice Preferred Silver PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990147","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS091","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990147-03","Blue Choice Preferred Silver PPO? 203","Limited Cost Sharing Plan Variation",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990147","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS091","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990147-04","Blue Choice Preferred Silver PPO? 203","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990147","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS091","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990147-05","Blue Choice Preferred Silver PPO? 203","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990147","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS091","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990147-06","Blue Choice Preferred Silver PPO? 203","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990148","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS101","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990148-00","Blue Choice Preferred Silver PPO? 203","Standard Silver Off Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990148","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS101","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990148-01","Blue Choice Preferred Silver PPO? 203","Standard Silver On Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990148","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS101","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990148-02","Blue Choice Preferred Silver PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990148","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS101","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990148-03","Blue Choice Preferred Silver PPO? 203","Limited Cost Sharing Plan Variation",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990148","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS101","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990148-04","Blue Choice Preferred Silver PPO? 203","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990148","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS101","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990148-05","Blue Choice Preferred Silver PPO? 203","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990148","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS101","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990148-06","Blue Choice Preferred Silver PPO? 203","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990149","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS111","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990149-00","Blue Choice Preferred Silver PPO? 203","Standard Silver Off Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990149","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS111","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990149-01","Blue Choice Preferred Silver PPO? 203","Standard Silver On Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990149","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS111","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990149-02","Blue Choice Preferred Silver PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990149","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS111","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990149-03","Blue Choice Preferred Silver PPO? 203","Limited Cost Sharing Plan Variation",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990149","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS111","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990149-04","Blue Choice Preferred Silver PPO? 203","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990149","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS111","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990149-05","Blue Choice Preferred Silver PPO? 203","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990149","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS111","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990149-06","Blue Choice Preferred Silver PPO? 203","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990150","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS121","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990150-00","Blue Choice Preferred Silver PPO? 203","Standard Silver Off Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-00.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990150","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS121","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990150-01","Blue Choice Preferred Silver PPO? 203","Standard Silver On Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-01.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990150","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS121","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990150-02","Blue Choice Preferred Silver PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-02.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990150","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS121","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990150-03","Blue Choice Preferred Silver PPO? 203","Limited Cost Sharing Plan Variation",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990150","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS121","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990150-04","Blue Choice Preferred Silver PPO? 203","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990150","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS121","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990150-05","Blue Choice Preferred Silver PPO? 203","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990150","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS121","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990150-06","Blue Choice Preferred Silver PPO? 203","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990151","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS131","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990151-03","Blue Choice Preferred Silver PPO? 203","Limited Cost Sharing Plan Variation",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-03.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990151","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS131","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990151-04","Blue Choice Preferred Silver PPO? 203","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-04.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990151","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS131","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990151-05","Blue Choice Preferred Silver PPO? 203","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-05.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","36096","SERFF","2017-09-26 20:16:14","Individual","No","36-1236610","36096IL0990151","Blue Choice Preferred Silver PPO? 203","36096IL099",,"ILN001","ILS131","ILF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/IL_6T_EX.pdf","36096IL0990151-06","Blue Choice Preferred Silver PPO? 203","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/sbc/2018/IL0990123-06.pdf","http://www.bcbsil.com/brochure/2018/il-plan-overview.pdf"
"2018","IL","40653","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","42-0127290","40653IL0050001","Principal Plan Dental 70","40653IL005",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Child-Only",,,,,"0.82","Estimated Rate","2018-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","40653IL0050001-00","Principal Plan Dental 70","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IL","45634","SERFF","2017-08-16 20:15:58","Individual","Yes","59-0397210","45634IL0010001","DentaQuest PPO  Pediatric High","45634IL001",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0010001-00","DentaQuest PPO  Pediatric High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2018","IL","45634","SERFF","2017-08-16 20:15:58","Individual","Yes","59-0397210","45634IL0010001","DentaQuest PPO  Pediatric High","45634IL001",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0010001-01","DentaQuest PPO  Pediatric High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2018","IL","45634","SERFF","2017-08-16 20:15:58","Individual","Yes","59-0397210","45634IL0010003","DentaQuest PPO Family High","45634IL001",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0010003-00","DentaQuest PPO Family High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2018","IL","45634","SERFF","2017-08-16 20:15:58","Individual","Yes","59-0397210","45634IL0010003","DentaQuest PPO Family High","45634IL001",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0010003-01","DentaQuest PPO Family High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2018","IL","45634","SERFF","2017-08-16 20:15:58","Individual","Yes","59-0397210","45634IL0010004","DentaQuest PPO Family Low","45634IL001",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0010004-00","DentaQuest PPO Family Low","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040008","Cigna Connect 1400","53882IL004",,"ILN001","ILS001","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040008-03","Cigna Connect 1400-1","Limited Cost Sharing Plan Variation","78.27%","0.786777050612056","Yes","Yes","No","100%",,"$1,400","$30","$2,200","$10","$130","$700","$0","$200","$1,400","$30","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1400-1-chi-il","http://www.cigna.com/2018/sob/cigna-connect-1400-1-chi-il"
"2018","IL","45634","SERFF","2017-08-16 20:15:58","Individual","Yes","59-0397210","45634IL0010004","DentaQuest PPO Family Low","45634IL001",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0010004-01","DentaQuest PPO Family Low","Standard Low On Exchange Plan","69.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2018","IL","45634","SERFF","2017-08-16 20:15:58","Individual","Yes","59-0397210","45634IL0010005","DentaQuest PPO Family Preventative","45634IL001",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0010005-00","DentaQuest PPO Family Preventative","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2018","IL","45634","SERFF","2017-08-16 20:15:58","Individual","Yes","59-0397210","45634IL0010005","DentaQuest PPO Family Preventative","45634IL001",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","45634IL0010005-01","DentaQuest PPO Family Preventative","Standard Low On Exchange Plan","69.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/"
"2018","IL","52129","SERFF","2017-08-16 20:15:58","Individual","Yes","59-1031071","52129IL0030001","Cigna Dental Pediatric","52129IL003","7730182962","ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","52129IL0030001-00","Cigna Dental Pediatric","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2018/sob/cigna-dental-pediatric-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040009","Cigna Connect 7150","53882IL004",,"ILN001","ILS001","ILF001","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040009-00","Cigna Connect 7150","Standard Bronze Off Exchange Plan",,"0.585739614081393","Yes","Yes","No","100%",,"$7,150","$0","$200","$10","$6,910","$0","$0","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-7150-chi-il","http://www.cigna.com/2018/sob/cigna-connect-7150-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040009","Cigna Connect 7150","53882IL004",,"ILN001","ILS001","ILF001","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040009-01","Cigna Connect 7150","Standard Bronze On Exchange Plan",,"0.585739614081393","Yes","Yes","No","100%",,"$7,150","$0","$200","$10","$6,910","$0","$0","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-7150-chi-il","http://www.cigna.com/2018/sob/cigna-connect-7150-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040009","Cigna Connect 7150","53882IL004",,"ILN001","ILS001","ILF001","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040009-02","Cigna Connect-0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-chi-il","http://www.cigna.com/2018/sob/cigna-connect-0-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040009","Cigna Connect 7150","53882IL004",,"ILN001","ILS001","ILF001","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040009-03","Cigna Connect 7150-1","Limited Cost Sharing Plan Variation",,"0.585739614081393","Yes","Yes","No","100%",,"$7,150","$0","$200","$10","$6,910","$0","$0","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-7150-1-chi-il","http://www.cigna.com/2018/sob/cigna-connect-7150-1-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040011","Cigna Connect 4000","53882IL004",,"ILN001","ILS001","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040011-00","Cigna Connect 4000","Standard Silver Off Exchange Plan","66.15%","0.671451009579826","Yes","Yes","No","100%",,"$4,000","$40","$2,600","$10","$130","$800","$0","$200","$1,590","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4000-chi-il","http://www.cigna.com/2018/sob/cigna-connect-4000-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040011","Cigna Connect 4000","53882IL004",,"ILN001","ILS001","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040011-01","Cigna Connect 4000","Standard Silver On Exchange Plan","66.15%","0.671451009579826","Yes","Yes","No","100%",,"$4,000","$40","$2,600","$10","$130","$800","$0","$200","$1,590","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4000-chi-il","http://www.cigna.com/2018/sob/cigna-connect-4000-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040011","Cigna Connect 4000","53882IL004",,"ILN001","ILS001","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040011-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-chi-il","http://www.cigna.com/2018/sob/cigna-connect-0-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040011","Cigna Connect 4000","53882IL004",,"ILN001","ILS001","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040011-03","Cigna Connect 4000-1","Limited Cost Sharing Plan Variation","66.15%","0.671451009579826","Yes","Yes","No","100%",,"$4,000","$40","$2,600","$10","$130","$800","$0","$200","$1,590","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4000-1-chi-il","http://www.cigna.com/2018/sob/cigna-connect-4000-1-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040011","Cigna Connect 4000","53882IL004",,"ILN001","ILS001","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040011-04","Cigna Connect 2900-2","73% AV Level Silver Plan","72.13%","0.725711328481281","Yes","Yes","No","100%",,"$2,900","$40","$2,900","$10","$130","$800","$0","$200","$1,590","$50","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-2900-2-chi-il","http://www.cigna.com/2018/sob/cigna-connect-2900-2-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040011","Cigna Connect 4000","53882IL004",,"ILN001","ILS001","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040011-05","Cigna Connect 700-3","87% AV Level Silver Plan","86.03%","0.865509505947432","Yes","Yes","No","100%",,"$700","$10","$1,600","$10","$130","$400","$0","$200","$700","$400","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-700-3-chi-il","http://www.cigna.com/2018/sob/cigna-connect-700-3-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040011","Cigna Connect 4000","53882IL004",,"ILN001","ILS001","ILF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040011-06","Cigna Connect 140-4","94% AV Level Silver Plan","93.05%","0.933073517633687","Yes","Yes","No","100%",,"$140","$10","$1,100","$10","$130","$400","$0","$200","$140","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$140","$140 per person","$280 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-140-4-chi-il","http://www.cigna.com/2018/sob/cigna-connect-140-4-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040006","Cigna Connect 3400","53882IL004",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040006-00","Cigna Connect 3400","Standard Silver Off Exchange Plan","67.32%","0.683196600494952","Yes","Yes","No","100%",,"$3,400","$30","$2,800","$10","$130","$700","$0","$200","$1,590","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-3400-chi-il","http://www.cigna.com/2018/sob/cigna-connect-3400-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040006","Cigna Connect 3400","53882IL004",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040006-01","Cigna Connect 3400","Standard Silver On Exchange Plan","67.32%","0.683196600494952","Yes","Yes","No","100%",,"$3,400","$30","$2,800","$10","$130","$700","$0","$200","$1,590","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-3400-chi-il","http://www.cigna.com/2018/sob/cigna-connect-3400-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040006","Cigna Connect 3400","53882IL004",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040006-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-chi-il","http://www.cigna.com/2018/sob/cigna-connect-0-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040006","Cigna Connect 3400","53882IL004",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040006-03","Cigna Connect 3400-1","Limited Cost Sharing Plan Variation","67.32%","0.683196600494952","Yes","Yes","No","100%",,"$3,400","$30","$2,800","$10","$130","$700","$0","$200","$1,590","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-3400-1-chi-il","http://www.cigna.com/2018/sob/cigna-connect-3400-1-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040006","Cigna Connect 3400","53882IL004",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040006-04","Cigna Connect 2500-2","73% AV Level Silver Plan","72.13%","0.732047691478854","Yes","Yes","No","100%",,"$2,500","$30","$3,000","$10","$130","$700","$0","$200","$1,590","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-2500-2-chi-il","http://www.cigna.com/2018/sob/cigna-connect-2500-2-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040006","Cigna Connect 3400","53882IL004",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040006-05","Cigna Connect 500-3","87% AV Level Silver Plan","86.11%","0.866461438161579","Yes","Yes","No","100%",,"$500","$10","$1,900","$10","$130","$500","$0","$200","$500","$20","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-500-3-chi-il","http://www.cigna.com/2018/sob/cigna-connect-500-3-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040006","Cigna Connect 3400","53882IL004",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040006-06","Cigna Connect 100-4","94% AV Level Silver Plan","93.05%","0.93368391279177","Yes","Yes","No","100%",,"$100","$10","$1,200","$10","$100","$400","$0","$200","$100","$20","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-100-4-chi-il","http://www.cigna.com/2018/sob/cigna-connect-100-4-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040008","Cigna Connect 1400","53882IL004",,"ILN001","ILS001","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040008-00","Cigna Connect 1400","Standard Gold Off Exchange Plan","78.27%","0.786777050612056","Yes","Yes","No","100%",,"$1,400","$30","$2,200","$10","$130","$700","$0","$200","$1,400","$30","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1400-chi-il","http://www.cigna.com/2018/sob/cigna-connect-1400-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040008","Cigna Connect 1400","53882IL004",,"ILN001","ILS001","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040008-01","Cigna Connect 1400","Standard Gold On Exchange Plan","78.27%","0.786777050612056","Yes","Yes","No","100%",,"$1,400","$30","$2,200","$10","$130","$700","$0","$200","$1,400","$30","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1400-chi-il","http://www.cigna.com/2018/sob/cigna-connect-1400-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040008","Cigna Connect 1400","53882IL004",,"ILN001","ILS001","ILF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040008-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-chi-il","http://www.cigna.com/2018/sob/cigna-connect-0-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040002","Cigna Connect 6650","53882IL004",,"ILN001","ILS001","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040002-00","Cigna Connect 6650","Standard Bronze Off Exchange Plan","61.02%","0.626925297707575","Yes","Yes","No","100%",,"$6,650","$30","$700","$10","$650","$800","$0","$200","$1,590","$50","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6650-chi-il","http://www.cigna.com/2018/sob/cigna-connect-6650-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040002","Cigna Connect 6650","53882IL004",,"ILN001","ILS001","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040002-01","Cigna Connect 6650","Standard Bronze On Exchange Plan","61.02%","0.626925297707575","Yes","Yes","No","100%",,"$6,650","$30","$700","$10","$650","$800","$0","$200","$1,590","$50","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6650-chi-il","http://www.cigna.com/2018/sob/cigna-connect-6650-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040002","Cigna Connect 6650","53882IL004",,"ILN001","ILS001","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040002-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-chi-il","http://www.cigna.com/2018/sob/cigna-connect-0-chi-il"
"2018","IL","53882","SERFF","2017-09-25 20:16:04","Individual","No","36-3385638","53882IL0040002","Cigna Connect 6650","53882IL004",,"ILN001","ILS001","ILF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","53882IL0040002-03","Cigna Connect 6650-1","Limited Cost Sharing Plan Variation","61.02%","0.626925297707575","Yes","Yes","No","100%",,"$6,650","$30","$700","$10","$650","$800","$0","$200","$1,590","$50","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6650-1-chi-il","http://www.cigna.com/2018/sob/cigna-connect-6650-1-chi-il"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400010","BlueCare EPO Simple Bronze HDHP","18558KS040",,"KSN001","KSS001","KSF003","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400010-02","BlueCare EPO Simple Bronze HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400010-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400010-02"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400010","BlueCare EPO Simple Bronze HDHP","18558KS040",,"KSN001","KSS001","KSF003","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400010-03","BlueCare EPO Simple Bronze HDHP","Limited Cost Sharing Plan Variation",,"0.606270750044867","Yes","Yes","No","100%",,"$6,500","$0","$0","$60","$6,500","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400010-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400010-03"
"2018","KS","25268","SERFF","2017-08-16 20:15:58","Individual","Yes","36-3757528","25268KS0010001","TruAssure Basic Adult or Child Dental Plan","25268KS001",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","25268KS0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$105","$105 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=KS","https://www.truassure.com/brochure?state=KS"
"2018","KS","25268","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","36-3757528","25268KS0030001","TruAssure Dental Small Group Basic Plan","25268KS003",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","25268KS0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","KS","25268","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","36-3757528","25268KS0040001","TruAssure Dental Small Group Preferred Plan","25268KS004",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","25268KS0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","KS","25268","SERFF","2017-08-16 20:15:58","Individual","Yes","36-3757528","25268KS0010001","TruAssure Basic Adult or Child Dental Plan","25268KS001",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","25268KS0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$105","$105 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=KS","https://www.truassure.com/brochure?state=KS"
"2018","IL","59928","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","36-0883760","59928IL0040002","EHB High PPO","59928IL004",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","59928IL0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2018","IL","59928","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","36-0883760","59928IL0040001","EHB Low PPO","59928IL004",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","59928IL0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2018","IL","59928","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","36-0883760","59928IL0030002","EHB High Passive","59928IL003",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","59928IL0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2018","IL","59928","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","36-0883760","59928IL0030001","EHB Low Passive","59928IL003",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","59928IL0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2018","IL","60600","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","36-2612058","60600IL0030002","Delta Dental Individual Kids Preferred Plan","60600IL003",,"ILN001","ILS001",,"Existing","EPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Benefits; Must see a Delta Dental PPO Provider","Yes",,"","60600IL0030002-00","Delta Dental Individual Kids Preferred Plan","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IL","60600","SERFF","2017-08-16 20:15:58","Individual","Yes","36-2612058","60600IL0010002","Delta Dental Individual Kids Basic Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Benefits; Must see Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010002-00","Delta Dental Individual Kids Basic Plan","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/"
"2018","IL","60600","SERFF","2017-08-16 20:15:58","Individual","Yes","36-2612058","60600IL0010002","Delta Dental Individual Kids Basic Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Benefits; Must see Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010002-01","Delta Dental Individual Kids Basic Plan","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/"
"2018","IL","60600","SERFF","2017-08-16 20:15:58","Individual","Yes","36-2612058","60600IL0010001","Delta Dental Individual Kids Preferred Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Benefits; Must see Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010001-00","Delta Dental Individual Kids Preferred Plan","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/"
"2018","IL","60600","SERFF","2017-08-16 20:15:58","Individual","Yes","36-2612058","60600IL0010001","Delta Dental Individual Kids Preferred Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Benefits; Must see Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010001-01","Delta Dental Individual Kids Preferred Plan","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/"
"2018","IL","60600","SERFF","2017-08-16 20:15:58","Individual","Yes","36-2612058","60600IL0010004","Delta Dental Individual Basic Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Benefits; Must See Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010004-00","Delta Dental Individual Basic Plan","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/"
"2018","IL","60600","SERFF","2017-08-16 20:15:58","Individual","Yes","36-2612058","60600IL0010004","Delta Dental Individual Basic Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Benefits; Must See Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010004-01","Delta Dental Individual Basic Plan","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/"
"2018","IL","60600","SERFF","2017-08-16 20:15:58","Individual","Yes","36-2612058","60600IL0010003","Delta Dental Individual Preferred Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Benefits; Must See Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010003-00","Delta Dental Individual Preferred Plan","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/"
"2018","IL","60600","SERFF","2017-08-16 20:15:58","Individual","Yes","36-2612058","60600IL0010003","Delta Dental Individual Preferred Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Benefits; Must See Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010003-01","Delta Dental Individual Preferred Plan","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/"
"2018","IL","68303","SERFF","2017-08-16 20:15:58","Individual","Yes","39-1263473","68303IL0690001","Humana Dental Smart Choice - Low","68303IL069",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9799","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","68303IL0690001-01","Humana Dental Smart Choice - Low","Standard Low On Exchange Plan","68.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110302"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400006","BlueCare EPO Gold","18558KS040",,"KSN001","KSS001","KSF001","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400006-00","BlueCare EPO Gold","Standard Gold Off Exchange Plan","79.59%","0.795882235574002","Yes","Yes","No","100%",,"$1,500","$0","$2,000","$60","$1,500","$1,664","$336","$55","$859","$1,050","$215","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400006-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400006-00"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400006","BlueCare EPO Gold","18558KS040",,"KSN001","KSS001","KSF001","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400006-01","BlueCare EPO Gold","Standard Gold On Exchange Plan","79.59%","0.795882235574002","Yes","Yes","No","100%",,"$1,500","$0","$2,000","$60","$1,500","$1,664","$336","$55","$859","$1,050","$215","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400006-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400006-01"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400006","BlueCare EPO Gold","18558KS040",,"KSN001","KSS001","KSF001","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400006-02","BlueCare EPO Gold","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400006-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400006-02"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400006","BlueCare EPO Gold","18558KS040",,"KSN001","KSS001","KSF001","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400006-03","BlueCare EPO Gold","Limited Cost Sharing Plan Variation","79.59%","0.795882235574002","Yes","Yes","No","100%",,"$1,500","$0","$2,000","$60","$1,500","$1,664","$336","$55","$859","$1,050","$215","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400006-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400006-03"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400007","BlueCare EPO Silver","18558KS040",,"KSN001","KSS001","KSF001","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400007-00","BlueCare EPO Silver","Standard Silver Off Exchange Plan","71.67%","0.716723600665064","Yes","Yes","No","100%",,"$3,000","$150","$2,480","$60","$1,489","$1,885","$372","$55","$1,305","$210","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400007-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400007-00"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400007","BlueCare EPO Silver","18558KS040",,"KSN001","KSS001","KSF001","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400007-01","BlueCare EPO Silver","Standard Silver On Exchange Plan","71.67%","0.716723600665064","Yes","Yes","No","100%",,"$3,000","$150","$2,480","$60","$1,489","$1,885","$372","$55","$1,305","$210","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400007-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400007-01"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400007","BlueCare EPO Silver","18558KS040",,"KSN001","KSS001","KSF001","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400007-02","BlueCare EPO Silver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400007-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400007-02"
"2018","IL","68303","SERFF","2017-08-16 20:15:58","Individual","Yes","39-1263473","68303IL0690002","Humana Dental Smart Choice - High","68303IL069",,"ILN001","ILS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9787","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","68303IL0690002-01","Humana Dental Smart Choice - High","Standard High On Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110289"
"2018","IL","75159","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","47-0098400","75159IL0040002","EHB High PPO","75159IL004",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","75159IL0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","IL","75159","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","47-0098400","75159IL0040001","EHB Low PPO","75159IL004",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","75159IL0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","IL","75159","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","47-0098400","75159IL0030002","EHB High Passive","75159IL003",,"ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","75159IL0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","IL","75159","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","47-0098400","75159IL0030001","EHB Low Passive","75159IL003",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","75159IL0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","IL","80839","SERFF","2017-08-16 20:15:58","Individual","Yes","31-1185262","80839IL0010001","Illinois DentaTrust - PPO Pediatric High Option","80839IL001","7083617077","ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0010001-00","Illinois DentaTrust - PPO Pediatric High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtil.dentalcareplus.com","http://hixpbdtil.dentalcareplus.com"
"2018","IL","80839","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","31-1185262","80839IL0020003","DentaSpan Family High Option","80839IL002","7083617077","ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0020003-00","DentaSpan Family High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsil.dentalcareplus.com","http://hixpbdsil.dentalcareplus.com"
"2018","IL","80839","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","31-1185262","80839IL0020003","DentaSpan Family High Option","80839IL002","7083617077","ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0020003-01","DentaSpan Family High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsil.dentalcareplus.com","http://hixpbdsil.dentalcareplus.com"
"2018","IL","80839","SERFF","2017-08-16 20:15:58","Individual","Yes","31-1185262","80839IL0010001","Illinois DentaTrust - PPO Pediatric High Option","80839IL001","7083617077","ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0010001-01","Illinois DentaTrust - PPO Pediatric High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtil.dentalcareplus.com","http://hixpbdtil.dentalcareplus.com"
"2018","IL","80839","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","31-1185262","80839IL0020004","DentaSpan Family Low Option","80839IL002","7083617077","ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0020004-00","DentaSpan Family Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsil.dentalcareplus.com","http://hixpbdsil.dentalcareplus.com"
"2018","IL","80839","SERFF","2017-08-16 20:15:58","Individual","Yes","31-1185262","80839IL0010002","Illinois DentaTrust - PPO Pediatric Low Option","80839IL001","7083617077","ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0010002-00","Illinois DentaTrust - PPO Pediatric Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtil.dentalcareplus.com","http://hixpbdtil.dentalcareplus.com"
"2018","IL","80839","SERFF","2017-08-16 20:15:58","Individual","Yes","31-1185262","80839IL0010002","Illinois DentaTrust - PPO Pediatric Low Option","80839IL001","7083617077","ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0010002-01","Illinois DentaTrust - PPO Pediatric Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtil.dentalcareplus.com","http://hixpbdtil.dentalcareplus.com"
"2018","IL","80839","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","31-1185262","80839IL0020004","DentaSpan Family Low Option","80839IL002","7083617077","ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0020004-01","DentaSpan Family Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsil.dentalcareplus.com","http://hixpbdsil.dentalcareplus.com"
"2018","IL","80839","SERFF","2017-08-16 20:15:58","Individual","Yes","31-1185262","80839IL0010003","Illinois DentaTrust - PPO Family High Option","80839IL001","7083617077","ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0010003-00","Illinois DentaTrust - PPO Family High Option","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtil.dentalcareplus.com","http://hixpbdtil.dentalcareplus.com"
"2018","IL","80839","SERFF","2017-08-16 20:15:58","Individual","Yes","31-1185262","80839IL0010003","Illinois DentaTrust - PPO Family High Option","80839IL001","7083617077","ILN001","ILS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0010003-01","Illinois DentaTrust - PPO Family High Option","Standard High On Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtil.dentalcareplus.com","http://hixpbdtil.dentalcareplus.com"
"2018","IL","80839","SERFF","2017-08-16 20:15:58","Individual","Yes","31-1185262","80839IL0010004","Illinois DentaTrust - PPO Family Low Option","80839IL001","7083617077","ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0010004-00","Illinois DentaTrust - PPO Family Low Option","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtil.dentalcareplus.com","http://hixpbdtil.dentalcareplus.com"
"2018","IL","80839","SERFF","2017-08-16 20:15:58","Individual","Yes","31-1185262","80839IL0010004","Illinois DentaTrust - PPO Family Low Option","80839IL001","7083617077","ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","80839IL0010004-01","Illinois DentaTrust - PPO Family Low Option","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtil.dentalcareplus.com","http://hixpbdtil.dentalcareplus.com"
"2018","IL","83350","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","13-5581829","83350IL0170002","EHB Basic Dental Plan (Low)","83350IL017",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","83350IL0170002-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$200","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IL","84033","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","84033IL0020001","BESTOne Dental Plus-Silver","84033IL002",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","FULL","Yes","http://www.bestlife.com/exchange/payment_option.html","","84033IL0020001-00","BESTOne Dental Plus-Silver","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IL/current/IL_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","IL","84033","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","84033IL0020001","BESTOne Dental Plus-Silver","84033IL002",,"ILN001","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","FULL","Yes","http://www.bestlife.com/exchange/payment_option.html","","84033IL0020001-01","BESTOne Dental Plus-Silver","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IL/current/IL_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","IL","85099","SERFF","2017-08-16 20:15:58","Individual","Yes","13-5123390","85099IL0210001","Guardian Essentials for Families and Individuals","85099IL021",,"ILN002","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","85099IL0210001-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/illinois/","https://dentalexchange.guardianlife.com/our-plans/illinois/"
"2018","IL","85099","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","13-5123390","85099IL0190005","Guardian Pediatric Advantage","85099IL019",,"ILN001","ILS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is allowed outside of the Service Area.","Yes",,"","85099IL0190005-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IL","85099","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","13-5123390","85099IL0200005","Guardian Pediatric Essentials","85099IL020",,"ILN001","ILS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is allowed outside of the Service Area.","Yes",,"","85099IL0200005-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IL","85099","SERFF","2017-08-16 20:15:58","Individual","Yes","13-5123390","85099IL0210001","Guardian Essentials for Families and Individuals","85099IL021",,"ILN002","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","85099IL0210001-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/illinois/","https://dentalexchange.guardianlife.com/our-plans/illinois/"
"2018","IL","85099","SERFF","2017-08-16 20:15:58","Individual","Yes","13-5123390","85099IL0220001","Guardian Select for Families and Individuals","85099IL022",,"ILN002","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","85099IL0220001-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/illinois/","https://dentalexchange.guardianlife.com/our-plans/illinois/"
"2018","IL","85099","SERFF","2017-08-16 20:15:58","Individual","Yes","13-5123390","85099IL0220001","Guardian Select for Families and Individuals","85099IL022",,"ILN002","ILS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","85099IL0220001-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/illinois/","https://dentalexchange.guardianlife.com/our-plans/illinois/"
"2018","IL","87304","SERFF","2017-08-16 20:15:58","Individual","Yes","36-4189451","87304IL0060006","Managed DentalGuard IL Essentials 1","87304IL006",,"ILN002","ILS001",,"New","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.967","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","87304IL0060006-00","Managed DentalGuard IL Essentials 1","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/illinois/","https://dentalexchange.guardianlife.com/our-plans/illinois/"
"2018","IL","87304","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","36-4189451","87304IL0030003","Managed DentalGuard IL10 Family Plan","87304IL003",,"ILN001","ILS001",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.963","Estimated Rate","2018-01-01",,"No",,"No",,"No",,"","87304IL0030003-00","Managed DentalGuard IL10 Family Plan","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IL","87304","SERFF","2017-08-16 20:15:58","Individual","Yes","36-4189451","87304IL0060006","Managed DentalGuard IL Essentials 1","87304IL006",,"ILN002","ILS001",,"New","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.967","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","87304IL0060006-01","Managed DentalGuard IL Essentials 1","Standard Low On Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/illinois/","https://dentalexchange.guardianlife.com/our-plans/illinois/"
"2018","IL","87304","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","36-4189451","87304IL0040003","Managed DentalGuard IL20 Family Plan","87304IL004",,"ILN001","ILS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.964","Estimated Rate","2018-01-01",,"No",,"No",,"No",,"","87304IL0040003-00","Managed DentalGuard IL20 Family Plan","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","IL","87304","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","36-4189451","87304IL0050003","Managed DentalGuard IL30 Family Plan","87304IL005",,"ILN001","ILS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.968","Estimated Rate","2018-01-01",,"No",,"No",,"No",,"","87304IL0050003-00","Managed DentalGuard IL30 Family Plan","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","KS","11339","SERFF","2017-08-16 20:15:58","Individual","Yes","75-1233841","11339KS0010009","Dentegra Dental PPO Pediatric Basic Plan","11339KS001",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","11339KS0010009-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ks/11339ks0010009-18"
"2018","KS","11339","SERFF","2017-08-16 20:15:58","Individual","Yes","75-1233841","11339KS0010008","Dentegra Dental PPO Family Preferred Plan","11339KS001",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","11339KS0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ks/11339ks0010008-18"
"2018","KS","11339","SERFF","2017-08-16 20:15:58","Individual","Yes","75-1233841","11339KS0010007","Dentegra Dental PPO Family Basic Plan","11339KS001",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","11339KS0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ks/11339ks0010007-18"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400007","BlueCare EPO Silver","18558KS040",,"KSN001","KSS001","KSF001","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400007-03","BlueCare EPO Silver","Limited Cost Sharing Plan Variation","71.67%","0.716723600665064","Yes","Yes","No","100%",,"$3,000","$150","$2,480","$60","$1,489","$1,885","$372","$55","$1,305","$210","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400007-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400007-03"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400007","BlueCare EPO Silver","18558KS040",,"KSN001","KSS001","KSF001","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400007-04","BlueCare EPO Silver","73% AV Level Silver Plan","73.99%","0.739908110136341","Yes","Yes","No","100%",,"$2,750","$130","$2,480","$60","$1,489","$1,765","$372","$55","$1,305","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400007-04","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400007-04"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400007","BlueCare EPO Silver","18558KS040",,"KSN001","KSS001","KSF001","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400007-05","BlueCare EPO Silver","87% AV Level Silver Plan","87.80%","0.877982715300177","Yes","Yes","No","100%",,"$750","$0","$750","$60","$675","$655","$170","$55","$750","$120","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400007-05","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400007-05"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400007","BlueCare EPO Silver","18558KS040",,"KSN001","KSS001","KSF001","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400007-06","BlueCare EPO Silver","94% AV Level Silver Plan","94.52%","0.945165140625867","Yes","Yes","No","100%",,"$142","$0","$358","$60","$250","$183","$67","$55","$250","$0","$250","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400007-06","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400007-06"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400008","BlueCare EPO Simple Silver HDHP","18558KS040",,"KSN001","KSS001","KSF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400008-00","BlueCare EPO Simple Silver HDHP","Standard Silver Off Exchange Plan",,"0.700980885295207","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400008-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400008-00"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400008","BlueCare EPO Simple Silver HDHP","18558KS040",,"KSN001","KSS001","KSF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400008-01","BlueCare EPO Simple Silver HDHP","Standard Silver On Exchange Plan",,"0.700980885295207","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400008-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400008-01"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400008","BlueCare EPO Simple Silver HDHP","18558KS040",,"KSN001","KSS001","KSF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400008-02","BlueCare EPO Simple Silver HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400008-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400008-02"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400008","BlueCare EPO Simple Silver HDHP","18558KS040",,"KSN001","KSS001","KSF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400008-03","BlueCare EPO Simple Silver HDHP","Limited Cost Sharing Plan Variation",,"0.700980885295207","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400008-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400008-03"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400008","BlueCare EPO Simple Silver HDHP","18558KS040",,"KSN001","KSS001","KSF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400008-04","BlueCare EPO Simple Silver HDHP","73% AV Level Silver Plan",,"0.734355954395736","Yes","Yes","No","100%",,"$3,250","$0","$0","$60","$3,250","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400008-04","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400008-04"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400008","BlueCare EPO Simple Silver HDHP","18558KS040",,"KSN001","KSS001","KSF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400008-05","BlueCare EPO Simple Silver HDHP","87% AV Level Silver Plan",,"0.862986553804247","Yes","Yes","No","100%",,"$1,250","$0","$0","$60","$1,250","$0","$0","$55","$1,250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400008-05","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400008-05"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400008","BlueCare EPO Simple Silver HDHP","18558KS040",,"KSN001","KSS001","KSF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400008-06","BlueCare EPO Simple Silver HDHP","94% AV Level Silver Plan",,"0.937977340786209","Yes","Yes","No","100%",,"$500","$0","$0","$60","$500","$0","$0","$55","$500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400008-06","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400008-06"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400009","BlueCare EPO Bronze","18558KS040",,"KSN001","KSS001","KSF002","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400009-00","BlueCare EPO Bronze","Standard Bronze Off Exchange Plan",,"0.622674769441054","Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$6,052","$860","$0","$271","$1,925","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400009-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400009-00"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400009","BlueCare EPO Bronze","18558KS040",,"KSN001","KSS001","KSF002","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400009-01","BlueCare EPO Bronze","Standard Bronze On Exchange Plan",,"0.622674769441054","Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$6,052","$860","$0","$271","$1,925","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400009-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400009-01"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400009","BlueCare EPO Bronze","18558KS040",,"KSN001","KSS001","KSF002","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400009-02","BlueCare EPO Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400009-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400009-02"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400009","BlueCare EPO Bronze","18558KS040",,"KSN001","KSS001","KSF002","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400009-03","BlueCare EPO Bronze","Limited Cost Sharing Plan Variation",,"0.622674769441054","Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$6,052","$860","$0","$271","$1,925","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400009-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400009-03"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400010","BlueCare EPO Simple Bronze HDHP","18558KS040",,"KSN001","KSS001","KSF003","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400010-00","BlueCare EPO Simple Bronze HDHP","Standard Bronze Off Exchange Plan",,"0.606270750044867","Yes","Yes","No","100%",,"$6,500","$0","$0","$60","$6,500","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400010-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400010-00"
"2018","KS","18558","SERFF","2017-09-05 20:16:07","Individual","No","48-0952857","18558KS0400010","BlueCare EPO Simple Bronze HDHP","18558KS040",,"KSN001","KSS001","KSF003","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_KS_BlueCare_Medication_List.pdf","18558KS0400010-01","BlueCare EPO Simple Bronze HDHP","Standard Bronze On Exchange Plan",,"0.606270750044867","Yes","Yes","No","100%",,"$6,500","$0","$0","$60","$6,500","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=s&hi=18558KS0400010-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2018&sb=b&hi=18558KS0400010-01"
"2018","KS","25268","SERFF","2017-08-16 20:15:58","Individual","Yes","36-3757528","25268KS0020001","TruAssure Preferred Adult or Child Dental Plan","25268KS002",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","25268KS0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=KS","https://www.truassure.com/brochure?state=KS"
"2018","KS","25268","SERFF","2017-08-16 20:15:58","Individual","Yes","36-3757528","25268KS0020001","TruAssure Preferred Adult or Child Dental Plan","25268KS002",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","25268KS0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=KS","https://www.truassure.com/brochure?state=KS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010001","Medica Connect Gold Copay","39520KS001",,"KSN001","KSS001","KSF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010001-00","Medica Connect Gold Copay","Standard Gold Off Exchange Plan",,"0.776079800906465","Yes","Yes","Yes","95%","5%","$750","$10","$3,100","$60","$750","$500","$500","$0","$750","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","per person not applicable","$2250 per group","30.00%","$1,500","per person not applicable","$4500 per group","30.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CGCKS&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010001","Medica Connect Gold Copay","39520KS001",,"KSN001","KSS001","KSF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010001-01","Medica Connect Gold Copay","Standard Gold On Exchange Plan",,"0.776079800906465","Yes","Yes","Yes","95%","5%","$750","$10","$3,100","$60","$750","$500","$500","$0","$750","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","per person not applicable","$2250 per group","30.00%","$1,500","per person not applicable","$4500 per group","30.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CGCKS&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010001","Medica Connect Gold Copay","39520KS001",,"KSN001","KSS001","KSF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010001-02","Medica Connect Gold Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","95%","5%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CGCKSZ&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010001","Medica Connect Gold Copay","39520KS001",,"KSN001","KSS001","KSF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010001-03","Medica Connect Gold Copay","Limited Cost Sharing Plan Variation",,"0.776079800906465","Yes","Yes","Yes","95%","5%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","per person not applicable","$2250 per group","30.00%","$1,500","per person not applicable","$4500 per group","30.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CGCKSL&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010019","Medica Connect Gold Copay Plus","39520KS001",,"KSN001","KSS001","KSF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010019-00","Medica Connect Gold Copay Plus","Standard Gold Off Exchange Plan",,"0.801020465506427","Yes","Yes","Yes","95%","5%","$1,000","$300","$400","$60","$1,000","$500","$300","$0","$1,000","$300","$30","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%","$1,500","per person not applicable","$4500 per group","30.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CGPCKS&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010019","Medica Connect Gold Copay Plus","39520KS001",,"KSN001","KSS001","KSF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010019-01","Medica Connect Gold Copay Plus","Standard Gold On Exchange Plan",,"0.801020465506427","Yes","Yes","Yes","95%","5%","$1,000","$300","$400","$60","$1,000","$500","$300","$0","$1,000","$300","$30","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%","$1,500","per person not applicable","$4500 per group","30.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CGPCKS&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010019","Medica Connect Gold Copay Plus","39520KS001",,"KSN001","KSS001","KSF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010019-02","Medica Connect Gold Copay Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","95%","5%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CGPCKSZ&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010019","Medica Connect Gold Copay Plus","39520KS001",,"KSN001","KSS001","KSF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010019-03","Medica Connect Gold Copay Plus","Limited Cost Sharing Plan Variation",,"0.801020465506427","Yes","Yes","Yes","95%","5%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%","$1,500","per person not applicable","$4500 per group","30.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CGPCKSL&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040001","Select by Medica Gold Copay","39520KS004",,"KSN002","KSS004","KSF001","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040001-00","Select by Medica Gold Copay","Standard Gold Off Exchange Plan",,"0.778934491962014","Yes","Yes","No","100%",,"$750","$10","$3,100","$60","$750","$500","$500","$0","$750","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","per person not applicable","$2250 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMGCKS&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040001","Select by Medica Gold Copay","39520KS004",,"KSN002","KSS004","KSF001","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040001-01","Select by Medica Gold Copay","Standard Gold On Exchange Plan",,"0.778934491962014","Yes","Yes","No","100%",,"$750","$10","$3,100","$60","$750","$500","$500","$0","$750","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","per person not applicable","$2250 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMGCKS&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040001","Select by Medica Gold Copay","39520KS004",,"KSN002","KSS004","KSF001","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040001-02","Select by Medica Gold Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMGCKSZ&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040001","Select by Medica Gold Copay","39520KS004",,"KSN002","KSS004","KSF001","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040001-03","Select by Medica Gold Copay","Limited Cost Sharing Plan Variation",,"0.778934491962014","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","per person not applicable","$2250 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMGCKSL&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040019","Select by Medica Gold Copay Plus","39520KS004",,"KSN002","KSS004","KSF002","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040019-00","Select by Medica Gold Copay Plus","Standard Gold Off Exchange Plan",,"0.804017911673024","Yes","Yes","No","100%",,"$1,000","$300","$400","$60","$1,000","$500","$300","$0","$1,000","$300","$30","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMGPCKS&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040019","Select by Medica Gold Copay Plus","39520KS004",,"KSN002","KSS004","KSF002","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040019-01","Select by Medica Gold Copay Plus","Standard Gold On Exchange Plan",,"0.804017911673024","Yes","Yes","No","100%",,"$1,000","$300","$400","$60","$1,000","$500","$300","$0","$1,000","$300","$30","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMGPCKS&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040019","Select by Medica Gold Copay Plus","39520KS004",,"KSN002","KSS004","KSF002","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040019-02","Select by Medica Gold Copay Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMGPCKSZ&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040019","Select by Medica Gold Copay Plus","39520KS004",,"KSN002","KSS004","KSF002","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040019-03","Select by Medica Gold Copay Plus","Limited Cost Sharing Plan Variation",,"0.804017911673024","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMGPCKSL&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010003","Medica Connect Silver Copay","39520KS001",,"KSN001","KSS001","KSF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010003-00","Medica Connect Silver Copay","Standard Silver Off Exchange Plan",,"0.685906697725399","Yes","Yes","Yes","95%","5%","$3,500","$10","$3,100","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%","$4,500","per person not applicable","$13500 per group","40.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CSCKS&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010003","Medica Connect Silver Copay","39520KS001",,"KSN001","KSS001","KSF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010003-01","Medica Connect Silver Copay","Standard Silver On Exchange Plan",,"0.685906697725399","Yes","Yes","Yes","95%","5%","$3,500","$10","$3,100","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%","$4,500","per person not applicable","$13500 per group","40.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CSCKS&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010003","Medica Connect Silver Copay","39520KS001",,"KSN001","KSS001","KSF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010003-02","Medica Connect Silver Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","95%","5%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CSCKSZ&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010003","Medica Connect Silver Copay","39520KS001",,"KSN001","KSS001","KSF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010003-03","Medica Connect Silver Copay","Limited Cost Sharing Plan Variation",,"0.685906697725399","Yes","Yes","Yes","95%","5%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%","$4,500","per person not applicable","$13500 per group","40.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CSCKSL&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010003","Medica Connect Silver Copay","39520KS001",,"KSN001","KSS001","KSF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010003-04","Medica Connect Silver Copay","73% AV Level Silver Plan",,"0.728366633174693","Yes","Yes","Yes","95%","5%","$2,500","$10","$2,600","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","30.00%","$2,500","per person not applicable","$7500 per group","30.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CSCKS73&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010003","Medica Connect Silver Copay","39520KS001",,"KSN001","KSS001","KSF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010003-05","Medica Connect Silver Copay","87% AV Level Silver Plan",,"0.867990210903513","Yes","Yes","Yes","95%","5%","$500","$0","$1,500","$60","$500","$500","$400","$0","$500","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1500 per group","20.00%","$500","per person not applicable","$1500 per group","20.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CSCKS87&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010003","Medica Connect Silver Copay","39520KS001",,"KSN001","KSS001","KSF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010003-06","Medica Connect Silver Copay","94% AV Level Silver Plan",,"0.930207154129895","Yes","Yes","Yes","95%","5%","$100","$10","$600","$60","$100","$500","$100","$0","$100","$100","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2400 per group","$1,200","$1200 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","5.00%","$100","per person not applicable","$300 per group","5.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CSCKS94&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040003","Select by Medica Silver Copay","39520KS004",,"KSN002","KSS004","KSF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040003-00","Select by Medica Silver Copay","Standard Silver Off Exchange Plan",,"0.687682525700993","Yes","Yes","No","100%",,"$3,500","$10","$3,100","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMSCKS&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040003","Select by Medica Silver Copay","39520KS004",,"KSN002","KSS004","KSF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040003-01","Select by Medica Silver Copay","Standard Silver On Exchange Plan",,"0.687682525700993","Yes","Yes","No","100%",,"$3,500","$10","$3,100","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMSCKS&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040003","Select by Medica Silver Copay","39520KS004",,"KSN002","KSS004","KSF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040003-02","Select by Medica Silver Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMSCKSZ&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040003","Select by Medica Silver Copay","39520KS004",,"KSN002","KSS004","KSF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040003-03","Select by Medica Silver Copay","Limited Cost Sharing Plan Variation",,"0.687682525700993","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMSCKSL&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040003","Select by Medica Silver Copay","39520KS004",,"KSN002","KSS004","KSF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040003-04","Select by Medica Silver Copay","73% AV Level Silver Plan",,"0.728366633174693","Yes","Yes","No","100%",,"$2,500","$10","$2,600","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMSCKS73&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040003","Select by Medica Silver Copay","39520KS004",,"KSN002","KSS004","KSF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040003-05","Select by Medica Silver Copay","87% AV Level Silver Plan",,"0.867990210903513","Yes","Yes","No","100%",,"$500","$0","$1,500","$60","$500","$500","$400","$0","$500","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMSCKS87&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040003","Select by Medica Silver Copay","39520KS004",,"KSN002","KSS004","KSF003","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040003-06","Select by Medica Silver Copay","94% AV Level Silver Plan",,"0.930441428891474","Yes","Yes","No","100%",,"$100","$10","$600","$60","$100","$500","$100","$0","$100","$100","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMSCKS94&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010005","Medica Connect Bronze Copay","39520KS001",,"KSN001","KSS001","KSF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010005-00","Medica Connect Bronze Copay","Standard Bronze Off Exchange Plan",,"0.607999306551722","Yes","Yes","Yes","95%","5%","$6,850","$0","$500","$60","$2,300","$1,000","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%","$6,850","per person not applicable","$13700 per group","50.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CBCKS&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010005","Medica Connect Bronze Copay","39520KS001",,"KSN001","KSS001","KSF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010005-01","Medica Connect Bronze Copay","Standard Bronze On Exchange Plan",,"0.607999306551722","Yes","Yes","Yes","95%","5%","$6,850","$0","$500","$60","$2,300","$1,000","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%","$6,850","per person not applicable","$13700 per group","50.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CBCKS&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010005","Medica Connect Bronze Copay","39520KS001",,"KSN001","KSS001","KSF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010005-02","Medica Connect Bronze Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","95%","5%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CBCKSZ&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010005","Medica Connect Bronze Copay","39520KS001",,"KSN001","KSS001","KSF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010005-03","Medica Connect Bronze Copay","Limited Cost Sharing Plan Variation",,"0.607999306551722","Yes","Yes","Yes","95%","5%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%","$6,850","per person not applicable","$13700 per group","50.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CBCKSL&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010011","Medica Connect Bronze H S A","39520KS001",,"KSN001","KSS001","KSF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010011-00","Medica Connect Bronze H S A","Standard Bronze Off Exchange Plan",,"0.604722667442752","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CBHKS&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010011","Medica Connect Bronze H S A","39520KS001",,"KSN001","KSS001","KSF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010011-01","Medica Connect Bronze H S A","Standard Bronze On Exchange Plan",,"0.604722667442752","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CBHKS&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010011","Medica Connect Bronze H S A","39520KS001",,"KSN001","KSS001","KSF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010011-02","Medica Connect Bronze H S A","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CBHKSZ&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010011","Medica Connect Bronze H S A","39520KS001",,"KSN001","KSS001","KSF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010011-03","Medica Connect Bronze H S A","Limited Cost Sharing Plan Variation",,"0.604722667442752","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CBHKSL&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010023","Medica Connect Bronze H S A Plus","39520KS001",,"KSN001","KSS001","KSF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010023-00","Medica Connect Bronze H S A Plus","Standard Bronze Off Exchange Plan",,"0.648959715508247","Yes","Yes","No","100%",,"$2,600","$0","$3,400","$60","$2,600","$0","$1,800","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CBPHKS&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010023","Medica Connect Bronze H S A Plus","39520KS001",,"KSN001","KSS001","KSF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010023-01","Medica Connect Bronze H S A Plus","Standard Bronze On Exchange Plan",,"0.648959715508247","Yes","Yes","No","100%",,"$2,600","$0","$3,400","$60","$2,600","$0","$1,800","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CBPHKS&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010023","Medica Connect Bronze H S A Plus","39520KS001",,"KSN001","KSS001","KSF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010023-02","Medica Connect Bronze H S A Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CBPHKSZ&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010023","Medica Connect Bronze H S A Plus","39520KS001",,"KSN001","KSS001","KSF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010023-03","Medica Connect Bronze H S A Plus","Limited Cost Sharing Plan Variation",,"0.648959715508247","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CBPHKSL&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040005","Select by Medica Bronze Copay","39520KS004",,"KSN002","KSS004","KSF004","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040005-00","Select by Medica Bronze Copay","Standard Bronze Off Exchange Plan",,"0.608542992553092","Yes","Yes","No","100%",,"$6,850","$0","$500","$60","$2,300","$1,000","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMBCKS&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040005","Select by Medica Bronze Copay","39520KS004",,"KSN002","KSS004","KSF004","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040005-01","Select by Medica Bronze Copay","Standard Bronze On Exchange Plan",,"0.608542992553092","Yes","Yes","No","100%",,"$6,850","$0","$500","$60","$2,300","$1,000","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMBCKS&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040005","Select by Medica Bronze Copay","39520KS004",,"KSN002","KSS004","KSF004","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040005-02","Select by Medica Bronze Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMBCKSZ&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040005","Select by Medica Bronze Copay","39520KS004",,"KSN002","KSS004","KSF004","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040005-03","Select by Medica Bronze Copay","Limited Cost Sharing Plan Variation",,"0.608542992553092","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMBCKSL&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040011","Select by Medica Bronze H S A","39520KS004",,"KSN002","KSS004","KSF005","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040011-00","Select by Medica Bronze H S A","Standard Bronze Off Exchange Plan",,"0.604722667442752","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMBHKS&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040011","Select by Medica Bronze H S A","39520KS004",,"KSN002","KSS004","KSF005","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040011-01","Select by Medica Bronze H S A","Standard Bronze On Exchange Plan",,"0.604722667442752","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMBHKS&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040011","Select by Medica Bronze H S A","39520KS004",,"KSN002","KSS004","KSF005","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040011-02","Select by Medica Bronze H S A","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMBHKSZ&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040011","Select by Medica Bronze H S A","39520KS004",,"KSN002","KSS004","KSF005","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040011-03","Select by Medica Bronze H S A","Limited Cost Sharing Plan Variation",,"0.604722667442752","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMBHKSL&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040023","Select by Medica Bronze H S A Plus","39520KS004",,"KSN002","KSS004","KSF006","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040023-00","Select by Medica Bronze H S A Plus","Standard Bronze Off Exchange Plan",,"0.648959715508247","Yes","Yes","No","100%",,"$2,600","$0","$3,400","$60","$2,600","$0","$1,800","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMBPHKS&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040023","Select by Medica Bronze H S A Plus","39520KS004",,"KSN002","KSS004","KSF006","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040023-01","Select by Medica Bronze H S A Plus","Standard Bronze On Exchange Plan",,"0.648959715508247","Yes","Yes","No","100%",,"$2,600","$0","$3,400","$60","$2,600","$0","$1,800","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMBPHKS&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040023","Select by Medica Bronze H S A Plus","39520KS004",,"KSN002","KSS004","KSF006","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040023-02","Select by Medica Bronze H S A Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMBPHKSZ&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040023","Select by Medica Bronze H S A Plus","39520KS004",,"KSN002","KSS004","KSF006","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040023-03","Select by Medica Bronze H S A Plus","Limited Cost Sharing Plan Variation",,"0.648959715508247","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMBPHKSL&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010013","Medica Connect Catastrophic","39520KS001",,"KSN001","KSS001","KSF007","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010013-00","Medica Connect Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CCKS&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0010013","Medica Connect Catastrophic","39520KS001",,"KSN001","KSS001","KSF007","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0010013-01","Medica Connect Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2CCKS&uid=FFM","https://www.medica.com/2018connectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040013","Select by Medica Catastrophic","39520KS004",,"KSN002","KSS004","KSF007","New","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040013-00","Select by Medica Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMCKS&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","39520","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","39520KS0040013","Select by Medica Catastrophic","39520KS004",,"KSN002","KSS004","KSF007","New","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","http://www.medica.com/ifbpharmacy","39520KS0040013-01","Select by Medica Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1SMCKS&uid=FFM","https://www.medica.com/2018SelectKS"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","63790KS0020003","BESTOne Advantage Gold","63790KS002",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/current/KS_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","63790KS0010007","BESTDental Premium","63790KS001",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010007-00","BESTDental Premium","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/current/KS_BESTDental_Premium_Plan.pdf"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","63790KS0010007","BESTDental Premium","63790KS001",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010007-01","BESTDental Premium","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/current/KS_BESTDental_Premium_Plan.pdf"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","63790KS0020003","BESTOne Advantage Gold","63790KS002",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/current/KS_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","63790KS0020004","BESTOne Plus Gold","63790KS002",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/current/KS_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","63790KS0010008","BESTDental Standard - H","63790KS001",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/current/KS_BESTDental_Standard-H_Plan.pdf"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","63790KS0010008","BESTDental Standard - H","63790KS001",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/current/KS_BESTDental_Standard-H_Plan.pdf"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","63790KS0020004","BESTOne Plus Gold","63790KS002",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/current/KS_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","63790KS0010010","BESTDental Choice - H","63790KS001",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/current/KS_BESTDental_Choice-H_Plan.pdf"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","63790KS0010010","BESTDental Choice - H","63790KS001",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/current/KS_BESTDental_Choice-H_Plan.pdf"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","63790KS0010009","BESTDental Standard - L","63790KS001",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/current/KS_BESTDental_Standard-L_Plan.pdf"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","63790KS0020005","BESTOne Plus Silver","63790KS002",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/current/KS_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","63790KS0020005","BESTOne Plus Silver","63790KS002",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/current/KS_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","63790KS0010009","BESTDental Standard - L","63790KS001",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/current/KS_BESTDental_Standard-L_Plan.pdf"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","63790KS0010011","BESTDental Choice - L","63790KS001",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/current/KS_BESTDental_Choice-L_Plan.pdf"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","63790KS0020006","BESTOne Basic Silver","63790KS002",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/current/KS_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","63790KS0020006","BESTOne Basic Silver","63790KS002",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/current/KS_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","63790KS0010011","BESTDental Choice - L","63790KS001",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/current/KS_BESTDental_Choice-L_Plan.pdf"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","63790KS0010012","BESTDental Value","63790KS001",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/current/KS_BESTDental_Value_Plan.pdf"
"2018","KS","63790","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","63790KS0010012","BESTDental Value","63790KS001",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/KS/current/KS_BESTDental_Value_Plan.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010005","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","80065KS001",,"KSN001","KSS001","KSF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010005-00","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.794524017421217","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/80065KS0010005-00.pdf","https://api.centene.com/Brochures/2018/80065KS0010005-00.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010005","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","80065KS001",,"KSN001","KSS001","KSF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010005-01","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.794524017421217","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/80065KS0010005-01.pdf","https://api.centene.com/Brochures/2018/80065KS0010005-01.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010005","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","80065KS001",,"KSN001","KSS001","KSF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010005-02","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/80065KS0010005-02.pdf","https://api.centene.com/Brochures/2018/80065KS0010005-02.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010005","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","80065KS001",,"KSN001","KSS001","KSF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010005-03","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.794524017421217","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/80065KS0010005-03.pdf","https://api.centene.com/Brochures/2018/80065KS0010005-03.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010002","Ambetter Balanced Care 3 (2018)","80065KS001",,"KSN001","KSS001","KSF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010002-00","Ambetter Balanced Care 3 (2018)","Standard Silver Off Exchange Plan",,"0.7076471164186","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/80065KS0010002-00.pdf","https://api.centene.com/Brochures/2018/80065KS0010002-00.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010002","Ambetter Balanced Care 3 (2018)","80065KS001",,"KSN001","KSS001","KSF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010002-01","Ambetter Balanced Care 3 (2018)","Standard Silver On Exchange Plan",,"0.7076471164186","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/80065KS0010002-01.pdf","https://api.centene.com/Brochures/2018/80065KS0010002-01.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010002","Ambetter Balanced Care 3 (2018)","80065KS001",,"KSN001","KSS001","KSF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010002-02","Ambetter Balanced Care 3 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/80065KS0010002-02.pdf","https://api.centene.com/Brochures/2018/80065KS0010002-02.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010002","Ambetter Balanced Care 3 (2018)","80065KS001",,"KSN001","KSS001","KSF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010002-03","Ambetter Balanced Care 3 (2018)","Limited Cost Sharing Plan Variation",,"0.7076471164186","Yes","Yes","No","100%",,"$3,000","$1,400","$300","$60","$1,300","$1,800","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/80065KS0010002-03.pdf","https://api.centene.com/Brochures/2018/80065KS0010002-03.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010002","Ambetter Balanced Care 3 (2018)","80065KS001",,"KSN001","KSS001","KSF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010002-04","Ambetter Balanced Care 3 (2018)","73% AV Level Silver Plan",,"0.739622575110497","Yes","Yes","No","100%",,"$1,950","$1,300","$300","$60","$1,300","$1,700","$600","$60","$1,100","$200","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/80065KS0010002-04.pdf","https://api.centene.com/Brochures/2018/80065KS0010002-04.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010002","Ambetter Balanced Care 3 (2018)","80065KS001",,"KSN001","KSS001","KSF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010002-05","Ambetter Balanced Care 3 (2018)","87% AV Level Silver Plan",,"0.879953987027571","Yes","Yes","No","100%",,"$675","$200","$300","$60","$675","$300","$600","$60","$675","$20","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/80065KS0010002-05.pdf","https://api.centene.com/Brochures/2018/80065KS0010002-05.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010002","Ambetter Balanced Care 3 (2018)","80065KS001",,"KSN001","KSS001","KSF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010002-06","Ambetter Balanced Care 3 (2018)","94% AV Level Silver Plan",,"0.949879018774364","Yes","Yes","No","100%",,"$200","$90","$300","$60","$200","$200","$200","$60","$200","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/80065KS0010002-06.pdf","https://api.centene.com/Brochures/2018/80065KS0010002-06.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010004","Ambetter Balanced Care 4 (2018)","80065KS001",,"KSN001","KSS001","KSF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010004-00","Ambetter Balanced Care 4 (2018)","Standard Silver Off Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/80065KS0010004-00.pdf","https://api.centene.com/Brochures/2018/80065KS0010004-00.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010004","Ambetter Balanced Care 4 (2018)","80065KS001",,"KSN001","KSS001","KSF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010004-01","Ambetter Balanced Care 4 (2018)","Standard Silver On Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/80065KS0010004-01.pdf","https://api.centene.com/Brochures/2018/80065KS0010004-01.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010004","Ambetter Balanced Care 4 (2018)","80065KS001",,"KSN001","KSS001","KSF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010004-02","Ambetter Balanced Care 4 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/80065KS0010004-02.pdf","https://api.centene.com/Brochures/2018/80065KS0010004-02.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010004","Ambetter Balanced Care 4 (2018)","80065KS001",,"KSN001","KSS001","KSF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010004-03","Ambetter Balanced Care 4 (2018)","Limited Cost Sharing Plan Variation",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/80065KS0010004-03.pdf","https://api.centene.com/Brochures/2018/80065KS0010004-03.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010004","Ambetter Balanced Care 4 (2018)","80065KS001",,"KSN001","KSS001","KSF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010004-04","Ambetter Balanced Care 4 (2018)","73% AV Level Silver Plan",,"0.727430168333116","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$1,800","$1,300","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/80065KS0010004-04.pdf","https://api.centene.com/Brochures/2018/80065KS0010004-04.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010004","Ambetter Balanced Care 4 (2018)","80065KS001",,"KSN001","KSS001","KSF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010004-05","Ambetter Balanced Care 4 (2018)","87% AV Level Silver Plan",,"0.863154651499334","Yes","Yes","No","100%",,"$1,850","$0","$0","$60","$1,850","$0","$0","$60","$1,630","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/80065KS0010004-05.pdf","https://api.centene.com/Brochures/2018/80065KS0010004-05.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010004","Ambetter Balanced Care 4 (2018)","80065KS001",,"KSN001","KSS001","KSF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010004-06","Ambetter Balanced Care 4 (2018)","94% AV Level Silver Plan",,"0.940719200046497","Yes","Yes","No","100%",,"$600","$0","$0","$60","$600","$0","$0","$60","$600","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/80065KS0010004-06.pdf","https://api.centene.com/Brochures/2018/80065KS0010004-06.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010001","Ambetter Essential Care 1 (2018)","80065KS001",,"KSN001","KSS001","KSF005","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010001-00","Ambetter Essential Care 1 (2018)","Standard Bronze Off Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/80065KS0010001-00.pdf","https://api.centene.com/Brochures/2018/80065KS0010001-00.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010001","Ambetter Essential Care 1 (2018)","80065KS001",,"KSN001","KSS001","KSF005","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010001-01","Ambetter Essential Care 1 (2018)","Standard Bronze On Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/80065KS0010001-01.pdf","https://api.centene.com/Brochures/2018/80065KS0010001-01.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010001","Ambetter Essential Care 1 (2018)","80065KS001",,"KSN001","KSS001","KSF005","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010001-02","Ambetter Essential Care 1 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/80065KS0010001-02.pdf","https://api.centene.com/Brochures/2018/80065KS0010001-02.pdf"
"2018","KS","80065","SERFF","2017-10-31 20:15:29","Individual","No","45-3276702","80065KS0010001","Ambetter Essential Care 1 (2018)","80065KS001",,"KSN001","KSS001","KSF005","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.sunflowerhealthplan.com/payments","http://ambetter.sunflowerhealthplan.com/resources/pharmacy-resources.html","80065KS0010001-03","Ambetter Essential Care 1 (2018)","Limited Cost Sharing Plan Variation",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/80065KS0010001-03.pdf","https://api.centene.com/Brochures/2018/80065KS0010001-03.pdf"
"2018","KS","93384","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","13-5581829","93384KS0090001","EHB Basic Dental Plan (Low)","93384KS009",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","93384KS0090001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","KS","95038","SERFF","2017-08-16 20:15:58","Individual","Yes","47-0397286","95038KS0020003","Renaissance Individual Dental PPO, EHB Certified","95038KS002",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","95038KS0020003-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","KS","95038","SERFF","2017-08-16 20:15:58","Individual","Yes","47-0397286","95038KS0020004","Renaissance Individual Dental PPO, EHB Certified","95038KS002",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","95038KS0020004-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","KS","95038","SERFF","2017-08-16 20:15:58","Individual","Yes","47-0397286","95038KS0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","95038KS004",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/95038","","95038KS0040001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/KS_EHB_High_2018","http://www.renaissancedental.com/KS_EHB_High_2018"
"2018","KS","95038","SERFF","2017-08-16 20:15:58","Individual","Yes","47-0397286","95038KS0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","95038KS004",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/95038","","95038KS0040002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/KS_EHB_Low_2018","http://www.renaissancedental.com/KS_EHB_Low_2018"
"2018","KS","95038","SERFF","2017-08-16 20:15:58","Individual","Yes","47-0397286","95038KS0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","95038KS005",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/95038","","95038KS0050001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/KS_Ped_High_2018","http://www.renaissancedental.com/KS_Ped_High_2018"
"2018","KS","95038","SERFF","2017-08-16 20:15:58","Individual","Yes","47-0397286","95038KS0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","95038KS005",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/95038","","95038KS0050002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/KS_Ped_Low_2018","http://www.renaissancedental.com/KS_Ped_Low_2018"
"2018","KS","95038","SERFF","2017-08-16 20:15:58","Individual","Yes","47-0397286","95038KS0060001","Renaissance Individual Dental Pediatric-Only, EHB Certified","95038KS006",,"KSN001","KSS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","95038KS0060001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","KS","95038","SERFF","2017-08-16 20:15:58","Individual","Yes","47-0397286","95038KS0060002","Renaissance Individual Dental Pediatric-Only, EHB Certified","95038KS006",,"KSN001","KSS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","95038KS0060002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","KY","11469","SERFF","2017-06-13 20:15:36","Individual","Yes","52-1157181","11469KY0010001","Humana Dental Smart Choice - Low","11469KY001",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.997","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","11469KY0010001-01","Humana Dental Smart Choice - Low","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110328"
"2018","KY","11469","SERFF","2017-06-13 20:15:36","Individual","Yes","52-1157181","11469KY0010002","Humana Dental Smart Choice - High","11469KY001",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9975","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","11469KY0010002-01","Humana Dental Smart Choice - High","Standard High On Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110315"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140001","Anthem Bronze Pathway X HMO 6100","36239KY114",,"KYN001","KYS003","KYF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140001-02","Anthem Bronze Pathway X HMO 6100 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","55%","45%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J5T","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140001","Anthem Bronze Pathway X HMO 6100","36239KY114",,"KYN001","KYS003","KYF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140001-03","Anthem Bronze Pathway X HMO 6100","Limited Cost Sharing Plan Variation","62.00%","0.623975492671968","Yes","Yes","Yes","55%","45%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","40.00%","$6,100","$6100 per person","$12200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GG6","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140005","Anthem Silver Pathway X HMO 3500","36239KY114",,"KYN001","KYS003","KYF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140005-00","Anthem Silver Pathway HMO 3500","Standard Silver Off Exchange Plan","71.43%","0.721104142516392","No","Yes","Yes","55%","45%","$2,580","$0","$3,270","$60","$2,396","$495","$1,898","$55","$1,062","$270","$354","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1GHT","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140005","Anthem Silver Pathway X HMO 3500","36239KY114",,"KYN001","KYS003","KYF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140005-01","Anthem Silver Pathway X HMO 3500","Standard Silver On Exchange Plan","71.43%","0.721104142516392","No","Yes","Yes","55%","45%","$2,580","$0","$3,270","$60","$2,396","$495","$1,898","$55","$1,062","$270","$354","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1GHS","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140005","Anthem Silver Pathway X HMO 3500","36239KY114",,"KYN001","KYS003","KYF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140005-04","Anthem Silver Pathway X HMO 3500 S04","73% AV Level Silver Plan","73.70%","0.743781623354849","No","Yes","Yes","55%","45%","$2,500","$0","$3,200","$60","$2,396","$405","$1,898","$55","$1,062","$175","$354","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","25.00%","$2,500","$2500 per person","$5000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1H88","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140005","Anthem Silver Pathway X HMO 3500","36239KY114",,"KYN001","KYS003","KYF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140005-05","Anthem Silver Pathway X HMO 3500 S05","87% AV Level Silver Plan","86.78%","0.871144458303392","No","Yes","Yes","55%","45%","$700","$0","$1,100","$60","$895","$155","$750","$55","$700","$105","$354","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","25.00%","$700","$700 per person","$1400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%","$300","$300 per person","$600 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1H89","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","18726","SERFF","2017-06-14 20:15:39","Individual","Yes","31-1185262","18726KY0040001","DentaTrust - PPO Pediatric High Option","18726KY004","7083617077","KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0040001-00","DentaTrust - PPO Pediatric High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtky.dentalcareplus.com","http://hixpbdtky.dentalcareplus.com"
"2018","KY","18726","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","31-1185262","18726KY0050003","DentaSpan Family High Option","18726KY005","7083617077","KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0050003-00","DentaSpan Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsky.dentalcareplus.com","http://hiopbdsky.dentalcareplus.com"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140005","Anthem Silver Pathway X HMO 3500","36239KY114",,"KYN001","KYS003","KYF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140005-02","Anthem Silver Pathway X HMO 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","55%","45%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1J60","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140005","Anthem Silver Pathway X HMO 3500","36239KY114",,"KYN001","KYS003","KYF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140005-03","Anthem Silver Pathway X HMO 3500","Limited Cost Sharing Plan Variation","71.43%","0.721104142516392","No","Yes","Yes","55%","45%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25.00%","$3,500","$3500 per person","$7000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%","$1,000","$1000 per person","$2000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1GHS","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","18726","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","31-1185262","18726KY0050003","DentaSpan Family High Option","18726KY005","7083617077","KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0050003-01","DentaSpan Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsky.dentalcareplus.com","http://hixpbdsky.dentalcareplus.com"
"2018","KY","18726","SERFF","2017-06-14 20:15:39","Individual","Yes","31-1185262","18726KY0040001","DentaTrust - PPO Pediatric High Option","18726KY004","7083617077","KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0040001-01","DentaTrust - PPO Pediatric High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtky.dentalcareplus.com","http://hixpbdtky.dentalcareplus.com"
"2018","KY","18726","SERFF","2017-06-14 20:15:39","Individual","Yes","31-1185262","18726KY0040002","DentaTrust - PPO Pediatric Low Option","18726KY004","7083617077","KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0040002-00","DentaTrust - PPO Pediatric Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtky.dentalcareplus.com","http://hixpbdtky.dentalcareplus.com"
"2018","KY","18726","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","31-1185262","18726KY0050004","DentaSpan Family Low Option","18726KY005","7083617077","KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0050004-00","DentaSpan Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsky.dentalcareplus.com","http://hiopbdsky.dentalcareplus.com"
"2018","KY","18726","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","31-1185262","18726KY0050004","DentaSpan Family Low Option","18726KY005","7083617077","KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0050004-01","DentaSpan Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsky.dentalcareplus.com","http://hixpbdsky.dentalcareplus.com"
"2018","KY","18726","SERFF","2017-06-14 20:15:39","Individual","Yes","31-1185262","18726KY0040002","DentaTrust - PPO Pediatric Low Option","18726KY004","7083617077","KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0040002-01","DentaTrust - PPO Pediatric Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtky.dentalcareplus.com","http://hixpbdtky.dentalcareplus.com"
"2018","KY","18726","SERFF","2017-06-14 20:15:39","Individual","Yes","31-1185262","18726KY0040003","DentaTrust - PPO Family High Option","18726KY004","7083617077","KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0040003-00","DentaTrust - PPO Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtky.dentalcareplus.com","http://hixpbdtky.dentalcareplus.com"
"2018","KY","18726","SERFF","2017-06-14 20:15:39","Individual","Yes","31-1185262","18726KY0040003","DentaTrust - PPO Family High Option","18726KY004","7083617077","KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0040003-01","DentaTrust - PPO Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtky.dentalcareplus.com","http://hixpbdtky.dentalcareplus.com"
"2018","KY","18726","SERFF","2017-06-14 20:15:39","Individual","Yes","31-1185262","18726KY0040004","DentaTrust - PPO Family Low Option","18726KY004","7083617077","KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0040004-00","DentaTrust - PPO Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtky.dentalcareplus.com","http://hixpbdtky.dentalcareplus.com"
"2018","KY","18726","SERFF","2017-06-14 20:15:39","Individual","Yes","31-1185262","18726KY0040004","DentaTrust - PPO Family Low Option","18726KY004","7083617077","KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","18726KY0040004-01","DentaTrust - PPO Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtky.dentalcareplus.com","http://hixpbdtky.dentalcareplus.com"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140036","Anthem Silver Pathway X HMO 2000","36239KY114",,"KYN001","KYS003","KYF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140036-00","Anthem Silver Pathway HMO 2000","Standard Silver Off Exchange Plan","69.89%","0.720640656050223","Yes","Yes","Yes","55%","45%","$2,000","$40","$5,207","$60","$2,000","$310","$2,018","$55","$1,540","$0","$385","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VA0","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","Yes","61-1237516","36239KY1060005","Anthem Dental Family Value","36239KY106",,"KYN003","KYS009",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","36239KY1060005-01","Anthem Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/ky/f0/s0/t0/pw_e215609.pdf",
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140036","Anthem Silver Pathway X HMO 2000","36239KY114",,"KYN001","KYS003","KYF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140036-01","Anthem Silver Pathway X HMO 2000","Standard Silver On Exchange Plan","69.89%","0.720640656050223","Yes","Yes","Yes","55%","45%","$2,000","$40","$5,207","$60","$2,000","$310","$2,018","$55","$1,540","$0","$385","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VA1","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140036","Anthem Silver Pathway X HMO 2000","36239KY114",,"KYN001","KYS003","KYF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140036-02","Anthem Silver Pathway X HMO 2000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","55%","45%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VA2","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140036","Anthem Silver Pathway X HMO 2000","36239KY114",,"KYN001","KYS003","KYF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140036-03","Anthem Silver Pathway X HMO 2000","Limited Cost Sharing Plan Variation","69.89%","0.720640656050223","Yes","Yes","Yes","55%","45%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$2,000","$2000 per person","$4000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VA1","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140036","Anthem Silver Pathway X HMO 2000","36239KY114",,"KYN001","KYS003","KYF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140036-04","Anthem Silver Pathway X HMO 2000 S04","73% AV Level Silver Plan","72.76%","0.746691325960194","Yes","Yes","Yes","55%","45%","$1,700","$0","$4,000","$60","$1,700","$310","$2,018","$55","$1,540","$0","$385","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","20.00%","$1,700","$1700 per person","$3400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VA3","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140036","Anthem Silver Pathway X HMO 2000","36239KY114",,"KYN001","KYS003","KYF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140036-05","Anthem Silver Pathway X HMO 2000 S05","87% AV Level Silver Plan","86.01%","0.872301952476527","Yes","Yes","Yes","55%","45%","$700","$0","$850","$60","$700","$110","$740","$55","$700","$0","$385","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group","$1,550","$1550 per person","$3100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%","$700","$700 per person","$1400 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VA4","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140036","Anthem Silver Pathway X HMO 2000","36239KY114",,"KYN001","KYS003","KYF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140036-06","Anthem Silver Pathway X HMO 2000 S06","94% AV Level Silver Plan","93.09%","0.934497694062139","Yes","Yes","Yes","55%","45%","$175","$0","$525","$60","$175","$60","$465","$55","$175","$0","$385","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","20.00%","$175","$175 per person","$350 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VA5","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140039","Anthem Catastrophic Pathway X HMO 7350","36239KY114",,"KYN001","KYS003","KYF002","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140039-00","Anthem Catastrophic Pathway HMO 7350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","55%","45%","$7,350","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%","$7,350","$7350 per person","$14700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VAF","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140039","Anthem Catastrophic Pathway X HMO 7350","36239KY114",,"KYN001","KYS003","KYF002","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140039-01","Anthem Catastrophic Pathway X HMO 7350","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","55%","45%","$7,350","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%","$7,350","$7350 per person","$14700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VAG","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","Yes","61-1237516","36239KY1060003","Anthem Dental Family","36239KY106",,"KYN003","KYS009",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","36239KY1060003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/ky/f0/s0/t0/pw_e215607.pdf",
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140001","Anthem Bronze Pathway X HMO 6100","36239KY114",,"KYN001","KYS003","KYF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140001-00","Anthem Bronze Pathway HMO 6100","Standard Bronze Off Exchange Plan","62.00%","0.623975492671968","Yes","Yes","Yes","55%","45%","$2,064","$0","$5,286","$60","$3,836","$280","$2,557","$55","$1,026","$140","$684","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","40.00%","$6,100","$6100 per person","$12200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GG7","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140001","Anthem Bronze Pathway X HMO 6100","36239KY114",,"KYN001","KYS003","KYF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140001-01","Anthem Bronze Pathway X HMO 6100","Standard Bronze On Exchange Plan","62.00%","0.623975492671968","Yes","Yes","Yes","55%","45%","$2,064","$0","$5,286","$60","$3,836","$280","$2,557","$55","$1,026","$140","$684","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","40.00%","$6,100","$6100 per person","$12200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GG6","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140005","Anthem Silver Pathway X HMO 3500","36239KY114",,"KYN001","KYS003","KYF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140005-06","Anthem Silver Pathway X HMO 3500 S06","94% AV Level Silver Plan","93.42%","0.93590316960579","No","Yes","Yes","55%","45%","$134","$0","$566","$60","$350","$70","$280","$55","$250","$70","$354","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25.00%","$250","$250 per person","$500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40.00%","$100","$100 per person","$200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1H8A","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140035","Anthem Silver Pathway X HMO 3000 for HSA","36239KY114",,"KYN001","KYS003","KYF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140035-06","Anthem Silver Pathway X HMO 3000 S06","94% AV Level Silver Plan","93.24%","0.933533058945656","Yes","Yes","Yes","55%","45%","$200","$0","$525","$60","$200","$40","$485","$55","$200","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$725","$725 per person","$1450 per group","$725","$725 per person","$1450 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%","$200","$200 per person","$400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2V9Z","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140038","Anthem Bronze Pathway X Transition HMO 6750","36239KY114",,"KYN001","KYS004","KYF006","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140038-00","Anthem Bronze Pathway Transition HMO 6750","Standard Bronze Off Exchange Plan","63.51%","0.637489717316426","Yes","Yes","Yes","55%","45%","$2,390","$0","$4,960","$60","$3,251","$355","$2,466","$55","$1,026","$100","$684","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","40.00%","$6,750","$6750 per person","$13500 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VAC","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140038","Anthem Bronze Pathway X Transition HMO 6750","36239KY114",,"KYN001","KYS004","KYF006","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140038-01","Anthem Bronze Pathway X Transition HMO 6750","Standard Bronze On Exchange Plan","63.51%","0.637489717316426","Yes","Yes","Yes","55%","45%","$2,390","$0","$4,960","$60","$3,251","$355","$2,466","$55","$1,026","$100","$684","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","40.00%","$6,750","$6750 per person","$13500 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VAD","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140038","Anthem Bronze Pathway X Transition HMO 6750","36239KY114",,"KYN001","KYS004","KYF006","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140038-02","Anthem Bronze Pathway X Transition HMO 6750 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","55%","45%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VAE","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140038","Anthem Bronze Pathway X Transition HMO 6750","36239KY114",,"KYN001","KYS004","KYF006","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140038-03","Anthem Bronze Pathway X Transition HMO 6750","Limited Cost Sharing Plan Variation","63.51%","0.637489717316426","Yes","Yes","Yes","55%","45%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","40.00%","$6,750","$6750 per person","$13500 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VAD","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140040","Anthem Silver Pathway X Transition HMO 6350","36239KY114",,"KYN001","KYS004","KYF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140040-01","Anthem Silver Pathway X Transition HMO 6350","Standard Silver On Exchange Plan","66.23%","0.665782840150284","Yes","Yes","Yes","55%","45%","$2,580","$0","$4,770","$60","$3,750","$855","$1,966","$55","$1,282","$40","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","25.00%","$6,350","$6350 per person","$12700 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VAH","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140040","Anthem Silver Pathway X Transition HMO 6350","36239KY114",,"KYN001","KYS004","KYF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140040-02","Anthem Silver Pathway X Transition HMO 6350 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","55%","45%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VAM","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140009","Anthem Gold Pathway X HMO 1350","36239KY114",,"KYN001","KYS003","KYF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140009-00","Anthem Gold Pathway HMO 1350","Standard Gold Off Exchange Plan","76.01%","0.76780371299637","No","Yes","Yes","55%","45%","$1,350","$0","$4,450","$60","$1,950","$455","$1,805","$55","$1,133","$250","$283","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20.00%","$1,350","$1350 per person","$2700 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1GH9","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140009","Anthem Gold Pathway X HMO 1350","36239KY114",,"KYN001","KYS003","KYF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140009-01","Anthem Gold Pathway X HMO 1350","Standard Gold On Exchange Plan","76.01%","0.76780371299637","No","Yes","Yes","55%","45%","$1,350","$0","$4,450","$60","$1,950","$455","$1,805","$55","$1,133","$250","$283","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20.00%","$1,350","$1350 per person","$2700 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1GH8","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140009","Anthem Gold Pathway X HMO 1350","36239KY114",,"KYN001","KYS003","KYF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140009-02","Anthem Gold Pathway X HMO 1350 AI","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","55%","45%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1J5Z","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140009","Anthem Gold Pathway X HMO 1350","36239KY114",,"KYN001","KYS003","KYF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140009-03","Anthem Gold Pathway X HMO 1350","Limited Cost Sharing Plan Variation","76.01%","0.76780371299637","No","Yes","Yes","55%","45%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20.00%","$1,350","$1350 per person","$2700 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40.00%","$600","$600 per person","$1200 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1GH8","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140040","Anthem Silver Pathway X Transition HMO 6350","36239KY114",,"KYN001","KYS004","KYF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140040-00","Anthem Silver Pathway Transition HMO 6350","Standard Silver Off Exchange Plan","66.23%","0.665782840150284","Yes","Yes","Yes","55%","45%","$2,580","$0","$4,770","$60","$3,750","$855","$1,966","$55","$1,282","$40","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","25.00%","$6,350","$6350 per person","$12700 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VAN","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140033","Anthem Silver Pathway X HMO 5300","36239KY114",,"KYN001","KYS003","KYF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140033-00","Anthem Silver Pathway HMO 5300","Standard Silver Off Exchange Plan","68.91%","0.691718642000242","Yes","Yes","Yes","55%","45%","$2,580","$0","$4,420","$60","$3,750","$315","$1,966","$55","$1,282","$80","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDC","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140033","Anthem Silver Pathway X HMO 5300","36239KY114",,"KYN001","KYS003","KYF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140033-01","Anthem Silver Pathway X HMO 5300","Standard Silver On Exchange Plan","68.91%","0.691718642000242","Yes","Yes","Yes","55%","45%","$2,580","$0","$4,420","$60","$3,750","$315","$1,966","$55","$1,282","$80","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDB","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140033","Anthem Silver Pathway X HMO 5300","36239KY114",,"KYN001","KYS003","KYF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140033-02","Anthem Silver Pathway X HMO 5300 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","55%","45%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EDG","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140033","Anthem Silver Pathway X HMO 5300","36239KY114",,"KYN001","KYS003","KYF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140033-03","Anthem Silver Pathway X HMO 5300","Limited Cost Sharing Plan Variation","68.91%","0.691718642000242","Yes","Yes","Yes","55%","45%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDB","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140033","Anthem Silver Pathway X HMO 5300","36239KY114",,"KYN001","KYS003","KYF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140033-04","Anthem Silver Pathway X HMO 5300 S04","73% AV Level Silver Plan","72.77%","0.730361846643702","Yes","Yes","Yes","55%","45%","$2,580","$0","$2,920","$60","$3,435","$255","$1,810","$55","$1,282","$60","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group","25.00%","$3,700","$3700 per person","$7400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDD","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140033","Anthem Silver Pathway X HMO 5300","36239KY114",,"KYN001","KYS003","KYF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140033-05","Anthem Silver Pathway X HMO 5300 S05","87% AV Level Silver Plan","86.37%","0.865218256635122","Yes","Yes","Yes","55%","45%","$650","$0","$1,350","$60","$650","$125","$1,225","$55","$650","$20","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","25.00%","$650","$650 per person","$1300 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDE","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140033","Anthem Silver Pathway X HMO 5300","36239KY114",,"KYN001","KYS003","KYF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140033-06","Anthem Silver Pathway X HMO 5300 S06","94% AV Level Silver Plan","93.18%","0.932254339528275","Yes","Yes","Yes","55%","45%","$150","$0","$650","$60","$150","$55","$595","$55","$150","$20","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","25.00%","$150","$150 per person","$300 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EDF","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140034","Anthem Bronze Pathway X HMO 6650 for HSA","36239KY114",,"KYN001","KYS003","KYF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140034-00","Anthem Bronze Pathway HMO 6650 for HSA","Standard Bronze Off Exchange Plan","60.22%","0.602242886076114","Yes","Yes","Yes","55%","45%","$6,650","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%","$6,650","$6650 per person","$13300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2V9R","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140034","Anthem Bronze Pathway X HMO 6650 for HSA","36239KY114",,"KYN001","KYS003","KYF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140034-01","Anthem Bronze Pathway X HMO 6650 for HSA","Standard Bronze On Exchange Plan","60.22%","0.602242886076114","Yes","Yes","Yes","55%","45%","$6,650","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%","$6,650","$6650 per person","$13300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2V9S","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140034","Anthem Bronze Pathway X HMO 6650 for HSA","36239KY114",,"KYN001","KYS003","KYF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140034-02","Anthem Bronze Pathway X HMO 6650 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","55%","45%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2V9T","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140034","Anthem Bronze Pathway X HMO 6650 for HSA","36239KY114",,"KYN001","KYS003","KYF002","New","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140034-03","Anthem Bronze Pathway X HMO 6650 for HSA","Limited Cost Sharing Plan Variation","60.22%","0.602242886076114","Yes","Yes","Yes","55%","45%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%","$6,650","$6650 per person","$13300 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2V9S","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140035","Anthem Silver Pathway X HMO 3000 for HSA","36239KY114",,"KYN001","KYS003","KYF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140035-00","Anthem Silver Pathway HMO 3000 for HSA","Standard Silver Off Exchange Plan","68.30%","0.685995241802235","Yes","Yes","Yes","55%","45%","$3,000","$0","$2,700","$60","$3,000","$310","$1,725","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2V9U","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140035","Anthem Silver Pathway X HMO 3000 for HSA","36239KY114",,"KYN001","KYS003","KYF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140035-01","Anthem Silver Pathway X HMO 3000 for HSA","Standard Silver On Exchange Plan","68.30%","0.685995241802235","Yes","Yes","Yes","55%","45%","$3,000","$0","$2,700","$60","$3,000","$310","$1,725","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2V9V","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140035","Anthem Silver Pathway X HMO 3000 for HSA","36239KY114",,"KYN001","KYS003","KYF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140035-02","Anthem Silver Pathway X HMO 3000 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","55%","45%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2V9W","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140035","Anthem Silver Pathway X HMO 3000 for HSA","36239KY114",,"KYN001","KYS003","KYF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140035-03","Anthem Silver Pathway X HMO 3000 for HSA","Limited Cost Sharing Plan Variation","68.30%","0.685995241802235","Yes","Yes","Yes","55%","45%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd2V9V","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140035","Anthem Silver Pathway X HMO 3000 for HSA","36239KY114",,"KYN001","KYS003","KYF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140035-04","Anthem Silver Pathway X HMO 3000 S04","73% AV Level Silver Plan","73.94%","0.744426165250456","Yes","Yes","Yes","55%","45%","$1,600","$0","$3,800","$60","$1,600","$310","$1,725","$55","$1,600","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","10.00%","$1,600","$1600 per person","$3200 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2V9X","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140035","Anthem Silver Pathway X HMO 3000 for HSA","36239KY114",,"KYN001","KYS003","KYF001","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140035-05","Anthem Silver Pathway X HMO 3000 S05","87% AV Level Silver Plan","86.76%","0.870834246520749","Yes","Yes","Yes","55%","45%","$500","$0","$1,300","$60","$500","$100","$1,200","$55","$500","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%","$500","$500 per person","$1000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2V9Y","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140040","Anthem Silver Pathway X Transition HMO 6350","36239KY114",,"KYN001","KYS004","KYF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140040-03","Anthem Silver Pathway X Transition HMO 6350","Limited Cost Sharing Plan Variation","66.23%","0.665782840150284","Yes","Yes","Yes","55%","45%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","25.00%","$6,350","$6350 per person","$12700 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VAH","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140040","Anthem Silver Pathway X Transition HMO 6350","36239KY114",,"KYN001","KYS004","KYF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140040-04","Anthem Silver Pathway X Transition HMO 6350 S04","73% AV Level Silver Plan","72.02%","0.722820908521028","Yes","Yes","Yes","55%","45%","$2,580","$0","$3,020","$60","$3,315","$485","$1,800","$55","$1,282","$40","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","25.00%","$3,600","$3600 per person","$7200 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VAJ","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140040","Anthem Silver Pathway X Transition HMO 6350","36239KY114",,"KYN001","KYS004","KYF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140040-05","Anthem Silver Pathway X Transition HMO 6350 S05","87% AV Level Silver Plan","86.02%","0.861653362948217","Yes","Yes","Yes","55%","45%","$1,000","$0","$700","$60","$1,000","$110","$590","$55","$1,000","$40","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25.00%","$1,000","$1000 per person","$2000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VAK","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","No","61-1237516","36239KY1140040","Anthem Silver Pathway X Transition HMO 6350","36239KY114",,"KYN001","KYS004","KYF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Emergency Coverage Only","No","Emergency Coverage Only.  Urgent Care is covered only if rendered by a BlueCard Provider.","No","https://payment.anthem.com/sales/payment/exchange?state=KY","https://www.anthem.com/KYSelectdrugtier4","36239KY1140040-06","Anthem Silver Pathway X Transition HMO 6350 S06","94% AV Level Silver Plan","93.05%","0.93161171865593","Yes","Yes","Yes","55%","45%","$134","$0","$616","$60","$150","$90","$510","$55","$150","$40","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","25.00%","$150","$150 per person","$300 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VAL","http://editiondigital.net/view/IU65/2018/ON_HIX_KY_KIT_2018"
"2018","KY","36239","SERFF","2017-08-16 20:15:58","Individual","Yes","61-1237516","36239KY1060004","Anthem Dental Family Enhanced","36239KY106",,"KYN003","KYS009",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.837","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","36239KY1060004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/ky/f0/s0/t0/pw_e215608.pdf",
"2018","KY","43492","SERFF","2017-06-13 20:15:36","Individual","Yes","75-1233841","43492KY0010009","Dentegra Dental PPO Family Preferred Plan","43492KY001",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","43492KY0010009-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ky/43492ky0010009-18"
"2018","KY","43492","SERFF","2017-06-13 20:15:36","Individual","Yes","75-1233841","43492KY0010008","Dentegra Dental PPO Family Basic Plan","43492KY001",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","43492KY0010008-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","$65 per person","per group not applicable",,,,,,"$65","$65 per person","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ky/43492ky0010008-18"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010013","CareSource HSA Bronze","45636KY001",,"KYN001","KYS001","KYF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9937",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010013-00","CareSource HSA Bronze","Standard Bronze Off Exchange Plan",,"0.618651277477805","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"https://www.caresource.com/document/MP-2018-ky-hsa-bronze-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010013","CareSource HSA Bronze","45636KY001",,"KYN001","KYS001","KYF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9937",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010013-01","CareSource HSA Bronze","Standard Bronze On Exchange Plan",,"0.618651277477805","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"https://www.caresource.com/document/MP-2018-ky-hsa-bronze-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010013","CareSource HSA Bronze","45636KY001",,"KYN001","KYS001","KYF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9937",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010013-02","CareSource HSA Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-hsa-bronzezero-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010013","CareSource HSA Bronze","45636KY001",,"KYN001","KYS001","KYF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9937",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010013-03","CareSource HSA Bronze Limited","Limited Cost Sharing Plan Variation",,"0.618651277477805","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"https://www.caresource.com/document/MP-2018-ky-hsa-bronzeltd-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010014","CareSource Low Premium Silver","45636KY001",,"KYN001","KYS001","KYF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010014-00","CareSource Low Premium Silver","Standard Silver Off Exchange Plan",,"0.689409535860672","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,204","$200","$212","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-lp-silver-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010014","CareSource Low Premium Silver","45636KY001",,"KYN001","KYS001","KYF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010014-01","CareSource Low Premium Silver","Standard Silver On Exchange Plan",,"0.689409535860672","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,204","$200","$212","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-lp-silver-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010014","CareSource Low Premium Silver","45636KY001",,"KYN001","KYS001","KYF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010014-02","CareSource Low Premium Silver Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-lp-silverzero-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010014","CareSource Low Premium Silver","45636KY001",,"KYN001","KYS001","KYF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010014-03","CareSource Low Premium Silver Limited","Limited Cost Sharing Plan Variation",,"0.689409535860672","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,204","$200","$212","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-lp-silverltd-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010014","CareSource Low Premium Silver","45636KY001",,"KYN001","KYS001","KYF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010014-04","CareSource Low Premium Silver 1","73% AV Level Silver Plan",,"0.728592707103115","Yes","Yes","No","100%",,"$4,800","$465","$516","$60","$1,582","$1,305","$279","$55","$1,204","$165","$212","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,800","$5800 per person","$11600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,800","$4800 per person","$9600 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-lp-silver1-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010014","CareSource Low Premium Silver","45636KY001",,"KYN001","KYS001","KYF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010014-05","CareSource Low Premium Silver 2","87% AV Level Silver Plan",,"0.878297152603727","Yes","Yes","No","100%",,"$950","$306","$344","$60","$909","$590","$101","$55","$950","$130","$142","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-lp-silver2-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010014","CareSource Low Premium Silver","45636KY001",,"KYN001","KYS001","KYF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010014-06","CareSource Low Premium Silver 3","94% AV Level Silver Plan",,"0.933269288943385","Yes","Yes","No","100%",,"$571","$0","$129","$60","$517","$155","$28","$55","$600","$33","$67","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-lp-silver3-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010029","CareSource Gold","45636KY001",,"KYN001","KYS001","KYF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9957",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010029-00","CareSource Gold","Standard Gold Off Exchange Plan",,"0.795969250972381","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$190","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-gold-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010029","CareSource Gold","45636KY001",,"KYN001","KYS001","KYF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9957",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010029-01","CareSource Gold","Standard Gold On Exchange Plan",,"0.795969250972381","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$190","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-gold-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010029","CareSource Gold","45636KY001",,"KYN001","KYS001","KYF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9957",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010029-02","CareSource Gold Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-goldzero-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010029","CareSource Gold","45636KY001",,"KYN001","KYS001","KYF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9957",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010029-03","CareSource Gold Limited","Limited Cost Sharing Plan Variation",,"0.795969250972381","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$190","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-goldltd-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010017","CareSource Bronze","45636KY001",,"KYN001","KYS001","KYF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9932",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010017-00","CareSource Bronze","Standard Bronze Off Exchange Plan",,"0.618817449418548","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$3,430","$1,015","$2,287","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-bronze-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010017","CareSource Bronze","45636KY001",,"KYN001","KYS001","KYF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9932",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010017-01","CareSource Bronze","Standard Bronze On Exchange Plan",,"0.618817449418548","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$3,430","$1,015","$2,287","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-bronze-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010017","CareSource Bronze","45636KY001",,"KYN001","KYS001","KYF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9932",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010017-02","CareSource Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-bronzezero-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010017","CareSource Bronze","45636KY001",,"KYN001","KYS001","KYF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9932",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010017-03","CareSource Bronze Limited","Limited Cost Sharing Plan Variation",,"0.618817449418548","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$3,430","$1,015","$2,287","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-bronzeltd-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010030","CareSource Silver","45636KY001",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010030-00","CareSource Silver","Standard Silver Off Exchange Plan",,"0.718671059780731","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$340","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-silver-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010030","CareSource Silver","45636KY001",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010030-01","CareSource Silver","Standard Silver On Exchange Plan",,"0.718671059780731","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$340","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-silver-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010030","CareSource Silver","45636KY001",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010030-02","CareSource Silver Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-silverzero-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010030","CareSource Silver","45636KY001",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010030-03","CareSource Silver Limited","Limited Cost Sharing Plan Variation",,"0.718671059780731","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$340","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-silverltd-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010030","CareSource Silver","45636KY001",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010030-04","CareSource Silver 1","73% AV Level Silver Plan",,"0.739664364435595","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,320","$518","$55","$970","$310","$416","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-silver1-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010030","CareSource Silver","45636KY001",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010030-05","CareSource Silver 2","87% AV Level Silver Plan",,"0.879062515482481","Yes","Yes","No","100%",,"$950","$591","$359","$60","$781","$980","$139","$55","$950","$105","$208","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-silver2-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010030","CareSource Silver","45636KY001",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010030-06","CareSource Silver 3","94% AV Level Silver Plan",,"0.945421805242358","Yes","Yes","No","100%",,"$205","$300","$120","$60","$244","$369","$13","$55","$325","$75","$69","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$625","$625 per person","$1250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$625","$625 per person","$1250 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$325","$325 per person","$650 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$325","$325 per person","$650 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-silver3-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020014","CareSource Low Premium Silver Dental and Vision","45636KY002",,"KYN001","KYS001","KYF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020014-00","CareSource Low Premium Silver Dental and Vision","Standard Silver Off Exchange Plan",,"0.689409535860672","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,204","$200","$212","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-lp-silver-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020014","CareSource Low Premium Silver Dental and Vision","45636KY002",,"KYN001","KYS001","KYF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020014-01","CareSource Low Premium Silver Dental and Vision","Standard Silver On Exchange Plan",,"0.689409535860672","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,204","$200","$212","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-lp-silver-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020014","CareSource Low Premium Silver Dental and Vision","45636KY002",,"KYN001","KYS001","KYF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020014-02","CareSource Low Premium Silver Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-lp-silverzero-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020014","CareSource Low Premium Silver Dental and Vision","45636KY002",,"KYN001","KYS001","KYF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020014-03","CareSource Low Premium Silver Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.689409535860672","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,204","$200","$212","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-lp-silverltd-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020014","CareSource Low Premium Silver Dental and Vision","45636KY002",,"KYN001","KYS001","KYF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020014-04","CareSource Low Premium Silver 1 Dental and Vision","73% AV Level Silver Plan",,"0.728592707103115","Yes","Yes","No","100%",,"$4,800","$465","$516","$60","$1,582","$1,305","$279","$55","$1,204","$165","$212","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,800","$5800 per person","$11600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,800","$4800 per person","$9600 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-lp-silver1-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020014","CareSource Low Premium Silver Dental and Vision","45636KY002",,"KYN001","KYS001","KYF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020014-05","CareSource Low Premium Silver 2 Dental and Vision","87% AV Level Silver Plan",,"0.878297152603727","Yes","Yes","No","100%",,"$950","$306","$344","$60","$909","$590","$101","$55","$950","$130","$142","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-lp-silver2-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020014","CareSource Low Premium Silver Dental and Vision","45636KY002",,"KYN001","KYS001","KYF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020014-06","CareSource Low Premium Silver 3 Dental and Vision","94% AV Level Silver Plan",,"0.933269288943385","Yes","Yes","No","100%",,"$571","$0","$129","$60","$517","$155","$28","$55","$600","$33","$67","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-lp-silver3-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020015","CareSource Gold Dental and Vision","45636KY002",,"KYN001","KYS001","KYF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9573",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020015-00","CareSource Gold Dental and Vision","Standard Gold Off Exchange Plan",,"0.795969250972381","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$190","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-gold-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020015","CareSource Gold Dental and Vision","45636KY002",,"KYN001","KYS001","KYF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9573",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020015-01","CareSource Gold Dental and Vision","Standard Gold On Exchange Plan",,"0.795969250972381","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$190","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-gold-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020015","CareSource Gold Dental and Vision","45636KY002",,"KYN001","KYS001","KYF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9573",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020015-02","CareSource Gold Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-goldzero-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020015","CareSource Gold Dental and Vision","45636KY002",,"KYN001","KYS001","KYF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9573",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020015-03","CareSource Gold Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.795969250972381","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$190","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-goldltd-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020017","CareSource Bronze Dental and Vision","45636KY002",,"KYN001","KYS001","KYF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9338",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020017-00","CareSource Bronze Dental and Vision","Standard Bronze Off Exchange Plan",,"0.618817449418548","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$3,430","$1,015","$2,287","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-bronze-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020017","CareSource Bronze Dental and Vision","45636KY002",,"KYN001","KYS001","KYF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9338",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020017-01","CareSource Bronze Dental and Vision","Standard Bronze On Exchange Plan",,"0.618817449418548","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$3,430","$1,015","$2,287","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-bronze-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020017","CareSource Bronze Dental and Vision","45636KY002",,"KYN001","KYS001","KYF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9338",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020017-02","CareSource Bronze Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-bronzezero-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020017","CareSource Bronze Dental and Vision","45636KY002",,"KYN001","KYS001","KYF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9338",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020017-03","CareSource Bronze Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.618817449418548","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$3,430","$1,015","$2,287","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-bronzeltd-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020016","CareSource Silver Dental and Vision","45636KY002",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9522",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020016-00","CareSource Silver Dental and Vision","Standard Silver Off Exchange Plan",,"0.718671059780731","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$340","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-silver-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020016","CareSource Silver Dental and Vision","45636KY002",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9522",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020016-01","CareSource Silver Dental and Vision","Standard Silver On Exchange Plan",,"0.718671059780731","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$340","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-silver-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020016","CareSource Silver Dental and Vision","45636KY002",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9522",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020016-02","CareSource Silver Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-silverzero-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020016","CareSource Silver Dental and Vision","45636KY002",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9522",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020016-03","CareSource Silver Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.718671059780731","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$340","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-silverltd-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020016","CareSource Silver Dental and Vision","45636KY002",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9522",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020016-04","CareSource Silver 1 Dental and Vision","73% AV Level Silver Plan",,"0.739664364435595","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,320","$518","$55","$970","$310","$416","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-silver1-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020016","CareSource Silver Dental and Vision","45636KY002",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9522",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020016-05","CareSource Silver 2 Dental and Vision","87% AV Level Silver Plan",,"0.879062515482481","Yes","Yes","No","100%",,"$950","$591","$359","$60","$781","$980","$139","$55","$950","$105","$208","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-silver2-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0020016","CareSource Silver Dental and Vision","45636KY002",,"KYN001","KYS001","KYF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9522",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0020016-06","CareSource Silver 3 Dental and Vision","94% AV Level Silver Plan",,"0.945421805242358","Yes","Yes","No","100%",,"$205","$300","$120","$60","$244","$369","$13","$55","$325","$75","$69","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$625","$625 per person","$1250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$625","$625 per person","$1250 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$325","$325 per person","$650 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$325","$325 per person","$650 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-silver3-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0030004","CareSource Federal Simple Choice Silver","45636KY003",,"KYN001","KYS001","KYF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9954",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0030004-00","CareSource Federal Simple Choice Silver","Standard Silver Off Exchange Plan",,"0.710269195121069","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,133","$315","$283","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-silver-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0030004","CareSource Federal Simple Choice Silver","45636KY003",,"KYN001","KYS001","KYF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9954",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0030004-01","CareSource Federal Simple Choice Silver","Standard Silver On Exchange Plan",,"0.710269195121069","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,133","$315","$283","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-silver-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0030004","CareSource Federal Simple Choice Silver","45636KY003",,"KYN001","KYS001","KYF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9954",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0030004-02","CareSource Federal Simple Choice Silver Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-silverzero-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0030004","CareSource Federal Simple Choice Silver","45636KY003",,"KYN001","KYS001","KYF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9954",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0030004-03","CareSource Federal Simple Choice Silver Limited","Limited Cost Sharing Plan Variation",,"0.710269195121069","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,133","$315","$283","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-silverltd-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0030004","CareSource Federal Simple Choice Silver","45636KY003",,"KYN001","KYS001","KYF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9954",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0030004-04","CareSource Federal Simple Choice Silver 1","73% AV Level Silver Plan",,"0.738794924688866","No","Yes","No","100%",,"$3,000","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,133","$315","$283","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-silver1-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0030004","CareSource Federal Simple Choice Silver","45636KY003",,"KYN001","KYS001","KYF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9954",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0030004-05","CareSource Federal Simple Choice Silver 2","87% AV Level Silver Plan",,"0.877035341535135","No","Yes","No","100%",,"$700","$0","$1,750","$60","$700","$610","$372","$55","$700","$115","$283","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-silver2-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0030004","CareSource Federal Simple Choice Silver","45636KY003",,"KYN001","KYS001","KYF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9954",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0030004-06","CareSource Federal Simple Choice Silver 3","94% AV Level Silver Plan",,"0.946789936071581","No","Yes","No","100%",,"$250","$22","$620","$60","$250","$218","$93","$55","$250","$50","$71","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-silver3-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0030005","CareSource Federal Simple Choice Bronze","45636KY003",,"KYN001","KYS001","KYF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9941",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0030005-00","CareSource Federal Simple Choice Bronze","Standard Bronze Off Exchange Plan",,"0.627854145469795","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$4,179","$2,035","$745","$55","$850","$365","$566","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-bronze-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0030005","CareSource Federal Simple Choice Bronze","45636KY003",,"KYN001","KYS001","KYF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9941",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0030005-01","CareSource Federal Simple Choice Bronze","Standard Bronze On Exchange Plan",,"0.627854145469795","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$4,179","$2,035","$745","$55","$850","$365","$566","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-bronze-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0030005","CareSource Federal Simple Choice Bronze","45636KY003",,"KYN001","KYS001","KYF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9941",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0030005-02","CareSource Federal Simple Choice Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-bronzezero-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0030005","CareSource Federal Simple Choice Bronze","45636KY003",,"KYN001","KYS001","KYF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9941",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0030005-03","CareSource Federal Simple Choice Bronze Limited","Limited Cost Sharing Plan Variation",,"0.627854145469795","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$4,179","$2,035","$745","$55","$850","$365","$566","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-bronzeltd-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","ME","33653","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","45-3416923","33653ME0101809","Community Prime GRP","33653ME010",,"MEN001","MES001","MEF001","Existing","PPO","Gold","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9898",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0101809-00","Community Prime GRP","Standard Gold Off Exchange Plan","77.07%","0.768629848878328","Yes","Yes","No","100%",,"$1,500","$0","$2,700","$0","$56","$1,619","$0","$0","$1,500","$260","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/documents/2018/33653ME0101809","https://www.healthoptions.org/documents/2018/33653ME0101809-0817"
"2018","ME","33653","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","45-3416923","33653ME0101809","Community Prime GRP","33653ME010",,"MEN001","MES001","MEF001","Existing","PPO","Gold","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9898",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0101809-01","Community Prime GRP","Standard Gold On Exchange Plan","77.07%","0.768629848878328","Yes","Yes","No","100%",,"$1,500","$0","$2,700","$0","$56","$1,619","$0","$0","$1,500","$260","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/documents/2018/33653ME0101809","https://www.healthoptions.org/documents/2018/33653ME0101809-0817"
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0010001","Community Safe Harbor PPO","33653ME001",,"MEN001","MES001","MEF001","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0010001-00","Community Safe Harbor PPO","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$6,685","$0","$0","$0","$1,925","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"7350","$7350 per person","$14700 per group",,,,"21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7350","$7350 per person","$14700 per group","0",,,,,"21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0010001-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0010001","Community Safe Harbor PPO","33653ME001",,"MEN001","MES001","MEF001","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0010001-01","Community Safe Harbor PPO","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$6,685","$0","$0","$0","$1,925","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"7350","$7350 per person","$14700 per group",,,,"21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7350","$7350 per person","$14700 per group","0",,,,,"21450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0010001-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0010002","Community Focus PPO","33653ME001",,"MEN001","MES001","MEF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0010002-00","Community Focus PPO","Standard Bronze Off Exchange Plan","59.22%","0.592057619392603","Yes","Yes","No","100%",,"$5,500","$0","$1,850","$0","$1,488","$0","$561","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0010002-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","45-3416923","33653ME0101802","Community Access HSA GRP","33653ME010",,"MEN001","MES001","MEF002","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9912",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0101802-00","Community Access HSA GRP","Standard Bronze Off Exchange Plan","57.85%","0.605856884899998","Yes","Yes","No","100%",,"$6,300","$27","$0","$0","$6,297","$252","$0","$0","$1,925","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$12,600","$12600 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/documents/2018/33653ME0101802","https://www.healthoptions.org/documents/2018/33653ME0101802-0817"
"2018","ME","33653","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","45-3416923","33653ME0101802","Community Access HSA GRP","33653ME010",,"MEN001","MES001","MEF002","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9912",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0101802-01","Community Access HSA GRP","Standard Bronze On Exchange Plan","57.85%","0.605856884899998","Yes","Yes","No","100%",,"$6,300","$27","$0","$0","$6,297","$252","$0","$0","$1,925","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0.00%",,,,,"$12,600","$12600 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/documents/2018/33653ME0101802","https://www.healthoptions.org/documents/2018/33653ME0101802-0817"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0050004","CareSource Federal Simple Choice Silver Dental and Vision","45636KY005",,"KYN001","KYS001","KYF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9545",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0050004-00","CareSource Federal Simple Choice Silver Dental and Vision","Standard Silver Off Exchange Plan",,"0.710269195121069","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,133","$315","$283","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-silver-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0050004","CareSource Federal Simple Choice Silver Dental and Vision","45636KY005",,"KYN001","KYS001","KYF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9545",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0050004-01","CareSource Federal Simple Choice Silver Dental and Vision","Standard Silver On Exchange Plan",,"0.710269195121069","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,133","$315","$283","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-silver-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0050004","CareSource Federal Simple Choice Silver Dental and Vision","45636KY005",,"KYN001","KYS001","KYF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9545",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0050004-02","CareSource Federal Simple Choice Silver Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-silverzero-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0050004","CareSource Federal Simple Choice Silver Dental and Vision","45636KY005",,"KYN001","KYS001","KYF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9545",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0050004-03","CareSource Federal Simple Choice Silver Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.710269195121069","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,133","$315","$283","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-silverltd-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0050004","CareSource Federal Simple Choice Silver Dental and Vision","45636KY005",,"KYN001","KYS001","KYF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9545",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0050004-04","CareSource Federal Simple Choice Silver 1 Dental and Vision","73% AV Level Silver Plan",,"0.738794924688866","No","Yes","No","100%",,"$3,000","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,133","$315","$283","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-silver1-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0050004","CareSource Federal Simple Choice Silver Dental and Vision","45636KY005",,"KYN001","KYS001","KYF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9545",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0050004-05","CareSource Federal Simple Choice Silver 2 Dental and Vision","87% AV Level Silver Plan",,"0.877035341535135","No","Yes","No","100%",,"$700","$0","$1,750","$60","$700","$610","$372","$55","$700","$115","$283","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-silver2-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0050004","CareSource Federal Simple Choice Silver Dental and Vision","45636KY005",,"KYN001","KYS001","KYF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9545",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0050004-06","CareSource Federal Simple Choice Silver 3 Dental and Vision","94% AV Level Silver Plan",,"0.946789936071581","No","Yes","No","100%",,"$250","$22","$620","$60","$250","$218","$93","$55","$250","$50","$71","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-silver3-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0050005","CareSource Federal Simple Choice Bronze Dental and Vision","45636KY005",,"KYN001","KYS001","KYF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9425",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0050005-00","CareSource Federal Simple Choice Bronze Dental and Vision","Standard Bronze Off Exchange Plan",,"0.627854145469795","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$4,179","$2,035","$745","$55","$850","$365","$566","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-bronze-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0050005","CareSource Federal Simple Choice Bronze Dental and Vision","45636KY005",,"KYN001","KYS001","KYF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9425",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0050005-01","CareSource Federal Simple Choice Bronze Dental and Vision","Standard Bronze On Exchange Plan",,"0.627854145469795","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$4,179","$2,035","$745","$55","$850","$365","$566","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-bronze-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0050005","CareSource Federal Simple Choice Bronze Dental and Vision","45636KY005",,"KYN001","KYS001","KYF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9425",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0050005-02","CareSource Federal Simple Choice Bronze Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-bronzezero-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0050005","CareSource Federal Simple Choice Bronze Dental and Vision","45636KY005",,"KYN001","KYS001","KYF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9425",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0050005-03","CareSource Federal Simple Choice Bronze Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.627854145469795","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$4,179","$2,035","$745","$55","$850","$365","$566","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-fedstd-bronzeltd-dv-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010010","CareSource Catastrophic","45636KY001",,"KYN001","KYS001","KYF008","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9863",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010010-00","CareSource Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,393","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-catastrophic-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","45636","SERFF","2017-09-26 20:16:14","Individual","No","46-4991603","45636KY0010010","CareSource Catastrophic","45636KY001",,"KYN001","KYS001","KYF008","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9863",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","45636KY0010010-01","CareSource Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,393","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","No",,,"https://www.caresource.com/document/MP-2018-ky-catastrophic-sum","https://www.caresource.com/document/MP-2018-ky-a-broch"
"2018","KY","62201","SERFF","2017-08-16 20:15:58","Individual","Yes","61-0659432","62201KY0290001","Delta Dental PPO Gold","62201KY029","7568465752","KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","If a member does not use a network dentist, services will be reimbursed at the out of network level.","Yes","If a member does not use a network dentist services will be reimbursed at the out of network level.","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/alias/62201","","62201KY0290001-01","Delta Dental PPO Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$25","$25 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","KY","62201","SERFF","2017-08-16 20:15:58","Individual","Yes","61-0659432","62201KY0300001","Delta Dental PPO Silver","62201KY030","7568465752","KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","If a member does not use a network dentist, services will be reimbursed at the out of network level","Yes","If a member does not use a network dentist, services will be reimbursed at the out of network level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/alias/62201","","62201KY0300001-01","Delta Dental PPO Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","KY","62201","SERFF","2017-08-16 20:15:58","Individual","Yes","61-0659432","62201KY0420001","Delta Dental PPO Individual and Family Value Plan with EHB","62201KY042","7568465752","KYN001","KYS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","If a member does not use a network dentist, services will be reimbursed at the out of network level","Yes","If a member does not use a network dentist, services will be reimbursed at the out of network level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/alias/62201","","62201KY0420001-01","Delta Dental PPO Individual and Family Value Plan with EHB","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","KY","86825","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","86825KY0010007","BESTDental Premium","86825KY001",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010007-00","BESTDental Premium","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTDental_Premium_Plan.pdf"
"2018","KY","86825","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","86825KY0020003","BESTOne Advantage Gold","86825KY002",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","KY","86825","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","86825KY0020003","BESTOne Advantage Gold","86825KY002",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","KY","86825","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","86825KY0010007","BESTDental Premium","86825KY001",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010007-01","BESTDental Premium","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTDental_Premium_Plan.pdf"
"2018","KY","86825","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","86825KY0010008","BESTDental Standard - H","86825KY001",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTDental_Standard-H_Plan.pdf"
"2018","KY","86825","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","86825KY0020004","BESTOne Plus Gold","86825KY002",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","KY","86825","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","86825KY0020004","BESTOne Plus Gold","86825KY002",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","KY","86825","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","86825KY0010008","BESTDental Standard - H","86825KY001",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTDental_Standard-H_Plan.pdf"
"2018","KY","86825","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","86825KY0010010","BESTDental Choice - H","86825KY001",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTDental_Choice-H_Plan.pdf"
"2018","KY","86825","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","86825KY0010010","BESTDental Choice - H","86825KY001",,"KYN001","KYS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTDental_Choice-H_Plan.pdf"
"2018","KY","86825","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","86825KY0010009","BESTDental Standard - L","86825KY001",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTDental_Standard-L_Plan.pdf"
"2018","KY","86825","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","86825KY0020005","BESTOne Plus Silver","86825KY002",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","KY","86825","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","86825KY0020005","BESTOne Plus Silver","86825KY002",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","KY","86825","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","86825KY0010009","BESTDental Standard - L","86825KY001",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTDental_Standard-L_Plan.pdf"
"2018","KY","86825","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","86825KY0010011","BESTDental Choice - L","86825KY001",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTDental_Choice-L_Plan.pdf"
"2018","KY","86825","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","86825KY0020006","BESTOne Basic Silver","86825KY002",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","KY","86825","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","86825KY0020006","BESTOne Basic Silver","86825KY002",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","KY","86825","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","86825KY0010011","BESTDental Choice - L","86825KY001",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTDental_Choice-L_Plan.pdf"
"2018","KY","86825","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","86825KY0010012","BESTDental Value","86825KY001",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010012-00","BESTDental Value","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTDental_Value_Plan.pdf"
"2018","KY","86825","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","86825KY0010012","BESTDental Value","86825KY001",,"KYN001","KYS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","86825KY0010012-01","BESTDental Value","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KY/current/KY_BESTDental_Value_Plan.pdf"
"2018","ME","28804","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","13-5581829","28804ME0100001","EHB Basic Dental Plan (Low)","28804ME010",,"MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","28804ME0100001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","ME","33653","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","45-3416923","33653ME0101804","Community Core HSA GRP","33653ME010",,"MEN001","MES001","MEF002","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9911",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0101804-01","Community Core HSA GRP","Standard Silver On Exchange Plan","66.21%","0.6861604800212","Yes","Yes","No","100%",,"$3,000","$27","$955","$0","$3,000","$1,680","$33","$0","$1,925","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/documents/2018/33653ME0101804","https://www.healthoptions.org/documents/2018/33653ME0101804-0817"
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0050002","Community Advance PPO","33653ME005",,"MEN001","MES001","MEF006","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0050002-01","Community Advance PPO","Standard Silver On Exchange Plan","67.69%","0.676604837988888","Yes","Yes","No","100%",,"$2,500","$27","$4,020","$0","$2,500","$605","$1,157","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0050002-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0050002","Community Advance PPO","33653ME005",,"MEN001","MES001","MEF006","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0050002-02","Community Advance PPO","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthoptions.org/documents/2018/33653ME[#######-02]",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0010002","Community Focus PPO","33653ME001",,"MEN001","MES001","MEF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0010002-01","Community Focus PPO","Standard Bronze On Exchange Plan","59.22%","0.592057619392603","Yes","Yes","No","100%",,"$5,500","$0","$1,850","$0","$1,488","$0","$561","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0010002-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0010002","Community Focus PPO","33653ME001",,"MEN001","MES001","MEF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0010002-02","Community Focus PPO","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthoptions.org/documents/2018/33653ME[#######-02]",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0010002","Community Focus PPO","33653ME001",,"MEN001","MES001","MEF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0010002-03","Community Focus PPO","Limited Cost Sharing Plan Variation","59.22%","0.592057619392603","Yes","Yes","No","100%",,"$5,500","$0","$1,850","$0","$1,488","$0","$561","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0010002-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0010003","Community Choice PPO","33653ME001",,"MEN001","MES001","MEF006","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0010003-00","Community Choice PPO","Standard Silver Off Exchange Plan","67.69%","0.676604837988888","Yes","Yes","No","100%",,"$2,500","$27","$4,020","$0","$2,500","$605","$1,157","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0010003-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0010003","Community Choice PPO","33653ME001",,"MEN001","MES001","MEF006","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0010003-01","Community Choice PPO","Standard Silver On Exchange Plan","67.69%","0.676604837988888","Yes","Yes","No","100%",,"$2,500","$27","$4,020","$0","$2,500","$605","$1,157","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0010003-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0010003","Community Choice PPO","33653ME001",,"MEN001","MES001","MEF006","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0010003-02","Community Choice PPO","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthoptions.org/documents/2018/33653ME[#######-02]",
"2018","ME","48396","SERFF","2017-09-06 20:16:09","Individual","Yes","31-1705652","48396ME0860004","Anthem Dental Family Enhanced","48396ME086",,"MEN003","MES008",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.865","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","48396ME0860004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/me/f0/s0/t0/pw_e215727.pdf",
"2018","ME","48396","SERFF","2017-09-06 20:16:09","Individual","Yes","31-1705652","48396ME0920004","Anthem Dental Family Enhanced","48396ME092",,"MEN003","MES008",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.865","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","48396ME0920004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/me/f0/s0/t0/pw_e215727.pdf",
"2018","ME","50165","SERFF","2017-08-11 20:15:53","Individual","Yes","01-0286541","50165ME0160001","Delta Dental Family High Plan","50165ME016","7447253908","MEN001","MES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.8911","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","50165ME0160001-00","Delta Dental Family High Plan","Standard High Off Exchange Plan","84.66%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/OFFHIX/oocme2018a.pdf"
"2018","ME","50165","SERFF","2017-08-11 20:15:53","Individual","Yes","01-0286541","50165ME0160001","Delta Dental Family High Plan","50165ME016","7447253908","MEN001","MES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.8911","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","50165ME0160001-01","Delta Dental Family High Plan","Standard High On Exchange Plan","84.66%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/me/oocme20181.pdf"
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0010003","Community Choice PPO","33653ME001",,"MEN001","MES001","MEF006","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0010003-03","Community Choice PPO","Limited Cost Sharing Plan Variation","67.69%","0.676604837988888","Yes","Yes","No","100%",,"$2,500","$27","$4,020","$0","$2,500","$605","$1,157","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0010003-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0010003","Community Choice PPO","33653ME001",,"MEN001","MES001","MEF006","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0010003-04","Community Choice PPO","73% AV Level Silver Plan","72.12%","0.715438133641727","Yes","Yes","No","100%",,"$2,100","$27","$3,135","$0","$2,100","$605","$988","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","30.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0010003-04",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0010003","Community Choice PPO","33653ME001",,"MEN001","MES001","MEF006","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0010003-05","Community Choice PPO","87% AV Level Silver Plan","86.03%","0.857739890972414","Yes","Yes","No","100%",,"$800","$0","$1,120","$0","$800","$329","$790","$0","$800","$0","$279","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,920","$1920 per person","$3840 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","20.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0010003-05",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0010003","Community Choice PPO","33653ME001",,"MEN001","MES001","MEF006","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0010003-06","Community Choice PPO","94% AV Level Silver Plan","93.06%","0.929558957320982","Yes","Yes","No","100%",,"$400","$0","$350","$0","$400","$120","$229","$0","$400","$0","$199","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","10.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0010003-06",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0010007","Community Edge PPO","33653ME001",,"MEN001","MES001","MEF008","Existing","PPO","Gold","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0010007-00","Community Edge PPO","Standard Gold Off Exchange Plan","76.02%","0.753819780972632","Yes","Yes","No","100%",,"$1,200","$27","$2,837","$0","$1,200","$745","$784","$0","$1,200","$0","$130","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","25.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0010007-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0010007","Community Edge PPO","33653ME001",,"MEN001","MES001","MEF008","Existing","PPO","Gold","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0010007-01","Community Edge PPO","Standard Gold On Exchange Plan","76.02%","0.753819780972632","Yes","Yes","No","100%",,"$1,200","$27","$2,837","$0","$1,200","$745","$784","$0","$1,200","$0","$130","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","25.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0010007-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0010007","Community Edge PPO","33653ME001",,"MEN001","MES001","MEF008","Existing","PPO","Gold","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0010007-02","Community Edge PPO","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthoptions.org/documents/2018/33653ME[#######-02]",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0010007","Community Edge PPO","33653ME001",,"MEN001","MES001","MEF008","Existing","PPO","Gold","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0010007-03","Community Edge PPO","Limited Cost Sharing Plan Variation","76.02%","0.753819780972632","Yes","Yes","No","100%",,"$1,200","$27","$2,837","$0","$1,200","$745","$784","$0","$1,200","$0","$130","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","25.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0010007-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0020001","Community Reliant HSA PPO","33653ME002",,"MEN001","MES001","MEF003","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0020001-00","Community Reliant HSA PPO","Standard Bronze Off Exchange Plan",,"0.608011718450699","Yes","Yes","No","100%",,"$5,500","$0","$1,050","$0","$5,500","$0","$750","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthoptions.org/documents/2018/33653ME0020001-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0020001","Community Reliant HSA PPO","33653ME002",,"MEN001","MES001","MEF003","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0020001-01","Community Reliant HSA PPO","Standard Bronze On Exchange Plan",,"0.608011718450699","Yes","Yes","No","100%",,"$5,500","$0","$1,050","$0","$5,500","$0","$750","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthoptions.org/documents/2018/33653ME0020001-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0020001","Community Reliant HSA PPO","33653ME002",,"MEN001","MES001","MEF003","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0020001-02","Community Reliant HSA PPO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthoptions.org/documents/2018/33653ME[#######-02]",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0020001","Community Reliant HSA PPO","33653ME002",,"MEN001","MES001","MEF003","Existing","PPO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0020001-03","Community Reliant HSA PPO","Limited Cost Sharing Plan Variation",,"0.608011718450699","Yes","Yes","No","100%",,"$5,500","$0","$1,050","$0","$5,500","$0","$750","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthoptions.org/documents/2018/33653ME0020001-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0050001","Community Align PPO","33653ME005",,"MEN001","MES001","MEF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0050001-00","Community Align PPO","Standard Bronze Off Exchange Plan","59.22%","0.592057619392603","Yes","Yes","No","100%",,"$5,500","$0","$1,850","$0","$1,488","$0","$561","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0050001-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0050001","Community Align PPO","33653ME005",,"MEN001","MES001","MEF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0050001-01","Community Align PPO","Standard Bronze On Exchange Plan","59.22%","0.592057619392603","Yes","Yes","No","100%",,"$5,500","$0","$1,850","$0","$1,488","$0","$561","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0050001-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0050001","Community Align PPO","33653ME005",,"MEN001","MES001","MEF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0050001-02","Community Align PPO","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthoptions.org/documents/2018/33653ME[#######-02]",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0050001","Community Align PPO","33653ME005",,"MEN001","MES001","MEF004","Existing","PPO","Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0050001-03","Community Align PPO","Limited Cost Sharing Plan Variation","59.22%","0.592057619392603","Yes","Yes","No","100%",,"$5,500","$0","$1,850","$0","$1,488","$0","$561","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0050001-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0050002","Community Advance PPO","33653ME005",,"MEN001","MES001","MEF006","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0050002-00","Community Advance PPO","Standard Silver Off Exchange Plan","67.69%","0.676604837988888","Yes","Yes","No","100%",,"$2,500","$27","$4,020","$0","$2,500","$605","$1,157","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0050002-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","45-3416923","33653ME0101804","Community Core HSA GRP","33653ME010",,"MEN001","MES001","MEF002","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9911",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0101804-00","Community Core HSA GRP","Standard Silver Off Exchange Plan","66.21%","0.6861604800212","Yes","Yes","No","100%",,"$3,000","$27","$955","$0","$3,000","$1,680","$33","$0","$1,925","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/documents/2018/33653ME0101804","https://www.healthoptions.org/documents/2018/33653ME0101804-0817"
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0050002","Community Advance PPO","33653ME005",,"MEN001","MES001","MEF006","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0050002-03","Community Advance PPO","Limited Cost Sharing Plan Variation","67.69%","0.676604837988888","Yes","Yes","No","100%",,"$2,500","$27","$4,020","$0","$2,500","$605","$1,157","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0050002-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0050002","Community Advance PPO","33653ME005",,"MEN001","MES001","MEF006","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0050002-04","Community Advance PPO","73% AV Level Silver Plan","72.12%","0.715438133641727","Yes","Yes","No","100%",,"$2,100","$27","$3,135","$0","$2,100","$605","$988","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","30.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0050002-04",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0050002","Community Advance PPO","33653ME005",,"MEN001","MES001","MEF006","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0050002-05","Community Advance PPO","87% AV Level Silver Plan","86.03%","0.857739890972414","Yes","Yes","No","100%",,"$800","$0","$1,120","$0","$800","$329","$790","$0","$800","$0","$279","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,920","$1920 per person","$3840 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","20.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0050002-05",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0050002","Community Advance PPO","33653ME005",,"MEN001","MES001","MEF006","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0050002-06","Community Advance PPO","94% AV Level Silver Plan","93.06%","0.929558957320982","Yes","Yes","No","100%",,"$400","$0","$350","$0","$400","$120","$229","$0","$400","$0","$199","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$21,450","$21450 per person","$42900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","10.00%",,,,,"$14,300","$14300 per person","$28600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0050002-06",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0530005","Community Value HMO","33653ME053",,"MEN001","MES001","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0530005-00","Community Value HMO","Standard Silver Off Exchange Plan","66.00%","0.660836166065966","Yes","Yes","No","100%",,"$3,350","$27","$3,680","$0","$3,350","$635","$817","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0530005-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0530005","Community Value HMO","33653ME053",,"MEN001","MES001","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0530005-01","Community Value HMO","Standard Silver On Exchange Plan","66.00%","0.660836166065966","Yes","Yes","No","100%",,"$3,350","$27","$3,680","$0","$3,350","$635","$817","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0530005-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0530005","Community Value HMO","33653ME053",,"MEN001","MES001","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0530005-02","Community Value HMO","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthoptions.org/documents/2018/33653ME[#######-02]",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0530005","Community Value HMO","33653ME053",,"MEN001","MES001","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0530005-03","Community Value HMO","Limited Cost Sharing Plan Variation","66.00%","0.660836166065966","Yes","Yes","No","100%",,"$3,350","$27","$3,680","$0","$3,350","$635","$817","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0530005-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0530005","Community Value HMO","33653ME053",,"MEN001","MES001","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0530005-04","Community Value HMO","73% AV Level Silver Plan","73.97%","0.736249029756988","Yes","Yes","No","100%",,"$2,000","$27","$3,165","$0","$2,000","$411","$849","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0530005-04",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0530005","Community Value HMO","33653ME053",,"MEN001","MES001","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0530005-05","Community Value HMO","87% AV Level Silver Plan","87.70%","0.876987474268321","Yes","Yes","No","100%",,"$650","$0","$1,270","$0","$329","$195","$1,012","$0","$650","$0","$359","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,920","$1920 per person","$3840 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0530005-05",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0530005","Community Value HMO","33653ME053",,"MEN001","MES001","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0530005-06","Community Value HMO","94% AV Level Silver Plan","94.13%","0.940949857062705","Yes","Yes","No","100%",,"$250","$0","$500","$0","$250","$85","$415","$0","$250","$0","$332","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0530005-06",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0540005","Community Complete HMO","33653ME054",,"MEN001","MES001","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0540005-00","Community Complete HMO","Standard Silver Off Exchange Plan","66.00%","0.660836166065966","Yes","Yes","No","100%",,"$3,350","$27","$3,680","$0","$3,350","$635","$817","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0540005-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0540005","Community Complete HMO","33653ME054",,"MEN001","MES001","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0540005-01","Community Complete HMO","Standard Silver On Exchange Plan","66.00%","0.660836166065966","Yes","Yes","No","100%",,"$3,350","$27","$3,680","$0","$3,350","$635","$817","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0540005-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0540005","Community Complete HMO","33653ME054",,"MEN001","MES001","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0540005-02","Community Complete HMO","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthoptions.org/documents/2018/33653ME[#######-02]",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0540005","Community Complete HMO","33653ME054",,"MEN001","MES001","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0540005-03","Community Complete HMO","Limited Cost Sharing Plan Variation","66.00%","0.660836166065966","Yes","Yes","No","100%",,"$3,350","$27","$3,680","$0","$3,350","$635","$817","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0540005-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0540005","Community Complete HMO","33653ME054",,"MEN001","MES001","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0540005-04","Community Complete HMO","73% AV Level Silver Plan","73.97%","0.736249029756988","Yes","Yes","No","100%",,"$2,000","$27","$3,165","$0","$2,000","$411","$849","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0054005-04",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0540005","Community Complete HMO","33653ME054",,"MEN001","MES001","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0540005-05","Community Complete HMO","87% AV Level Silver Plan","87.70%","0.876987474268321","Yes","Yes","No","100%",,"$650","$0","$1,270","$0","$329","$195","$1,012","$0","$650","$0","$359","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,920","$1920 per person","$3840 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0540005-05",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0540005","Community Complete HMO","33653ME054",,"MEN001","MES001","MEF005","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0540005-06","Community Complete HMO","94% AV Level Silver Plan","94.13%","0.940949857062705","Yes","Yes","No","100%",,"$250","$0","$500","$0","$250","$85","$415","$0","$250","$0","$332","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0540005-06",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0550001","Community Best HMO","33653ME055",,"MEN001","MES001","MEF005","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0550001-00","Community Best HMO","Standard Bronze Off Exchange Plan","64.68%","0.64130834306305","Yes","Yes","No","100%",,"$4,000","$0","$3,350","$0","$1,164","$455","$618","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0550001-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0550001","Community Best HMO","33653ME055",,"MEN001","MES001","MEF005","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0550001-01","Community Best HMO","Standard Bronze On Exchange Plan","64.65%","0.64130834306305","Yes","Yes","No","100%",,"$4,000","$0","$3,350","$0","$1,164","$455","$618","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0550001-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0550001","Community Best HMO","33653ME055",,"MEN001","MES001","MEF005","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0550001-02","Community Best HMO","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthoptions.org/documents/2018/33653ME[#######-02]",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","Individual","No","45-3416923","33653ME0550001","Community Best HMO","33653ME055",,"MEN001","MES001","MEF005","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0550001-03","Community Best HMO","Limited Cost Sharing Plan Variation","64.65%","0.64130834306305","Yes","Yes","No","100%",,"$4,000","$0","$3,350","$0","$1,164","$455","$618","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthoptions.org/documents/2018/33653ME0550001-00",
"2018","ME","33653","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","45-3416923","33653ME0101807","Community Preferred GRP","33653ME010",,"MEN001","MES001","MEF001","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9895",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0101807-00","Community Preferred GRP","Standard Silver Off Exchange Plan","71.75%","0.712518615525094","Yes","Yes","No","100%",,"$2,500","$27","$3,015","$0","$56","$1,634","$0","$0","$1,526","$298","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/documents/2018/33653ME0101807","https://www.healthoptions.org/documents/2018/33653ME0101807-0817"
"2018","ME","33653","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","45-3416923","33653ME0101807","Community Preferred GRP","33653ME010",,"MEN001","MES001","MEF001","Existing","PPO","Silver","Not Applicable","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9895",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.","No",,"https://www.healthoptions.org/formulary","33653ME0101807-01","Community Preferred GRP","Standard Silver On Exchange Plan","71.75%","0.712518615525094","Yes","Yes","No","100%",,"$2,500","$27","$3,015","$0","$56","$1,634","$0","$0","$1,526","$298","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/documents/2018/33653ME0101807","https://www.healthoptions.org/documents/2018/33653ME0101807-0817"
"2018","ME","48396","SERFF","2017-09-06 20:16:09","Individual","Yes","31-1705652","48396ME0860005","Anthem Dental Family Value","48396ME086",,"MEN003","MES008",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","48396ME0860005-01","Anthem Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/me/f0/s0/t0/pw_e215728.pdf",
"2018","ME","48396","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","Yes","31-1705652","48396ME0890003","Anthem Dental Family","48396ME089",,"MEN003","MES008",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","48396ME0890003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/me/f0/s0/t0/pw_e215726.pdf",
"2018","ME","48396","SERFF","2017-09-06 20:16:09","Individual","Yes","31-1705652","48396ME0920005","Anthem Dental Family Value","48396ME092",,"MEN003","MES008",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","48396ME0920005-00","Anthem Dental Family Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/me/f0/s0/t0/pw_e215728.pdf",
"2018","ME","48396","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","Yes","31-1705652","48396ME0890004","Anthem Dental Family Enhanced","48396ME089",,"MEN003","MES008",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.865","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","48396ME0890004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/me/f0/s0/t0/pw_e215727.pdf",
"2018","ME","48396","SERFF","2017-09-06 20:16:09","Individual","Yes","31-1705652","48396ME0860003","Anthem Dental Family","48396ME086",,"MEN003","MES008",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","48396ME0860003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/me/f0/s0/t0/pw_e215726.pdf",
"2018","ME","48396","SERFF","2017-09-06 20:16:09","Individual","Yes","31-1705652","48396ME0920003","Anthem Dental Family","48396ME092",,"MEN003","MES008",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","48396ME0920003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.anthem.com/agent/me/f0/s0/t0/pw_e215726.pdf",
"2018","ME","50165","SERFF","2017-08-11 20:15:53","Individual","Yes","01-0286541","50165ME0170001","Delta Dental Family Low Plan","50165ME017","7447253908","MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.9942","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","50165ME0170001-00","Delta Dental Family Low Plan","Standard Low Off Exchange Plan","71.52%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/OFFHIX/oocme2018b.pdf"
"2018","ME","50165","SERFF","2017-08-11 20:15:53","Individual","Yes","01-0286541","50165ME0170001","Delta Dental Family Low Plan","50165ME017","7447253908","MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.9942","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","50165ME0170001-01","Delta Dental Family Low Plan","Standard Low On Exchange Plan","71.52%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/me/oocme20182.pdf"
"2018","ME","50165","SERFF","2017-08-11 20:15:53","Individual","Yes","01-0286541","50165ME0180001","Delta Dental Pediatric High Plan","50165ME018","7447253908","MEN001","MES001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Child-Only",,,,,"0.9942","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","50165ME0180001-01","Delta Dental Pediatric High Plan","Standard High On Exchange Plan","84.66%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/me/oocme20183.pdf"
"2018","ME","50165","SERFF","2017-08-11 20:15:53","Individual","Yes","01-0286541","50165ME0190001","Delta Dental Pediatric Low Plan","50165ME019","7447253908","MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Child-Only",,,,,"0.9942","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","50165ME0190001-01","Delta Dental Pediatric Low Plan","Standard Low On Exchange Plan","71.52%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/me/oocme20184.pdf"
"2018","ME","76302","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0397286","76302ME0020003","Renaissance Individual Dental PPO, EHB Certified","76302ME002",,"MEN001","MES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","76302ME0020003-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","ME","76302","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0397286","76302ME0020004","Renaissance Individual Dental PPO, EHB Certified","76302ME002",,"MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","76302ME0020004-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","ME","76302","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0397286","76302ME0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","76302ME004",,"MEN001","MES001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/76302","","76302ME0040001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/ME_EHB_High_2018","http://www.renaissancedental.com/ME_EHB_High_2018"
"2018","ME","76302","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0397286","76302ME0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","76302ME004",,"MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/76302","","76302ME0040002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/ME_EHB_Low_2018","http://www.renaissancedental.com/ME_EHB_Low_2018"
"2018","ME","76302","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0397286","76302ME0060001","Renaissance Individual Dental Pediatric-Only, EHB Certified","76302ME006",,"MEN001","MES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","76302ME0060001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","ME","76302","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0397286","76302ME0060002","Renaissance Individual Dental Pediatric-Only, EHB Certified","76302ME006",,"MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","76302ME0060002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","ME","76302","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0397286","76302ME0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","76302ME005",,"MEN001","MES001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/76302","","76302ME0050001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/ME_Ped_High_2018","http://www.renaissancedental.com/ME_Ped_High_2018"
"2018","ME","76302","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0397286","76302ME0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","76302ME005",,"MEN001","MES001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/76302","","76302ME0050002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/ME_Ped_Low_2018","http://www.renaissancedental.com/ME_Ped_Low_2018"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0240018","Gold HMO 1500","96667ME024",,"MEN001","MES001","MEF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0240018-00","Gold HMO 1500","Standard Gold Off Exchange Plan",,"0.760275449139711","Yes","Yes","No","100%",,"$1,500","$100","$2,170","$0","$1,500","$2,020","$10","$30","$1,500","$0","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005693.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004577"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0240018","Gold HMO 1500","96667ME024",,"MEN001","MES001","MEF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0240018-01","Gold HMO 1500","Standard Gold On Exchange Plan",,"0.760275449139711","Yes","Yes","No","100%",,"$1,500","$100","$2,170","$0","$1,500","$2,020","$10","$30","$1,500","$0","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005693.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004577"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0240018","Gold HMO 1500","96667ME024",,"MEN001","MES001","MEF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0240018-02","Gold HMO 1500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$30","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005693.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004577"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0240018","Gold HMO 1500","96667ME024",,"MEN001","MES001","MEF002","New","HMO","Gold","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0240018-03","Gold HMO 1500","Limited Cost Sharing Plan Variation",,"0.760275449139711","Yes","Yes","No","100%",,"$1,500","$100","$2,170","$0","$1,500","$2,020","$10","$30","$1,500","$0","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005693.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004577"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0240022","Silver HMO","96667ME024",,"MEN001","MES001","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0240022-00","Silver HMO","Standard Silver Off Exchange Plan","68.16%","0.68489776093717","Yes","Yes","No","100%",,"$2,500","$100","$2,950","$0","$2,500","$720","$1,010","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005710.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004582"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0240022","Silver HMO","96667ME024",,"MEN001","MES001","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0240022-01","Silver HMO","Standard Silver On Exchange Plan","68.16%","0.68489776093717","Yes","Yes","No","100%",,"$2,500","$100","$2,950","$0","$2,500","$720","$1,010","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005710.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004582"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0240022","Silver HMO","96667ME024",,"MEN001","MES001","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0240022-02","Silver HMO","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$30","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005710.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004582"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0240022","Silver HMO","96667ME024",,"MEN001","MES001","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0240022-03","Silver HMO","Limited Cost Sharing Plan Variation","68.16%","0.68489776093717","Yes","Yes","No","100%",,"$2,500","$100","$2,950","$0","$2,500","$720","$1,010","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005710.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004582"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0240022","Silver HMO","96667ME024",,"MEN001","MES001","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0240022-04","Silver HMO","73% AV Level Silver Plan","73.88%","0.744202114444108","Yes","Yes","No","100%",,"$2,000","$50","$2,450","$0","$2,000","$640","$1,160","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005713.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004585"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0240022","Silver HMO","96667ME024",,"MEN001","MES001","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0240022-05","Silver HMO","87% AV Level Silver Plan","86.45%","0.870052954641342","Yes","Yes","No","100%",,"$750","$50","$700","$0","$750","$240","$510","$30","$750","$0","$240","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005712.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004584"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0240022","Silver HMO","96667ME024",,"MEN001","MES001","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0240022-06","Silver HMO","94% AV Level Silver Plan","93.25%","0.932799437245572","Yes","Yes","No","100%",,"$500","$10","$90","$0","$500","$40","$60","$30","$500","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005711.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004583"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0240020","Bronze HMO 6500","96667ME024",,"MEN001","MES001","MEF004","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0240020-00","Bronze HMO 6500","Standard Bronze Off Exchange Plan",,"0.598538834683667","Yes","Yes","No","100%",,"$6,500","$50","$800","$0","$6,500","$400","$50","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005698.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004579"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0240020","Bronze HMO 6500","96667ME024",,"MEN001","MES001","MEF004","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0240020-01","Bronze HMO 6500","Standard Bronze On Exchange Plan",,"0.598538834683667","Yes","Yes","No","100%",,"$6,500","$50","$800","$0","$6,500","$400","$50","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005698.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004579"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0240020","Bronze HMO 6500","96667ME024",,"MEN001","MES001","MEF004","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0240020-02","Bronze HMO 6500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$30","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005700.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004578"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0240020","Bronze HMO 6500","96667ME024",,"MEN001","MES001","MEF004","New","HMO","Bronze","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0240020-03","Bronze HMO 6500","Limited Cost Sharing Plan Variation",,"0.598538834683667","Yes","Yes","No","100%",,"$6,500","$50","$800","$0","$6,500","$400","$50","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005698.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004579"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260020","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260020-00","Maine's Choice Casco Silver HMO","Standard Silver Off Exchange Plan","71.65%","0.725294994459476","Yes","Yes","Yes","70%","30%","$2,000","$100","$2,070","$0","$2,000","$720","$1,080","$30","$1,150","$150","$120","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$5,400","$5400 per person","$10800 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005718.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004586"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260020","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260020-01","Maine's Choice Casco Silver HMO","Standard Silver On Exchange Plan","71.65%","0.725294994459476","Yes","Yes","Yes","70%","30%","$2,000","$100","$2,070","$0","$2,000","$720","$1,080","$30","$1,150","$150","$120","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$5,400","$5400 per person","$10800 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005718.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004586"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260020","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260020-02","Maine's Choice Casco Silver HMO","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$30","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005705.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004581"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260024","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260024-04","Maine's Choice Pemaquid Silver HMO","73% AV Level Silver Plan","73.98%",,"Yes","Yes","Yes","70%","30%","$3,250","$50","$1,200","$0","$130","$2,460","$0","$30","$1,150","$120","$120","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","20.00%","$4,750","$4750 per person","$9500 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005737.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004597"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","Yes","38-2069753","15560MI0720001","Blue Dental PPO Standard","15560MI072","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"$1,200 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0720001-00","Blue Dental PPO Standard","Standard Low Off Exchange Plan","71.46%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2018/ppo.html"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350001","Blue Cross® Premier PPO Value","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350001-00","Blue Cross® Premier PPO Value","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$240","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-value-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/catastrophic/premier-ppo.html"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350001","Blue Cross® Premier PPO Value","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350001-01","Blue Cross® Premier PPO Value","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$240","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-value-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/catastrophic/premier-ppo.html"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","Yes","38-2069753","15560MI0720001","Blue Dental PPO Standard","15560MI072","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"$1,200 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0720001-01","Blue Dental PPO Standard","Standard Low On Exchange Plan","71.46%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2018/ppo.html"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0430002","Blue Dental PPO Plus 100/80/50/50 SG","15560MI043","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.929","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0430002-00","Blue Dental PPO Plus 100/80/50/50 SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-plus-100-80-50-50-1000-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0450001","Blue Dental PPO 100/80/50/50 (80/50/50/50) SG","15560MI045","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.  $1,250 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.897","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0450001-00","Blue Dental PPO 100/80/50/50 (80/50/50/50) SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-100-80-50-50-1250-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","Yes","38-2069753","15560MI0710001","Blue Dental PPO Plus Standard","15560MI071","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0710001-00","Blue Dental PPO Plus Standard","Standard Low Off Exchange Plan","70.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2018/ppo-plus.html"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier PPO Silver Saver HSA","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350006-01","Blue Cross® Premier PPO Silver Saver HSA","Standard Silver On Exchange Plan",,"0.665596593527977","Yes","Yes","No","100%",,"$3,100","$100","$2,500","$60","$3,100","$800","$1,300","$60","$1,400","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/premier-ppo-saver.html?costshare=70"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350005","Blue Cross® Premier PPO Bronze Saver","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350005-01","Blue Cross® Premier PPO Bronze Saver","Standard Bronze On Exchange Plan",,"0.585436865833666","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,200","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/premier-ppo-saver.html"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260020","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260020-03","Maine's Choice Casco Silver HMO","Limited Cost Sharing Plan Variation","71.65%","0.725294994459476","Yes","Yes","Yes","70%","30%","$2,000","$100","$2,070","$0","$2,000","$720","$1,080","$30","$1,150","$150","$120","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$5,400","$5400 per person","$10800 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005718.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004586"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260020","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260020-04","Maine's Choice Casco Silver HMO","73% AV Level Silver Plan","73.96%","0.750384951402668","Yes","Yes","Yes","70%","30%","$2,000","$100","$2,070","$0","$2,000","$680","$1,080","$30","$1,150","$140","$120","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%","$5,400","$5400 per person","$10800 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005721.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004589"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260020","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260020-05","Maine's Choice Casco Silver HMO","87% AV Level Silver Plan","86.42%","0.878741815509012","Yes","Yes","Yes","70%","30%","$750","$50","$550","$0","$750","$280","$320","$30","$750","$120","$200","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%","$1,500","$1500 per person","$3000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005720.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004588"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260020","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260020-06","Maine's Choice Casco Silver HMO","94% AV Level Silver Plan","93.27%","0.945245977479301","Yes","Yes","Yes","70%","30%","$250","$10","$240","$0","$250","$100","$150","$30","$250","$30","$220","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%","$500","$500 per person","$1000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005719.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004587"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260022","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260022-00","Maine's Choice Sebago Silver HMO","Standard Silver Off Exchange Plan","69.31%","0.699758274367435","Yes","Yes","Yes","70%","30%","$3,000","$100","$1,870","$0","$3,000","$760","$780","$30","$1,150","$150","$120","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%","$6,500","$6500 per person","$13000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005726.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004590"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260022","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260022-01","Maine's Choice Sebago Silver HMO","Standard Silver On Exchange Plan","69.31%","0.699758274367435","Yes","Yes","Yes","70%","30%","$3,000","$100","$1,870","$0","$3,000","$760","$780","$30","$1,150","$150","$120","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%","$6,500","$6500 per person","$13000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005726.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004590"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260022","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260022-02","Maine's Choice Sebago Silver HMO","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$30","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005705.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004581"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260022","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260022-03","Maine's Choice Sebago Silver HMO","Limited Cost Sharing Plan Variation","69.31%","0.699758274367435","Yes","Yes","Yes","70%","30%","$3,000","$100","$1,870","$0","$3,000","$760","$780","$30","$1,150","$150","$120","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%","$6,500","$6500 per person","$13000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005726.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004590"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260022","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260022-04","Maine's Choice Sebago Silver HMO","73% AV Level Silver Plan","72.74%","0.738590830454446","Yes","Yes","Yes","70%","30%","$3,000","$50","$1,450","$0","$3,000","$690","$780","$30","$1,150","$120","$120","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%","$4,500","$4500 per person","$9000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005729.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004593"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260022","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260022-05","Maine's Choice Sebago Silver HMO","87% AV Level Silver Plan","86.38%","0.877945016902787","Yes","Yes","Yes","70%","30%","$750","$50","$550","$0","$750","$280","$320","$30","$750","$120","$200","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%","$1,500","$1500 per person","$3000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005728.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004592"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260022","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF004","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260022-06","Maine's Choice Sebago Silver HMO","94% AV Level Silver Plan","93.24%","0.944717889638211","Yes","Yes","Yes","70%","30%","$250","$10","$240","$0","$250","$100","$150","$30","$250","$30","$220","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%","$500","$500 per person","$1000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005727.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004591"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260024","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260024-00","Maine's Choice Pemaquid Silver HMO","Standard Silver Off Exchange Plan","69.40%",,"Yes","Yes","Yes","70%","30%","$4,500","$100","$1,570","$0","$130","$2,530","$0","$30","$1,150","$150","$120","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%","$6,800","$6800 per person","$13600 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005734.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004594"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260024","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260024-01","Maine's Choice Pemaquid Silver HMO","Standard Silver On Exchange Plan","69.40%",,"Yes","Yes","Yes","70%","30%","$4,500","$100","$1,570","$0","$130","$2,530","$0","$30","$1,150","$150","$120","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%","$6,800","$6800 per person","$13600 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005734.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004594"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260024","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260024-02","Maine's Choice Pemaquid Silver HMO","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$30","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005705.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004581"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260024","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260024-03","Maine's Choice Pemaquid Silver HMO","Limited Cost Sharing Plan Variation","69.40%",,"Yes","Yes","Yes","70%","30%","$4,500","$100","$1,570","$0","$130","$2,530","$0","$30","$1,150","$150","$120","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%","$6,800","$6800 per person","$13600 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005734.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004594"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260024","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260024-05","Maine's Choice Pemaquid Silver HMO","87% AV Level Silver Plan","86.61%",,"Yes","Yes","Yes","70%","30%","$750","$50","$550","$0","$90","$1,260","$0","$30","$750","$120","$200","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%","$1,500","$1500 per person","$3000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005736.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004596"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260024","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260024-06","Maine's Choice Pemaquid Silver HMO","94% AV Level Silver Plan","93.25%",,"Yes","Yes","Yes","70%","30%","$250","$10","$240","$0","$80","$420","$0","$30","$250","$30","$220","$0",,"0","1","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%","$500","$500 per person","$1000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005735.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004595"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260018","Maine's Choice HSA HMO 5000","96667ME026",,"MEN002","MES002","MEF005","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260018-00","Maine's Choice HSA HMO 5000","Standard Bronze Off Exchange Plan","63.57%","0.614764051198606","Yes","Yes","Yes","70%","30%","$5,000","$50","$1,550","$0","$5,000","$140","$610","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%","$6,000","$6000 per person","$12000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","$7350 per person","$14700 per group","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005703.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004580"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260018","Maine's Choice HSA HMO 5000","96667ME026",,"MEN002","MES002","MEF005","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260018-01","Maine's Choice HSA HMO 5000","Standard Bronze On Exchange Plan","63.57%","0.614764051198606","Yes","Yes","Yes","70%","30%","$5,000","$50","$1,550","$0","$5,000","$140","$610","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%","$6,000","$6000 per person","$12000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","$7350 per person","$14700 per group","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005703.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004580"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260018","Maine's Choice HSA HMO 5000","96667ME026",,"MEN002","MES002","MEF005","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260018-02","Maine's Choice HSA HMO 5000","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$30","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005705.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004581"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0260018","Maine's Choice HSA HMO 5000","96667ME026",,"MEN002","MES002","MEF005","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0260018-03","Maine's Choice HSA HMO 5000","Limited Cost Sharing Plan Variation","63.57%","0.614764051198606","Yes","Yes","Yes","70%","30%","$5,000","$50","$1,550","$0","$5,000","$140","$610","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%","$6,000","$6000 per person","$12000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","$7350 per person","$14700 per group","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005703.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004580"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0240024","Best Buy HSA HMO 5400","96667ME024",,"MEN001","MES003","MEF006","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0240024-00","Best Buy HSA HMO 5400","Standard Bronze Off Exchange Plan","61.00%","0.609978330642866","Yes","Yes","No","100%",,"$5,400","$0","$1,150","$0","$5,400","$120","$660","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005903.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004666"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0240024","Best Buy HSA HMO 5400","96667ME024",,"MEN001","MES003","MEF006","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0240024-01","Best Buy HSA HMO 5400","Standard Bronze On Exchange Plan","61.00%","0.609978330642866","Yes","Yes","No","100%",,"$5,400","$0","$1,150","$0","$5,400","$120","$660","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005903.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004666"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0240024","Best Buy HSA HMO 5400","96667ME024",,"MEN001","MES003","MEF006","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0240024-02","Best Buy HSA HMO 5400","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005700.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004578"
"2018","ME","96667","SERFF","2017-09-06 20:16:09","Individual","No","04-2452600","96667ME0240024","Best Buy HSA HMO 5400","96667ME024",,"MEN001","MES003","MEF006","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","Yes","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99751",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","96667ME0240024-03","Best Buy HSA HMO 5400","Limited Cost Sharing Plan Variation","61.00%","0.609978330642866","Yes","Yes","No","100%",,"$5,400","$0","$1,150","$0","$5,400","$120","$660","$30","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20ME%20FILES/SBC_PD0000005903.PDF","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000004666"
"2018","MI","11083","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","13-5581829","11083MI0100001","EHB Basic Dental Plan (Low)","11083MI010",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","11083MI0100001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$200","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","12858","SERFF","2017-08-14 20:15:51","Individual","Yes","36-3757528","12858MI0010001","TruAssure Basic Adult or Child Dental Plan","12858MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12858MI0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$110","$110 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MI","https://www.truassure.com/brochure?state=MI"
"2018","MI","12858","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","36-3757528","12858MI0030001","TruAssure Dental Small Group Basic Plan","12858MI003",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","12858MI0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","12858","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","36-3757528","12858MI0040001","TruAssure Dental Small Group Preferred Plan","12858MI004",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","12858MI0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","12858","SERFF","2017-08-14 20:15:51","Individual","Yes","36-3757528","12858MI0010001","TruAssure Basic Adult or Child Dental Plan","12858MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12858MI0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$110","$110 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MI","https://www.truassure.com/brochure?state=MI"
"2018","MI","12858","SERFF","2017-08-14 20:15:51","Individual","Yes","36-3757528","12858MI0020001","TruAssure Preferred Adult or Child Dental Plan","12858MI002",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12858MI0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MI","https://www.truassure.com/brochure?state=MI"
"2018","MI","12858","SERFF","2017-08-14 20:15:51","Individual","Yes","36-3757528","12858MI0020001","TruAssure Preferred Adult or Child Dental Plan","12858MI002",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12858MI0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MI","https://www.truassure.com/brochure?state=MI"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0430001","Blue Dental PPO Plus 100/80/50/50 SG","15560MI043","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins. $1,500 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.897","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0430001-00","Blue Dental PPO Plus 100/80/50/50 SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-plus-100-80-50-50-1500-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350002","Blue Cross® Premier PPO Bronze HSA","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350002-00","Blue Cross® Premier PPO Bronze HSA","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/premier-ppo.html"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350002","Blue Cross® Premier PPO Bronze HSA","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350002-01","Blue Cross® Premier PPO Bronze HSA","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/premier-ppo.html"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","Yes","38-2069753","15560MI0710001","Blue Dental PPO Plus Standard","15560MI071","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0710001-01","Blue Dental PPO Plus Standard","Standard Low On Exchange Plan","70.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2018/ppo-plus.html"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0450002","Blue Dental PPO 100/80/50/50 (50/50/50/50) SG","15560MI045","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins. $1,500 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.869","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0450002-00","Blue Dental PPO 100/80/50/50 (50/50/50/50) SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-100-80-50-50-1500-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0450003","Blue Dental PPO 100/80/50/50 (50/50/50/50) SG","15560MI045","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.908","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0450003-00","Blue Dental PPO 100/80/50/50 (50/50/50/50) SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-100-80-50-50-1000-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","Yes","38-2069753","15560MI0730001","Blue Dental EPO Standard","15560MI073","7538162760","MIN003","MIS003",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"$1,200 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","No",,"Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0730001-00","Blue Dental EPO Standard","Standard Low Off Exchange Plan","71.46%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2018/epo.html"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350002","Blue Cross® Premier PPO Bronze HSA","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350002-02","Blue Cross® Premier PPO Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-bronze-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-bronze-na-less-than-300-sbc.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350002","Blue Cross® Premier PPO Bronze HSA","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350002-03","Blue Cross® Premier PPO Bronze","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-bronze-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-bronze-na-more-than-300-sbc.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","Yes","38-2069753","15560MI0730001","Blue Dental EPO Standard","15560MI073","7538162760","MIN003","MIS003",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"$1,200 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","No",,"Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0730001-01","Blue Dental EPO Standard","Standard Low On Exchange Plan","71.46%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2018/epo.html"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0450004","Blue Dental PPO  80/50/50/50 (50/50/50/50) SG","15560MI045","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.895","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0450004-00","Blue Dental PPO  80/50/50/50 (50/50/50/50) SG","Standard Low Off Exchange Plan","71.59%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-80-50-50-50-1000-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0450005","Blue Dental PPO  80/50/50/50 (50/50/50/50) SG","15560MI045","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"$800 annual benefit maximum for members age 19 or older when coverage begins. $800 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.914","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0450005-00","Blue Dental PPO  80/50/50/50 (50/50/50/50) SG","Standard Low Off Exchange Plan","71.59%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-80-50-50-50-800-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","Yes","38-2069753","15560MI0720002","Blue Dental PPO Extra","15560MI072","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,"$1,200 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $1,000 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0720002-00","Blue Dental PPO Extra","Standard High Off Exchange Plan","86.23%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2018/ppo-extra.html"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350005","Blue Cross® Premier PPO Bronze Saver","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350005-00","Blue Cross® Premier PPO Bronze Saver","Standard Bronze Off Exchange Plan",,"0.585436865833666","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,200","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/premier-ppo-saver.html"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","Yes","38-2069753","15560MI0720002","Blue Dental PPO Extra","15560MI072","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,"$1,200 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $1,000 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0720002-01","Blue Dental PPO Extra","Standard High On Exchange Plan","86.23%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2018/ppo-extra.html"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0470001","Blue Dental EPO 100/80/50/50 SG","15560MI047","7538162760","MIN003","MIS003",,"Existing","EPO","High","Not Applicable",,"Off the Exchange",,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists. $1,250 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.899","Guaranteed Rate","2018-01-01",,"Yes","Emergency","No",,"Yes",,"","15560MI0470001-00","Blue Dental EPO 100/80/50/50 SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-epo-100-80-50-50-1250-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","Yes","38-2069753","15560MI0740001","Blue Dental PPO Pediatric","15560MI074","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0740001-00","Blue Dental PPO Pediatric","Standard Low Off Exchange Plan","71.46%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2018/ppo-pediatric.html"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0420001","Blue Dental PPO Plus 100/80/50 SG","15560MI042","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0420001-00","Blue Dental PPO Plus 100/80/50 SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-plus-100-80-50-1500-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","Yes","38-2069753","15560MI0740001","Blue Dental PPO Pediatric","15560MI074","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","","15560MI0740001-01","Blue Dental PPO Pediatric","Standard Low On Exchange Plan","71.46%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/2018/ppo-pediatric.html"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0420002","Blue Dental PPO Plus 100/80/50 SG","15560MI042","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0420002-00","Blue Dental PPO Plus 100/80/50 SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-plus-100-80-50-1000-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI1120001","Blue Cross® Premier PPO Bronze Extra","15560MI112","7538162760","MIN006","MIS001","MIF055","Existing","PPO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI1120001-01","Blue Cross® Premier PPO Bronze Extra","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,400","$0","$4,900","$60","$3,800","$1,500","$1,700","$60","$1,000","$200","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-bronze-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/premier-ppo-extra.html"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI1120001","Blue Cross® Premier PPO Bronze Extra","15560MI112","7538162760","MIN006","MIS001","MIF055","Existing","PPO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI1120001-02","Blue Cross® Premier PPO Bronze Extra","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-bronze-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-bronze-extra-na-less-than-300-sbc.pdf"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540060","MyPriority Gold 1100","29698MI054",,"MIN007","MIS001","MIF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540060-03","MyPriority Gold 1100","Limited Cost Sharing Plan Variation",,"0.761980248504188","Yes","Yes","No","100%",,"$1,100","$0","$2,527","$60","$1,100","$0","$1,955","$55","$1,100","$0","$396","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/2ABD27F9792744F6B49BBD6BA641EDAD.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-gold-1100?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540070","MyPriority Silver 3200","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540070-00","MyPriority Silver 3200","Standard Silver Off Exchange Plan",,"0.676504446383443","Yes","Yes","No","100%",,"$3,200","$640","$1,032","$60","$3,200","$1,925","$904","$55","$1,032","$885","$270","$0",,"10","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/DAB65DC153704F7C90519028BF3761D2.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540070","MyPriority Silver 3200","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540070-01","MyPriority Silver 3200","Standard Silver On Exchange Plan",,"0.676504446383443","Yes","Yes","No","100%",,"$3,200","$640","$1,032","$60","$3,200","$1,925","$904","$55","$1,032","$885","$270","$0",,"10","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/DAB65DC153704F7C90519028BF3761D2.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0430005","Blue Dental  PPO Plus  80/50/50/50 SG","15560MI043","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.91","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0430005-00","Blue Dental  PPO Plus  80/50/50/50 SG","Standard Low Off Exchange Plan","71.58%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-plus-80-50-50-50-1000-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350005","Blue Cross® Premier PPO Bronze Saver","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350005-02","Blue Cross® Premier PPO Bronze Saver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-bronze-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-bronze-saver-na-less-than-300-sbc.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350005","Blue Cross® Premier PPO Bronze Saver","15560MI035","7538162760","MIN006","MIS001","MIF051","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350005-03","Blue Cross® Premier PPO Bronze Saver","Limited Cost Sharing Plan Variation",,"0.585436865833666","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,200","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-bronze-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-bronze-saver-na-more-than-300-sbc.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier PPO Silver","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350003-00","Blue Cross® Premier PPO Silver","Standard Silver Off Exchange Plan",,"0.698237477282795","Yes","Yes","No","100%",,"$2,000","$100","$2,500","$60","$2,000","$800","$1,300","$60","$1,400","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/premier-ppo.html?costshare=70"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier PPO Silver","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350003-01","Blue Cross® Premier PPO Silver","Standard Silver On Exchange Plan",,"0.698237477282795","Yes","Yes","No","100%",,"$2,000","$100","$2,500","$60","$2,000","$800","$1,300","$60","$1,400","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/premier-ppo.html?costshare=70"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier PPO Silver","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350003-02","Blue Cross® Premier PPO Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-na-less-than-300-sbc.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier PPO Silver","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350003-03","Blue Cross® Premier PPO Silver","Limited Cost Sharing Plan Variation",,"0.698237477282795","Yes","Yes","No","100%",,"$2,000","$100","$2,500","$60","$2,000","$800","$1,300","$60","$1,400","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-na-more-than-300-sbc.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier PPO Silver","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350003-04","Blue Cross® Premier PPO Silver","73% AV Level Silver Plan",,"0.728040519764931","Yes","Yes","No","100%",,"$1,650","$100","$2,500","$60","$1,650","$800","$1,300","$60","$1,400","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","20.00%",,,,,"$3,300","$3300 per person","$6600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/premier-ppo.html?costshare=73"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier PPO Silver","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350003-05","Blue Cross® Premier PPO Silver","87% AV Level Silver Plan",,"0.869651075829034","Yes","Yes","No","100%",,"$500","$0","$1,100","$60","$500","$500","$600","$60","$500","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$3,200","$3200 per person","$6400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/premier-ppo.html?costshare=87"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier PPO Silver","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350003-06","Blue Cross® Premier PPO Silver","94% AV Level Silver Plan",,"0.944848641167866","Yes","Yes","No","100%",,"$200","$0","$300","$60","$200","$200","$100","$60","$200","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/premier-ppo.html?costshare=94"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier PPO Silver Saver HSA","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350006-00","Blue Cross® Premier PPO Silver Saver HSA","Standard Silver Off Exchange Plan",,"0.665596593527977","Yes","Yes","No","100%",,"$3,100","$100","$2,500","$60","$3,100","$800","$1,300","$60","$1,400","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/premier-ppo-saver.html?costshare=70"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier PPO Silver Saver HSA","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350006-02","Blue Cross® Premier PPO Silver Saver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-saver-na-less-than-300-sbc.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier PPO Silver Saver HSA","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350006-03","Blue Cross® Premier PPO Silver Saver","Limited Cost Sharing Plan Variation",,"0.665596593527977","Yes","Yes","No","100%",,"$3,100","$100","$2,500","$60","$3,100","$800","$1,300","$60","$1,400","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","20.00%",,,,,"$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-saver-na-more-than-300-sbc.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier PPO Silver Saver HSA","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350006-04","Blue Cross® Premier PPO Silver Saver","73% AV Level Silver Plan",,"0.727377790342578","Yes","Yes","No","100%",,"$1,850","$100","$2,500","$60","$1,850","$800","$1,300","$60","$1,400","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20.00%",,,,,"$3,700","$3700 per person","$7400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-saver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/premier-ppo-saver.html?costshare=73"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier PPO Silver Saver HSA","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350006-05","Blue Cross® Premier PPO Silver Saver","87% AV Level Silver Plan",,"0.867657311275849","Yes","Yes","No","100%",,"$600","$0","$900","$60","$600","$400","$500","$60","$600","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","10.00%",,,,,"$1,200","$1200 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-saver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/premier-ppo-saver.html?costshare=87"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier PPO Silver Saver HSA","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350006-06","Blue Cross® Premier PPO Silver Saver","94% AV Level Silver Plan",,"0.933837256572876","Yes","Yes","No","100%",,"$300","$0","$300","$60","$300","$200","$100","$60","$300","$90","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$1,200","$1200 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-saver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/premier-ppo-saver.html?costshare=94"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350004","Blue Cross® Premier PPO Gold","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350004-00","Blue Cross® Premier PPO Gold","Standard Gold Off Exchange Plan",,"0.797088627377018","Yes","Yes","No","100%",,"$500","$100","$2,500","$60","$500","$800","$1,300","$60","$500","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/gold/premier-ppo.html"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350004","Blue Cross® Premier PPO Gold","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350004-01","Blue Cross® Premier PPO Gold","Standard Gold On Exchange Plan",,"0.797088627377018","Yes","Yes","No","100%",,"$500","$100","$2,500","$60","$500","$800","$1,300","$60","$500","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/gold/premier-ppo.html"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350004","Blue Cross® Premier PPO Gold","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350004-02","Blue Cross® Premier PPO Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-gold-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-gold-na-less-than-300-sbc.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI0350004","Blue Cross® Premier PPO Gold","15560MI035","7538162760","MIN006","MIS001","MIF052","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI0350004-03","Blue Cross® Premier PPO Gold","Limited Cost Sharing Plan Variation",,"0.797088627377018","Yes","Yes","No","100%",,"$500","$100","$2,500","$60","$500","$800","$1,300","$60","$500","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-gold-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-gold-na-more-than-300-sbc.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI1120001","Blue Cross® Premier PPO Bronze Extra","15560MI112","7538162760","MIN006","MIS001","MIF055","Existing","PPO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI1120001-00","Blue Cross® Premier PPO Bronze Extra","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,400","$0","$4,900","$60","$3,800","$1,500","$1,700","$60","$1,000","$200","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-bronze-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/premier-ppo-extra.html"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0420005","Blue Dental PPO Plus 80/50/50 SG","15560MI042","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0420005-00","Blue Dental PPO Plus 80/50/50 SG","Standard Low Off Exchange Plan","71.58%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-plus-80-50-50-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0440001","Blue Dental PPO 100/80/50 (80/50/50) SG","15560MI044","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0440001-00","Blue Dental PPO 100/80/50 (80/50/50) SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-100-80-50-1250-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI1120001","Blue Cross® Premier PPO Bronze Extra","15560MI112","7538162760","MIN006","MIS001","MIF055","Existing","PPO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI1120001-03","Blue Cross® Premier PPO Bronze Extra","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$2,400","$0","$4,900","$60","$3,800","$1,500","$1,700","$60","$1,000","$200","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-bronze-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-bronze-extra-na-more-than-300-sbc.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0440002","Blue Dental PPO 100/80/50 (50/50/50) SG","15560MI044","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0440002-00","Blue Dental PPO 100/80/50 (50/50/50) SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-100-80-50-1500-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0440003","Blue Dental PPO 100/80/50 (50/50/50) SG","15560MI044","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0440003-00","Blue Dental PPO 100/80/50 (50/50/50) SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-100-80-50-1000-sg.pdf"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540070","MyPriority Silver 3200","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540070-05","MyPriority Silver 3200","87% AV Level Silver Plan",,"0.863347128675948","Yes","Yes","No","100%",,"$1,036","$0","$514","$60","$1,195","$190","$165","$55","$1,200","$56","$294","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/0DC3D8CA951542B689C34F0188B8C996.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540070","MyPriority Silver 3200","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540070-06","MyPriority Silver 3200","94% AV Level Silver Plan",,"0.931457330761075","Yes","Yes","No","100%",,"$161","$0","$514","$60","$471","$60","$144","$55","$500","$0","$175","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/4F19D112E9B84D688CEB0297A4C3F1AB.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540071","MyPriority Silver 3200 - Spectrum Health Partners","29698MI054",,"MIN002","MIS002","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540071-00","MyPriority Silver 3200 - Spectrum Health Partners","Standard Silver Off Exchange Plan",,"0.676504446383443","Yes","Yes","No","100%",,"$3,200","$640","$1,032","$60","$3,200","$1,925","$904","$55","$1,032","$885","$270","$0",,"10","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/71F43E1A23004E4CA185B3A827ECC9A4.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-spectrum-health-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0440004","Blue Dental PPO 80/50/50 (50/50/50) SG","15560MI044","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0440004-00","Blue Dental PPO 80/50/50 (50/50/50) SG","Standard Low Off Exchange Plan","71.59%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-80-50-50-1000-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0440005","Blue Dental PPO 80/50/50 (50/50/50) SG","15560MI044","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"$800 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0440005-00","Blue Dental PPO 80/50/50 (50/50/50) SG","Standard Low Off Exchange Plan","71.59%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-80-50-50-800-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0460001","Blue Dental EPO 100/80/50 SG","15560MI046","7538162760","MIN003","MIS003",,"Existing","EPO","High","Not Applicable",,"Off the Exchange",,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","No",,"Yes",,"","15560MI0460001-00","Blue Dental EPO 100/80/50 SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-epo-100-80-50-1250-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0480002","Blue Dental PPO Plus 80/50/50 Pediatric SG","15560MI048","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0480002-00","Blue Dental PPO Plus 80/50/50 Pediatric SG","Standard Low Off Exchange Plan","71.59%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-plus-80-50-50-pediatric-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI1130001","Blue Cross® Premier PPO Silver Extra","15560MI113","7538162760","MIN006","MIS001","MIF056","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI1130001-00","Blue Cross® Premier PPO Silver Extra","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/premier-ppo-extra.html?costshare=70"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI1130001","Blue Cross® Premier PPO Silver Extra","15560MI113","7538162760","MIN006","MIS001","MIF056","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI1130001-01","Blue Cross® Premier PPO Silver Extra","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/premier-ppo-extra.html?costshare=70"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI1130001","Blue Cross® Premier PPO Silver Extra","15560MI113","7538162760","MIN006","MIS001","MIF056","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI1130001-02","Blue Cross® Premier PPO Silver Extra","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-extra-na-less-than-300-sbc.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI1130001","Blue Cross® Premier PPO Silver Extra","15560MI113","7538162760","MIN006","MIS001","MIF056","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI1130001-03","Blue Cross® Premier PPO Silver Extra","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-extra-na-more-than-300-sbc.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI1130001","Blue Cross® Premier PPO Silver Extra","15560MI113","7538162760","MIN006","MIS001","MIF056","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI1130001-04","Blue Cross® Premier PPO Silver Extra","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$11,700","$11700 per person","$23400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-extra-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/premier-ppo-extra.html?costshare=73"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI1130001","Blue Cross® Premier PPO Silver Extra","15560MI113","7538162760","MIN006","MIS001","MIF056","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI1130001-05","Blue Cross® Premier PPO Silver Extra","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,700","$60","$700","$600","$400","$60","$700","$80","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$4,900","$4900 per person","$9800 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"$1,400","$1400 per person","$2800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-extra-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/premier-ppo-extra.html?costshare=87"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","Individual","No","38-2069753","15560MI1130001","Blue Cross® Premier PPO Silver Extra","15560MI113","7538162760","MIN006","MIS001","MIF056","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidental injury and emergency only","Yes","Accidental injury and emergency only","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/2018selectdruglist","15560MI1130001-06","Blue Cross® Premier PPO Silver Extra","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$20","$600","$60","$250","$200","$90","$60","$250","$30","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/premier-silver-extra-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/premier-ppo-extra.html?costshare=94"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0650001","Blue Dental PPO Plus 100/80/50/50 Voluntary SG","15560MI065","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.938","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0650001-00","Blue Dental PPO Plus 100/80/50/50 Voluntary SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-plus-100-80-50-50-1000-v-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0650002","Blue Dental PPO Plus 80/50/50/50 Voluntary SG","15560MI065","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.921","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0650002-00","Blue Dental PPO Plus 80/50/50/50 Voluntary SG","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-plus-80-50-50-50-1000-v-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0670001","Blue Dental PPO 100/80/50/50 (80/50/50/50) Voluntary SG","15560MI067","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.  $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.927","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0670001-00","Blue Dental PPO 100/80/50/50 (80/50/50/50) Voluntary SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-100-80-50-50-1250-v-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0670002","Blue Dental PPO 100/80/50/50 (80/50/50/50) Voluntary SG","15560MI067","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.  $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.927","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0670002-00","Blue Dental PPO 100/80/50/50 (80/50/50/50) Voluntary SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-100-80-50-50-1000-v-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0670003","Blue Dental PPO 80/50/50/50 (50/50/50/50)  Voluntary SG","15560MI067","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.  $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.908","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0670003-00","Blue Dental PPO 80/50/50/50 (50/50/50/50)  Voluntary SG","Standard Low Off Exchange Plan","71.58%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-80-50-50-50-1000-v-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0690001","Blue Dental EPO 100/80/50/50 Voluntary SG","15560MI069","7538162760","MIN003","MIS003",,"Existing","EPO","High","Not Applicable",,"Off the Exchange",,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists. $1,250 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"0.898","Guaranteed Rate","2018-01-01",,"Yes","Emergency","No",,"Yes",,"","15560MI0690001-00","Blue Dental EPO 100/80/50/50 Voluntary SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-epo-100-80-50-50-1250-v-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0490001","Blue Dental PPO Plus 100/80/50 Voluntary SG","15560MI049","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0490001-00","Blue Dental PPO Plus 100/80/50 Voluntary SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-plus-100-80-50-1000-v-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0490002","Blue Dental PPO Plus 80/50/50 Voluntary SG","15560MI049","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0490002-00","Blue Dental PPO Plus 80/50/50 Voluntary SG","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-plus-80-50-50-1000-v-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0660001","Blue Dental PPO 100/80/50 (80/50/50) Voluntary SG","15560MI066","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0660001-00","Blue Dental PPO 100/80/50 (80/50/50) Voluntary SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-100-80-50-1250-v-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0660002","Blue Dental PPO 100/80/50 (80/50/50) Voluntary SG","15560MI066","7538162760","MIN003","MIS004",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0660002-00","Blue Dental PPO 100/80/50 (80/50/50) Voluntary SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-100-80-50-1000-v-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0660003","Blue Dental PPO 80/50/50 (50/50/50) Voluntary SG","15560MI066","7538162760","MIN003","MIS004",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0660003-00","Blue Dental PPO 80/50/50 (50/50/50) Voluntary SG","Standard Low Off Exchange Plan","71.58%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-ppo-80-50-50-1000-v-sg.pdf"
"2018","MI","15560","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","38-2069753","15560MI0680001","Blue Dental EPO 100/80/50 Voluntary SG","15560MI068","7538162760","MIN003","MIS003",,"Existing","EPO","High","Not Applicable",,"Off the Exchange",,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency","No",,"Yes",,"","15560MI0680001-00","Blue Dental EPO 100/80/50 Voluntary SG","Standard High Off Exchange Plan","85.11%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2018-employer/brochures/blue-dental-epo-100-80-50-1250-v-sg.pdf"
"2018","MI","23426","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","31-1185262","23426MI0020003","DentaSpan Family High Option","23426MI002","7083617077","MIN001","MIS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","23426MI0020003-00","DentaSpan Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsmi.dentalcareplus.com","http://hixpbdsmi.dentalcareplus.com"
"2018","MI","23426","SERFF","2017-08-16 20:15:58","Individual","Yes","31-1185262","23426MI0010001","DentaTrust-PPO Pediatric High Option","23426MI001","7083617077","MIN001","MIS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","23426MI0010001-00","DentaTrust-PPO Pediatric High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtmi.dentalcareplus.com","http://hixpbdtmi.dentalcareplus.com"
"2018","MI","23426","SERFF","2017-08-16 20:15:58","Individual","Yes","31-1185262","23426MI0010001","DentaTrust-PPO Pediatric High Option","23426MI001","7083617077","MIN001","MIS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","23426MI0010001-01","DentaTrust-PPO Pediatric High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtmi.dentalcareplus.com","http://hixpbdtmi.dentalcareplus.com"
"2018","MI","23426","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","31-1185262","23426MI0020003","DentaSpan Family High Option","23426MI002","7083617077","MIN001","MIS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","23426MI0020003-01","DentaSpan Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsmi.dentalcareplus.com","http://hixpbdsmi.dentalcareplus.com"
"2018","MI","23426","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","31-1185262","23426MI0020004","DentaSpan Family Low Option","23426MI002","7083617077","MIN001","MIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","23426MI0020004-00","DentaSpan Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsmi.dentalcareplus.com","http://hixpbdsmi.dentalcareplus.com"
"2018","MI","23426","SERFF","2017-08-16 20:15:58","Individual","Yes","31-1185262","23426MI0010002","DentaTrust-PPO Pediatric Low Option","23426MI001","7083617077","MIN001","MIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","23426MI0010002-00","DentaTrust-PPO Pediatric Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtmi.dentalcareplus.com","http://hixpbdtmi.dentalcareplus.com"
"2018","MI","23426","SERFF","2017-08-16 20:15:58","Individual","Yes","31-1185262","23426MI0010002","DentaTrust-PPO Pediatric Low Option","23426MI001","7083617077","MIN001","MIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","23426MI0010002-01","DentaTrust-PPO Pediatric Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtmi.dentalcareplus.com","http://hixpbdtmi.dentalcareplus.com"
"2018","MI","23426","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","31-1185262","23426MI0020004","DentaSpan Family Low Option","23426MI002","7083617077","MIN001","MIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","23426MI0020004-01","DentaSpan Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsmi.dentalcareplus.com","http://hixpbdsmi.dentalcareplus.com"
"2018","MI","23426","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","31-1185262","23426MI0030003","DentaSpan Dental-Family High Option-Off Exchange","23426MI003","7083617077","MIN001","MIS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","23426MI0030003-00","DentaSpan Dental-Family High Option-Off Exchange","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsmi.dentalcareplus.com","http://hiopbdsmi.dentalcareplus.com"
"2018","MI","23426","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","31-1185262","23426MI0030004","DentaSpan Dental-Family Low Option-Off Exchange","23426MI003","7083617077","MIN001","MIS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","23426MI0030004-00","DentaSpan Dental-Family Low Option-Off Exchange","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsmi.dentalcareplus.com","http://hiopbdsmi.dentalcareplus.com"
"2018","MI","23426","SERFF","2017-08-16 20:15:58","Individual","Yes","31-1185262","23426MI0010003","DentaTrust-PPO Family High Option","23426MI001","7083617077","MIN001","MIS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","23426MI0010003-00","DentaTrust-PPO Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtmi.dentalcareplus.com","http://hixpbdtmi.dentalcareplus.com"
"2018","MI","23426","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","31-1185262","23426MI0030001","DentaSpan Pediatric High Option- Off Exchange","23426MI003","7083617077","MIN001","MIS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No",".https://hixenroll.insxcloud.com/payment","","23426MI0030001-00","DentaSpan Pediatric High Option- Off Exchange","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsmi.dentalcareplus.com","http://hiopbdsmi.dentalcareplus.com"
"2018","MI","23426","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","31-1185262","23426MI0030002","DentaSpan Pediatric Low Option- Off Exchange","23426MI003","7083617077","MIN001","MIS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No",".https://hixenroll.insxcloud.com/payment","","23426MI0030002-00","DentaSpan Pediatric Low Option- Off Exchange","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsmi.dentalcareplus.com","http://hiopbdsmi.dentalcareplus.com"
"2018","MI","23426","SERFF","2017-08-16 20:15:58","Individual","Yes","31-1185262","23426MI0010003","DentaTrust-PPO Family High Option","23426MI001","7083617077","MIN001","MIS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","23426MI0010003-01","DentaTrust-PPO Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtmi.dentalcareplus.com","http://hixpbdtmi.dentalcareplus.com"
"2018","MI","23426","SERFF","2017-08-16 20:15:58","Individual","Yes","31-1185262","23426MI0010004","DentaTrust-PPO Family Low Option","23426MI001","7083617077","MIN001","MIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","23426MI0010004-00","DentaTrust-PPO Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtmi.dentalcareplus.com","http://hixpbdtmi.dentalcareplus.com"
"2018","MI","23426","SERFF","2017-08-16 20:15:58","Individual","Yes","31-1185262","23426MI0010004","DentaTrust-PPO Family Low Option","23426MI001","7083617077","MIN001","MIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","23426MI0010004-01","DentaTrust-PPO Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtmi.dentalcareplus.com","http://hixpbdtmi.dentalcareplus.com"
"2018","MI","26380","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","57-0523959","26380MI0020001","Group Dental Policy","26380MI002",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","traditional with inside maximum","Yes","traditional with inside minimum","Yes",,"","26380MI0020001-00","Group Dental Policy","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","27093","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","44-0308260","27093MI0010001","KCL EHB Low PPO","27093MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010001-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","27093","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","44-0308260","27093MI0010003","KCL EHB Low MAC","27093MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010003-00","KCL EHB Low MAC","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","27093","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","44-0308260","27093MI0010005","KCL Fam Low PPO","27093MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010005-00","KCL Fam Low PPO","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","27093","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","44-0308260","27093MI0010007","KCL FAM Low MAC","27093MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010007-00","KCL FAM Low MAC","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","27093","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","44-0308260","27093MI0010002","KCL EHB High PPO","27093MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010002-00","KCL EHB High PPO","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","27093","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","44-0308260","27093MI0010004","KCL EHB High MAC","27093MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010004-00","KCL EHB High MAC","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","27093","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","44-0308260","27093MI0010006","KCL Fam High PPO","27093MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010006-00","KCL Fam High PPO","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","27093","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","44-0308260","27093MI0010008","KCL FAM High MAC","27093MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010008-00","KCL FAM High MAC","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540050","MyPriority HSA Bronze 6650","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540050-00","MyPriority HSA Bronze 6650","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.priorityhealth.com/-/media/3950B06CA22A4EF1A78F96BDD97C179A.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540050","MyPriority HSA Bronze 6650","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540050-01","MyPriority HSA Bronze 6650","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.priorityhealth.com/-/media/3950B06CA22A4EF1A78F96BDD97C179A.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540050","MyPriority HSA Bronze 6650","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540050-02","MyPriority HSA Bronze 6650","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/24656E3CBDD745008D4294E4B723DD0F.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540050","MyPriority HSA Bronze 6650","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540050-03","MyPriority HSA Bronze 6650","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.priorityhealth.com/-/media/C1A7F1AE22A044B5BA8237336AE6B9FD.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540051","MyPriority HSA Bronze 6650 - Spectrum Health Partners","29698MI054",,"MIN002","MIS002","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540051-00","MyPriority HSA Bronze 6650 - Spectrum Health Partners","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.priorityhealth.com/-/media/F58EFB1356A0473093BA64B606FAFF60.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-spectrum-health-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540051","MyPriority HSA Bronze 6650 - Spectrum Health Partners","29698MI054",,"MIN002","MIS002","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540051-01","MyPriority HSA Bronze 6650 - Spectrum Health Partners","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.priorityhealth.com/-/media/F58EFB1356A0473093BA64B606FAFF60.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-spectrum-health-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540051","MyPriority HSA Bronze 6650 - Spectrum Health Partners","29698MI054",,"MIN002","MIS002","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540051-02","MyPriority HSA Bronze 6650 - Spectrum Health Partners","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/24656E3CBDD745008D4294E4B723DD0F.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-spectrum-health-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540051","MyPriority HSA Bronze 6650 - Spectrum Health Partners","29698MI054",,"MIN002","MIS002","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540051-03","MyPriority HSA Bronze 6650 - Spectrum Health Partners","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.priorityhealth.com/-/media/5B333026A8C54E9A92653CF1FFD323B1.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-spectrum-health-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540052","MyPriority HSA Bronze 6650 - Bronson Healthcare Partners","29698MI054",,"MIN003","MIS003","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540052-00","MyPriority HSA Bronze 6650 - Bronson Healthcare Partners","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.priorityhealth.com/-/media/E5701C2F7FDE492FA2D6CC647A809A1A.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-bronson-healthcare-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540052","MyPriority HSA Bronze 6650 - Bronson Healthcare Partners","29698MI054",,"MIN003","MIS003","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540052-01","MyPriority HSA Bronze 6650 - Bronson Healthcare Partners","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.priorityhealth.com/-/media/E5701C2F7FDE492FA2D6CC647A809A1A.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-bronson-healthcare-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540052","MyPriority HSA Bronze 6650 - Bronson Healthcare Partners","29698MI054",,"MIN003","MIS003","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540052-02","MyPriority HSA Bronze 6650 - Bronson Healthcare Partners","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/24656E3CBDD745008D4294E4B723DD0F.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-bronson-healthcare-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540052","MyPriority HSA Bronze 6650 - Bronson Healthcare Partners","29698MI054",,"MIN003","MIS003","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540052-03","MyPriority HSA Bronze 6650 - Bronson Healthcare Partners","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.priorityhealth.com/-/media/C22D6D801AC14387BE6826EC9FDF58A7.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-bronson-healthcare-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540053","MyPriority HSA Bronze 6650 - Beaumont Health Network","29698MI054",,"MIN004","MIS004","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540053-00","MyPriority HSA Bronze 6650 - Beaumont Health Network","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.priorityhealth.com/-/media/6934B3CA8084481C821D878F5A2F1E37.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-beaumont-health-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540053","MyPriority HSA Bronze 6650 - Beaumont Health Network","29698MI054",,"MIN004","MIS004","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540053-01","MyPriority HSA Bronze 6650 - Beaumont Health Network","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.priorityhealth.com/-/media/6934B3CA8084481C821D878F5A2F1E37.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-beaumont-health-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540053","MyPriority HSA Bronze 6650 - Beaumont Health Network","29698MI054",,"MIN004","MIS004","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540053-02","MyPriority HSA Bronze 6650 - Beaumont Health Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/24656E3CBDD745008D4294E4B723DD0F.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-beaumont-health-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540053","MyPriority HSA Bronze 6650 - Beaumont Health Network","29698MI054",,"MIN004","MIS004","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540053-03","MyPriority HSA Bronze 6650 - Beaumont Health Network","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.priorityhealth.com/-/media/A8813C041B2B4300B7F4536E3EE30127.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-beaumont-health-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540054","MyPriority HSA Bronze 6650 - St. John Providence Network","29698MI054",,"MIN005","MIS005","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540054-00","MyPriority HSA Bronze 6650 - St. John Providence Network","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.priorityhealth.com/-/media/548D75164D3B498AA33991EF4A81390C.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-st-john-providence-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540054","MyPriority HSA Bronze 6650 - St. John Providence Network","29698MI054",,"MIN005","MIS005","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540054-01","MyPriority HSA Bronze 6650 - St. John Providence Network","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.priorityhealth.com/-/media/548D75164D3B498AA33991EF4A81390C.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-st-john-providence-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540054","MyPriority HSA Bronze 6650 - St. John Providence Network","29698MI054",,"MIN005","MIS005","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540054-02","MyPriority HSA Bronze 6650 - St. John Providence Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/24656E3CBDD745008D4294E4B723DD0F.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-st-john-providence-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540054","MyPriority HSA Bronze 6650 - St. John Providence Network","29698MI054",,"MIN005","MIS005","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540054-03","MyPriority HSA Bronze 6650 - St. John Providence Network","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.priorityhealth.com/-/media/D436D2A267934DE49894D1991796495C.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-st-john-providence-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540055","MyPriority HSA Bronze 6650 - St. Joseph Mercy Health System Network","29698MI054",,"MIN006","MIS006","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540055-00","MyPriority HSA Bronze 6650 - St. Joseph Mercy Health System Network","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.priorityhealth.com/-/media/32B8E5D7823841619EFCEAF68B04F0FB.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-st-joseph-mercy-health-system-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540055","MyPriority HSA Bronze 6650 - St. Joseph Mercy Health System Network","29698MI054",,"MIN006","MIS006","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540055-01","MyPriority HSA Bronze 6650 - St. Joseph Mercy Health System Network","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.priorityhealth.com/-/media/32B8E5D7823841619EFCEAF68B04F0FB.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-st-joseph-mercy-health-system-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540055","MyPriority HSA Bronze 6650 - St. Joseph Mercy Health System Network","29698MI054",,"MIN006","MIS006","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540055-02","MyPriority HSA Bronze 6650 - St. Joseph Mercy Health System Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/24656E3CBDD745008D4294E4B723DD0F.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-st-joseph-mercy-health-system-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540055","MyPriority HSA Bronze 6650 - St. Joseph Mercy Health System Network","29698MI054",,"MIN006","MIS006","MIF001","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540055-03","MyPriority HSA Bronze 6650 - St. Joseph Mercy Health System Network","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.priorityhealth.com/-/media/900F62C00260445AA28726AD90C0ACDB.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-hsa-bronze-6650-st-joseph-mercy-health-system-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540060","MyPriority Gold 1100","29698MI054",,"MIN007","MIS001","MIF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540060-00","MyPriority Gold 1100","Standard Gold Off Exchange Plan",,"0.761980248504188","Yes","Yes","No","100%",,"$1,100","$0","$2,527","$60","$1,100","$0","$1,955","$55","$1,100","$0","$396","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/B957F9D8EF1540A8808161E9BC7C9185.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-gold-1100?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540060","MyPriority Gold 1100","29698MI054",,"MIN007","MIS001","MIF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540060-01","MyPriority Gold 1100","Standard Gold On Exchange Plan",,"0.761980248504188","Yes","Yes","No","100%",,"$1,100","$0","$2,527","$60","$1,100","$0","$1,955","$55","$1,100","$0","$396","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/B957F9D8EF1540A8808161E9BC7C9185.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-gold-1100?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540060","MyPriority Gold 1100","29698MI054",,"MIN007","MIS001","MIF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540060-02","MyPriority Gold 1100","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/24656E3CBDD745008D4294E4B723DD0F.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-gold-1100?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540070","MyPriority Silver 3200","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540070-02","MyPriority Silver 3200","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.priorityhealth.com/-/media/24656E3CBDD745008D4294E4B723DD0F.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540070","MyPriority Silver 3200","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540070-03","MyPriority Silver 3200","Limited Cost Sharing Plan Variation",,"0.676504446383443","Yes","Yes","No","100%",,"$3,200","$640","$1,032","$60","$3,200","$1,925","$904","$55","$1,032","$885","$270","$0",,"10","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/9D13ABCA961A4DA8B524E04C6B90022F.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540070","MyPriority Silver 3200","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540070-04","MyPriority Silver 3200","73% AV Level Silver Plan",,"0.726859174113467","Yes","Yes","No","100%",,"$2,408","$0","$2,492","$60","$3,000","$1,095","$805","$55","$1,353","$75","$497","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/155D714C27C44ECFA2063791B0B86826.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540071","MyPriority Silver 3200 - Spectrum Health Partners","29698MI054",,"MIN002","MIS002","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540071-01","MyPriority Silver 3200 - Spectrum Health Partners","Standard Silver On Exchange Plan",,"0.676504446383443","Yes","Yes","No","100%",,"$3,200","$640","$1,032","$60","$3,200","$1,925","$904","$55","$1,032","$885","$270","$0",,"10","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/71F43E1A23004E4CA185B3A827ECC9A4.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-spectrum-health-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540071","MyPriority Silver 3200 - Spectrum Health Partners","29698MI054",,"MIN002","MIS002","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540071-02","MyPriority Silver 3200 - Spectrum Health Partners","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.priorityhealth.com/-/media/24656E3CBDD745008D4294E4B723DD0F.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-spectrum-health-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540071","MyPriority Silver 3200 - Spectrum Health Partners","29698MI054",,"MIN002","MIS002","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540071-03","MyPriority Silver 3200 - Spectrum Health Partners","Limited Cost Sharing Plan Variation",,"0.676504446383443","Yes","Yes","No","100%",,"$3,200","$640","$1,032","$60","$3,200","$1,925","$904","$55","$1,032","$885","$270","$0",,"10","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/A7841E3375F0475DB7BF9F2925ED3175.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-spectrum-health-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540071","MyPriority Silver 3200 - Spectrum Health Partners","29698MI054",,"MIN002","MIS002","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540071-04","MyPriority Silver 3200 - Spectrum Health Partners","73% AV Level Silver Plan",,"0.726859174113467","Yes","Yes","No","100%",,"$2,408","$0","$2,492","$60","$3,000","$1,095","$805","$55","$1,353","$75","$497","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/3447C0ADADCD4AC3B1E7A51D93791BD2.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-spectrum-health-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540071","MyPriority Silver 3200 - Spectrum Health Partners","29698MI054",,"MIN002","MIS002","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540071-05","MyPriority Silver 3200 - Spectrum Health Partners","87% AV Level Silver Plan",,"0.863347128675948","Yes","Yes","No","100%",,"$1,036","$0","$514","$60","$1,195","$190","$165","$55","$1,200","$56","$294","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/E10A7E7B5B574E59B0D00B663F07C9F7.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-spectrum-health-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540071","MyPriority Silver 3200 - Spectrum Health Partners","29698MI054",,"MIN002","MIS002","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540071-06","MyPriority Silver 3200 - Spectrum Health Partners","94% AV Level Silver Plan",,"0.931457330761075","Yes","Yes","No","100%",,"$161","$0","$514","$60","$471","$60","$144","$55","$500","$0","$175","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/A5B5A410E63B496F8DF40220C3229457.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-spectrum-health-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540072","MyPriority Silver 3200 - Bronson Healthcare Partners","29698MI054",,"MIN003","MIS003","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540072-00","MyPriority Silver 3200 - Bronson Healthcare Partners","Standard Silver Off Exchange Plan",,"0.676504446383443","Yes","Yes","No","100%",,"$3,200","$640","$1,032","$60","$3,200","$1,925","$904","$55","$1,032","$885","$270","$0",,"10","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/0C5D9B34B95E4BF9AAD90BFC58FEF9C5.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-bronson-healthcare-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540072","MyPriority Silver 3200 - Bronson Healthcare Partners","29698MI054",,"MIN003","MIS003","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540072-01","MyPriority Silver 3200 - Bronson Healthcare Partners","Standard Silver On Exchange Plan",,"0.676504446383443","Yes","Yes","No","100%",,"$3,200","$640","$1,032","$60","$3,200","$1,925","$904","$55","$1,032","$885","$270","$0",,"10","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/0C5D9B34B95E4BF9AAD90BFC58FEF9C5.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-bronson-healthcare-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540072","MyPriority Silver 3200 - Bronson Healthcare Partners","29698MI054",,"MIN003","MIS003","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540072-02","MyPriority Silver 3200 - Bronson Healthcare Partners","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.priorityhealth.com/-/media/24656E3CBDD745008D4294E4B723DD0F.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-bronson-healthcare-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540072","MyPriority Silver 3200 - Bronson Healthcare Partners","29698MI054",,"MIN003","MIS003","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540072-03","MyPriority Silver 3200 - Bronson Healthcare Partners","Limited Cost Sharing Plan Variation",,"0.676504446383443","Yes","Yes","No","100%",,"$3,200","$640","$1,032","$60","$3,200","$1,925","$904","$55","$1,032","$885","$270","$0",,"10","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/51069EF013B640809F63E3C5F6087BCC.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-bronson-healthcare-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540072","MyPriority Silver 3200 - Bronson Healthcare Partners","29698MI054",,"MIN003","MIS003","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540072-04","MyPriority Silver 3200 - Bronson Healthcare Partners","73% AV Level Silver Plan",,"0.726859174113467","Yes","Yes","No","100%",,"$2,408","$0","$2,492","$60","$3,000","$1,095","$805","$55","$1,353","$75","$497","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/458709A9CB0F4F4D847DC73D7DA3AB16.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-bronson-healthcare-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540072","MyPriority Silver 3200 - Bronson Healthcare Partners","29698MI054",,"MIN003","MIS003","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540072-05","MyPriority Silver 3200 - Bronson Healthcare Partners","87% AV Level Silver Plan",,"0.863347128675948","Yes","Yes","No","100%",,"$1,036","$0","$514","$60","$1,195","$190","$165","$55","$1,200","$56","$294","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/11967B346B054DDABC45EF0A7A0EE36A.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-bronson-healthcare-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540072","MyPriority Silver 3200 - Bronson Healthcare Partners","29698MI054",,"MIN003","MIS003","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540072-06","MyPriority Silver 3200 - Bronson Healthcare Partners","94% AV Level Silver Plan",,"0.931457330761075","Yes","Yes","No","100%",,"$161","$0","$514","$60","$471","$60","$144","$55","$500","$0","$175","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/77E7EC93712F4A19B9BDCEE6EF70E977.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-bronson-healthcare-partners?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540073","MyPriority Silver 3200 - Beaumont Health Network","29698MI054",,"MIN004","MIS004","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540073-00","MyPriority Silver 3200 - Beaumont Health Network","Standard Silver Off Exchange Plan",,"0.676504446383443","Yes","Yes","No","100%",,"$3,200","$640","$1,032","$60","$3,200","$1,925","$904","$55","$1,032","$885","$270","$0",,"10","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/3702D94D614A47FFBFAE5D0BD55A6406.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-beaumont-health-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540073","MyPriority Silver 3200 - Beaumont Health Network","29698MI054",,"MIN004","MIS004","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540073-01","MyPriority Silver 3200 - Beaumont Health Network","Standard Silver On Exchange Plan",,"0.676504446383443","Yes","Yes","No","100%",,"$3,200","$640","$1,032","$60","$3,200","$1,925","$904","$55","$1,032","$885","$270","$0",,"10","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/3702D94D614A47FFBFAE5D0BD55A6406.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-beaumont-health-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540073","MyPriority Silver 3200 - Beaumont Health Network","29698MI054",,"MIN004","MIS004","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540073-02","MyPriority Silver 3200 - Beaumont Health Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.priorityhealth.com/-/media/24656E3CBDD745008D4294E4B723DD0F.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-beaumont-health-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540073","MyPriority Silver 3200 - Beaumont Health Network","29698MI054",,"MIN004","MIS004","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540073-03","MyPriority Silver 3200 - Beaumont Health Network","Limited Cost Sharing Plan Variation",,"0.676504446383443","Yes","Yes","No","100%",,"$3,200","$640","$1,032","$60","$3,200","$1,925","$904","$55","$1,032","$885","$270","$0",,"10","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/D8EC59A30272494D9A4777374CA2DC8C.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-beaumont-health-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540073","MyPriority Silver 3200 - Beaumont Health Network","29698MI054",,"MIN004","MIS004","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540073-04","MyPriority Silver 3200 - Beaumont Health Network","73% AV Level Silver Plan",,"0.726859174113467","Yes","Yes","No","100%",,"$2,408","$0","$2,492","$60","$3,000","$1,095","$805","$55","$1,353","$75","$497","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/1692D8BD84F1412185C73AD7471E7FBE.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-beaumont-health-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540073","MyPriority Silver 3200 - Beaumont Health Network","29698MI054",,"MIN004","MIS004","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540073-05","MyPriority Silver 3200 - Beaumont Health Network","87% AV Level Silver Plan",,"0.863347128675948","Yes","Yes","No","100%",,"$1,036","$0","$514","$60","$1,195","$190","$165","$55","$1,200","$56","$294","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/A8E8B8FDF6314CAB89A217D9EAC9FEF6.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-beaumont-health-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540073","MyPriority Silver 3200 - Beaumont Health Network","29698MI054",,"MIN004","MIS004","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540073-06","MyPriority Silver 3200 - Beaumont Health Network","94% AV Level Silver Plan",,"0.931457330761075","Yes","Yes","No","100%",,"$161","$0","$514","$60","$471","$60","$144","$55","$500","$0","$175","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/435252855C0F485DB1352831D774A2EA.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-beaumont-health-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540074","MyPriority Silver 3200 - St. John Providence Network","29698MI054",,"MIN005","MIS005","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540074-00","MyPriority Silver 3200 - St. John Providence Network","Standard Silver Off Exchange Plan",,"0.676504446383443","Yes","Yes","No","100%",,"$3,200","$640","$1,032","$60","$3,200","$1,925","$904","$55","$1,032","$885","$270","$0",,"10","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/BA6E9F2392F2427D93BA1B5557012F9E.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-st-john-providence-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540074","MyPriority Silver 3200 - St. John Providence Network","29698MI054",,"MIN005","MIS005","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540074-01","MyPriority Silver 3200 - St. John Providence Network","Standard Silver On Exchange Plan",,"0.676504446383443","Yes","Yes","No","100%",,"$3,200","$640","$1,032","$60","$3,200","$1,925","$904","$55","$1,032","$885","$270","$0",,"10","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/BA6E9F2392F2427D93BA1B5557012F9E.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-st-john-providence-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540074","MyPriority Silver 3200 - St. John Providence Network","29698MI054",,"MIN005","MIS005","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540074-02","MyPriority Silver 3200 - St. John Providence Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.priorityhealth.com/-/media/24656E3CBDD745008D4294E4B723DD0F.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-st-john-providence-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540074","MyPriority Silver 3200 - St. John Providence Network","29698MI054",,"MIN005","MIS005","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540074-03","MyPriority Silver 3200 - St. John Providence Network","Limited Cost Sharing Plan Variation",,"0.676504446383443","Yes","Yes","No","100%",,"$3,200","$640","$1,032","$60","$3,200","$1,925","$904","$55","$1,032","$885","$270","$0",,"10","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/DACC29E7514347F0980DB2D2D1028B7B.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-st-john-providence-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540074","MyPriority Silver 3200 - St. John Providence Network","29698MI054",,"MIN005","MIS005","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540074-04","MyPriority Silver 3200 - St. John Providence Network","73% AV Level Silver Plan",,"0.726859174113467","Yes","Yes","No","100%",,"$2,408","$0","$2,492","$60","$3,000","$1,095","$805","$55","$1,353","$75","$497","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/DDEABFD456DE47A7BAA2823FEAAE84A5.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-st-john-providence-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540074","MyPriority Silver 3200 - St. John Providence Network","29698MI054",,"MIN005","MIS005","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540074-05","MyPriority Silver 3200 - St. John Providence Network","87% AV Level Silver Plan",,"0.863347128675948","Yes","Yes","No","100%",,"$1,036","$0","$514","$60","$1,195","$190","$165","$55","$1,200","$56","$294","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/B22D5B421B714D7AB8B626BD9577084D.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-st-john-providence-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540074","MyPriority Silver 3200 - St. John Providence Network","29698MI054",,"MIN005","MIS005","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540074-06","MyPriority Silver 3200 - St. John Providence Network","94% AV Level Silver Plan",,"0.931457330761075","Yes","Yes","No","100%",,"$161","$0","$514","$60","$471","$60","$144","$55","$500","$0","$175","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/42539C7D631542B1B7E34084E1DE3958.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-st-john-providence-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540075","MyPriority Silver 3200 - St. Joseph Mercy Health System Network","29698MI054",,"MIN006","MIS006","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540075-00","MyPriority Silver 3200 - St. Joseph Mercy Health System Network","Standard Silver Off Exchange Plan",,"0.676504446383443","Yes","Yes","No","100%",,"$3,200","$640","$1,032","$60","$3,200","$1,925","$904","$55","$1,032","$885","$270","$0",,"10","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/AC4DEA9486A6432AAEDAD9E5A28976FC.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-st-joseph-mercy-health-system-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540075","MyPriority Silver 3200 - St. Joseph Mercy Health System Network","29698MI054",,"MIN006","MIS006","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540075-01","MyPriority Silver 3200 - St. Joseph Mercy Health System Network","Standard Silver On Exchange Plan",,"0.676504446383443","Yes","Yes","No","100%",,"$3,200","$640","$1,032","$60","$3,200","$1,925","$904","$55","$1,032","$885","$270","$0",,"10","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/AC4DEA9486A6432AAEDAD9E5A28976FC.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-st-joseph-mercy-health-system-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540075","MyPriority Silver 3200 - St. Joseph Mercy Health System Network","29698MI054",,"MIN006","MIS006","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540075-02","MyPriority Silver 3200 - St. Joseph Mercy Health System Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.priorityhealth.com/-/media/24656E3CBDD745008D4294E4B723DD0F.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-st-joseph-mercy-health-system-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540075","MyPriority Silver 3200 - St. Joseph Mercy Health System Network","29698MI054",,"MIN006","MIS006","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540075-03","MyPriority Silver 3200 - St. Joseph Mercy Health System Network","Limited Cost Sharing Plan Variation",,"0.676504446383443","Yes","Yes","No","100%",,"$3,200","$640","$1,032","$60","$3,200","$1,925","$904","$55","$1,032","$885","$270","$0",,"10","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/C37986869AC4469DADCE4FAE30EAE062.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-st-joseph-mercy-health-system-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540075","MyPriority Silver 3200 - St. Joseph Mercy Health System Network","29698MI054",,"MIN006","MIS006","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540075-04","MyPriority Silver 3200 - St. Joseph Mercy Health System Network","73% AV Level Silver Plan",,"0.726859174113467","Yes","Yes","No","100%",,"$2,408","$0","$2,492","$60","$3,000","$1,095","$805","$55","$1,353","$75","$497","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/088828BB27B14A8F869F67224C0D6637.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-st-joseph-mercy-health-system-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540075","MyPriority Silver 3200 - St. Joseph Mercy Health System Network","29698MI054",,"MIN006","MIS006","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540075-05","MyPriority Silver 3200 - St. Joseph Mercy Health System Network","87% AV Level Silver Plan",,"0.863347128675948","Yes","Yes","No","100%",,"$1,036","$0","$514","$60","$1,195","$190","$165","$55","$1,200","$56","$294","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/C06684853C614E36BAAEEF298FA1F3AF.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-st-joseph-mercy-health-system-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","29698","SERFF","2017-08-16 20:15:58","Individual","No","38-2715520","29698MI0540075","MyPriority Silver 3200 - St. Joseph Mercy Health System Network","29698MI054",,"MIN006","MIS006","MIF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540075-06","MyPriority Silver 3200 - St. Joseph Mercy Health System Network","94% AV Level Silver Plan",,"0.931457330761075","Yes","Yes","No","100%",,"$161","$0","$514","$60","$471","$60","$144","$55","$500","$0","$175","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.priorityhealth.com/-/media/80B8E14825AD4926B192E8F544029A95.pdf","https://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2018/mypriority-silver-3200-st-joseph-mercy-health-system-network?utm_campaign=oep-2018&utm_medium=website&utm_source=ffm"
"2018","MI","31256","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","Yes","38-2587320","31256MI0020001","DENCAP Choice Dental Plan 2 Lives","31256MI002",,"MIN001","MIS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","In-network dentsits outside of Service Area","No",,"","31256MI0020001-00","DENCAP Choice Dental Plan 2 Lives","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dencap.com/insurance-plans/dencap-choice-dental-plan/","https://dencap.com/insurance-plans/dencap-choice-dental-plan/"
"2018","MI","31256","SERFF","2017-10-31 20:15:29","Individual","Yes","38-2587320","31256MI0010001","Senior  Value Dental Plan","31256MI001",,"MIN001","MIS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","In-network dentsits outside of Service Area","No",,"","31256MI0010001-00","Senior  Value Dental Plan","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dencap.com/insurance-plans/senior-value-plan/","https://dencap.com/wp-content/uploads/2016/10/Schedule-S5.pdf"
"2018","MI","31256","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","Yes","38-2587320","31256MI0020002","DENCAP Choice Dental Plan 3 Lives","31256MI002",,"MIN001","MIS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","In-network dentsits outside of Service Area","No",,"","31256MI0020002-00","DENCAP Choice Dental Plan 3 Lives","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dencap.com/insurance-plans/dencap-choice-dental-plan/","https://dencap.com/insurance-plans/dencap-choice-dental-plan/"
"2018","MI","31256","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","Yes","38-2587320","31256MI0020003","Hallmark Dental plan","31256MI002",,"MIN001","MIS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","In-network dentsits outside of Service Area","No",,"","31256MI0020003-00","Hallmark Dental plan","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dencap.com/insurance-plans/hallmark-dental-plan/","https://dencap.com/insurance-plans/hallmark-dental-plan/"
"2018","MI","31256","SERFF","2017-10-31 20:15:29","Individual","Yes","38-2587320","31256MI0010002","Individual Value Dental Plan","31256MI001",,"MIN001","MIS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","In-network dentsits outside of Service Area","No",,"","31256MI0010002-00","Individual Value Dental Plan","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dencap.com/insurance-plans/individual-value-plan/","https://dencap.com/wp-content/uploads/2016/10/Schedule-IN10.pdf"
"2018","MI","31256","SERFF","2017-10-31 20:15:29","Individual","Yes","38-2587320","31256MI0010003","Student Individual Value Dental Plan","31256MI001",,"MIN001","MIS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","In-network dentsits outside of Service Area","No",,"","31256MI0010003-00","Student Individual Value Dental Plan","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dencap.com/insurance-plans/student-individual-value-plan/","https://dencap.com/wp-content/uploads/2016/10/Schedule-IN10.pdf"
"2018","MI","31256","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","Yes","38-2587320","31256MI0020004","Grand Dental Plan","31256MI002",,"MIN001","MIS001",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","In-network dentsits outside of Service Area","No",,"","31256MI0020004-00","Grand Dental Plan","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dencap.com/insurance-plans/grand-dental-plan/","https://dencap.com/insurance-plans/grand-dental-plan/"
"2018","MI","31256","SERFF","2017-10-31 20:15:29","Individual","Yes","38-2587320","31256MI0010005","DENCAP Select Plus Dental Plan","31256MI001",,"MIN001","MIS001",,"Existing","HMO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","In-network dentsits outside of Service Area","No",,"","31256MI0010005-01","Select Plus Dental Plan","Standard High On Exchange Plan","85.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dencap.com/healthcare-gov-shoppers/","https://dencap.com/wp-content/uploads/2017/10/2018-Schedule-DSP.pdf"
"2018","MI","31256","SERFF","2017-10-31 20:15:29","Individual","Yes","38-2587320","31256MI0010004","DENCAP Select Dental Plan","31256MI001",,"MIN001","MIS001",,"Existing","HMO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.63","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","In-network dentsits outside of Service Area","No",,"","31256MI0010004-01","DENCAP Select Dental Plan","Standard High On Exchange Plan","85.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dencap.com/healthcare-gov-shoppers/","https://dencap.com/wp-content/uploads/2017/10/2018-Schedule-DS.pdf"
"2018","MI","34930","SERFF","2017-08-14 20:15:51","Individual","Yes","38-1791480","34930MI0090001","Delta Dental Individual PPO, EHB Certified","34930MI009",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0090001-00","Delta Dental Individual PPO, EHB Certified","Standard High Off Exchange Plan","84.84%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0010001","Molina Marketplace Gold Plan","40047MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0010001-01","Molina Marketplace Gold Plan","Standard Gold On Exchange Plan",,"0.770138560314203","No","Yes","No","100%",,"$3,800","$279","$2,271","$60","$1,382","$123","$346","$55","$59","$429","$166","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-gold-2018.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","34930","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","38-1791480","34930MI0100001","Delta Dental Group PPO, EHB Certified","34930MI010",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0100001-00","Delta Dental Group PPO, EHB Certified","Standard High Off Exchange Plan","84.85%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","34930","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","38-1791480","34930MI0100002","Delta Dental Group PPO, EHB Certified","34930MI010",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0100002-00","Delta Dental Group PPO, EHB Certified","Standard Low Off Exchange Plan","71.66%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","34930","SERFF","2017-08-14 20:15:51","Individual","Yes","38-1791480","34930MI0090002","Delta Dental Individual PPO, EHB Certified","34930MI009",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0090002-00","Delta Dental Individual PPO, EHB Certified","Standard Low Off Exchange Plan","71.66%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","34930","SERFF","2017-08-14 20:15:51","Individual","Yes","38-1791480","34930MI0150001","Delta Dental Individual PPO, EHB Certified (Exchange)","34930MI015",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34930","","34930MI0150001-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","84.84%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmi.com/MI_EHB_High_2018","http://www.deltadentalmi.com/MI_EHB_High_2018"
"2018","MI","34930","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","38-1791480","34930MI0100003","Delta Dental Group PPO, EHB Certified","34930MI010",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0100003-00","Delta Dental Group PPO, EHB Certified","Standard High Off Exchange Plan","84.85%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","34930","SERFF","2017-08-14 20:15:51","Individual","Yes","38-1791480","34930MI0150002","Delta Dental Individual PPO, EHB Certified (Exchange)","34930MI015",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34930","","34930MI0150002-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","71.66%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmi.com/MI_EHB_Low_2018","http://www.deltadentalmi.com/MI_EHB_Low_2018"
"2018","MI","34930","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","38-1791480","34930MI0100004","Delta Dental Group PPO, EHB Certified","34930MI010",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0100004-00","Delta Dental Group PPO, EHB Certified","Standard Low Off Exchange Plan","71.66%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","34930","SERFF","2017-08-14 20:15:51","Individual","Yes","38-1791480","34930MI0120001","Delta Dental Individual Pediatric-Only PPO, EHB Certified","34930MI012",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0120001-00","Delta Dental Individual Pediatric-Only PPO, EHB Certified","Standard High Off Exchange Plan","84.84%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","34930","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","38-1791480","34930MI0110001","Delta Dental Group Pediatric-Only PPO, EHB Certified","34930MI011",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0110001-00","Delta Dental Group Pediatric-Only PPO, EHB Certified","Standard High Off Exchange Plan","84.85%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","35700","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","35700MI0010038","BESTDental Standard - H","35700MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0010038-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mi/2017/MI_BESTDental_Standard-H_Plan.pdf"
"2018","MI","35700","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","35700MI0010038","BESTDental Standard - H","35700MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0010038-01","BESTDental Standard - H","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mi/2017/MI_BESTDental_Standard-H_Plan.pdf"
"2018","MI","34930","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","38-1791480","34930MI0110002","Delta Dental Group Pediatric-Only PPO, EHB Certified","34930MI011",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0110002-00","Delta Dental Group Pediatric-Only PPO, EHB Certified","Standard Low Off Exchange Plan","71.66%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","34930","SERFF","2017-08-14 20:15:51","Individual","Yes","38-1791480","34930MI0120002","Delta Dental Individual Pediatric-Only PPO, EHB Certified","34930MI012",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0120002-00","Delta Dental Individual Pediatric-Only PPO, EHB Certified","Standard Low Off Exchange Plan","71.66%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","34930","SERFF","2017-08-14 20:15:51","Individual","Yes","38-1791480","34930MI0170001","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","34930MI017",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34930","","34930MI0170001-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","84.84%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmi.com/MI_Ped_High_2018","http://www.deltadentalmi.com/MI_Ped_High_2018"
"2018","MI","34930","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","38-1791480","34930MI0110003","Delta Dental Group Pediatric-Only PPO, EHB Certified","34930MI011",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0110003-00","Delta Dental Group Pediatric-Only PPO, EHB Certified","Standard High Off Exchange Plan","84.85%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","34930","SERFF","2017-08-14 20:15:51","Individual","Yes","38-1791480","34930MI0170002","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","34930MI017",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34930","","34930MI0170002-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","71.66%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmi.com/MI_Ped_Low_2018","http://www.deltadentalmi.com/MI_Ped_Low_2018"
"2018","MI","34930","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","38-1791480","34930MI0110004","Delta Dental Group Pediatric-Only PPO, EHB Certified","34930MI011",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","34930MI0110004-00","Delta Dental Group Pediatric-Only PPO, EHB Certified","Standard Low Off Exchange Plan","71.66%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","35700","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","35700MI0020003","BESTOne Advantage Gold","35700MI002",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/CURRENT/MI_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","MI","35700","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","35700MI0010037","BESTDental Premium","35700MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0010037-00","BESTDental Premium","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mi/2017MI_BESTDental_Premium_Plan.pdf"
"2018","MI","35700","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","35700MI0010037","BESTDental Premium","35700MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0010037-01","BESTDental Premium","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mi/2017MI_BESTDental_Premium_Plan.pdf"
"2018","MI","35700","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","35700MI0020003","BESTOne Advantage Gold","35700MI002",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/CURRENT/MI_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","MI","35700","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","35700MI0020004","BESTOne Plus Gold","35700MI002",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/CURRENT/MI_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","MI","35700","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","35700MI0020004","BESTOne Plus Gold","35700MI002",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/CURRENT/MI_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","MI","35700","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","35700MI0010040","BESTDental Choice - H","35700MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0010040-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mi/2017/MI_BESTDental_Choice-H_Plan.pdf"
"2018","MI","35700","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","35700MI0010040","BESTDental Choice - H","35700MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0010040-01","BESTDental Choice - H","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mi/2017/MI_BESTDental_Choice-H_Plan.pdf"
"2018","MI","35700","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","35700MI0020005","BESTOne Plus Silver","35700MI002",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/current/MI_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","MI","35700","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","35700MI0010039","BEST Dental Standard-L","35700MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes",,"","35700MI0010039-00","BEST Dental Standard-L","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","35700","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","35700MI0010039","BEST Dental Standard-L","35700MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes",,"","35700MI0010039-01","BEST Dental Standard-L","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","35700","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","35700MI0020005","BESTOne Plus Silver","35700MI002",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/current/MI_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","MI","35700","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","35700MI0020006","BESTOne Basic Silver","35700MI002",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/current/MI_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","MI","35700","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","35700MI0010041","BEST Dental Choice-L","35700MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes",,"","35700MI0010041-00","BEST Dental Choice-L","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","35700","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","35700MI0010041","BEST Dental Choice-L","35700MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes",,"","35700MI0010041-01","BEST Dental Choice-L","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","35700","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","35700MI0020006","BESTOne Basic Silver","35700MI002",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/current/MI_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","MI","35700","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","35700MI0010042","BEST Dental Value","35700MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes",,"","35700MI0010042-00","BEST Dental Value","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","35700","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","35700MI0010042","BEST Dental Value","35700MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes",,"","35700MI0010042-01","BEST Dental Value","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0070001","Molina Marketplace Options Silver Plan","40047MI007",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0070001-00","Molina Marketplace Options Silver Off Exchange Plan","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$96","$2,480","$60","$1,489","$1,409","$372","$55","$859","$379","$215","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0070001","Molina Marketplace Options Silver Plan","40047MI007",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0070001-01","Molina Marketplace Options Silver 250 Plan","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$96","$2,480","$60","$1,489","$1,409","$372","$55","$859","$379","$215","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0070001","Molina Marketplace Options Silver Plan","40047MI007",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0070001-02","Molina Marketplace Options Silver Zero Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-zero-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0070001","Molina Marketplace Options Silver Plan","40047MI007",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0070001-03","Molina Marketplace Options Silver LCS Plan","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$96","$2,480","$60","$1,489","$1,409","$372","$55","$859","$379","$215","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0070001","Molina Marketplace Options Silver Plan","40047MI007",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0070001-04","Molina Marketplace Options Silver 200 Plan","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$96","$2,480","$60","$1,489","$1,409","$372","$55","$859","$379","$215","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-200-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","38791","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","47-0098400","38791MI0040002","EHB High PPO","38791MI004",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","38791MI0040002-00","EHB High PPO","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","MI","38791","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","47-0098400","38791MI0040001","EHB Low PPO","38791MI004",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","38791MI0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","MI","38791","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","47-0098400","38791MI0030002","EHB High Passive","38791MI003",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","38791MI0030002-00","EHB High Passive","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","MI","38791","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","47-0098400","38791MI0030001","EHB Low Passive","38791MI003",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","38791MI0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0010001","Molina Marketplace Gold Plan","40047MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0010001-00","Molina Marketplace Gold Off Exchange Plan","Standard Gold Off Exchange Plan",,"0.770138560314203","No","Yes","No","100%",,"$3,800","$279","$2,271","$60","$1,382","$123","$346","$55","$59","$429","$166","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-gold-2018.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0010001","Molina Marketplace Gold Plan","40047MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0010001-02","Molina Marketplace Gold Zero Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-gold-zero-2018.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0010001","Molina Marketplace Gold Plan","40047MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0010001-03","Molina Marketplace Gold LCS Plan","Limited Cost Sharing Plan Variation",,"0.770138560314203","No","Yes","No","100%",,"$3,800","$279","$2,271","$60","$1,382","$123","$346","$55","$59","$429","$166","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-gold-2018.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0010002-00","Molina Marketplace Silver Off Exchange Plan","Standard Silver Off Exchange Plan",,"0.678048193152746","No","Yes","No","100%",,"$2,054","$379","$2,271","$60","$1,037","$1,730","$691","$55","$44","$653","$331","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,950","$4950 per person","$9900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,950","$4950 per person","$9900 per group","$400","$400 per person","$800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2018.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0010002-01","Molina Marketplace Silver 250 Plan","Standard Silver On Exchange Plan",,"0.678048193152746","No","Yes","No","100%",,"$2,054","$379","$2,271","$60","$1,037","$1,730","$691","$55","$44","$653","$331","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,950","$4950 per person","$9900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,950","$4950 per person","$9900 per group","$400","$400 per person","$800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2018.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0010002-02","Molina Marketplace Silver Zero Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-silver-zero-2018.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0010002-03","Molina Marketplace Silver LCS Plan","Limited Cost Sharing Plan Variation",,"0.678048193152746","No","Yes","No","100%",,"$2,054","$379","$2,271","$60","$1,037","$1,730","$691","$55","$44","$653","$331","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,950","$4950 per person","$9900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,950","$4950 per person","$9900 per group","$400","$400 per person","$800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2018.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0010002-04","Molina Marketplace Silver 200 Plan","73% AV Level Silver Plan",,"0.739709064127067","No","Yes","No","100%",,"$1,437","$369","$3,668","$60","$1,037","$1,493","$691","$55","$44","$565","$331","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$2,500","$2500 per person","$5000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$400","$400 per person","$800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-silver-200-2018.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0010002-05","Molina Marketplace Silver 150 Plan","87% AV Level Silver Plan",,"0.879609893257353","No","Yes","No","100%",,"$525","$172","$1,725","$60","$525","$803","$346","$55","$59","$330","$166","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$525","$525 per person","$1050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$525","$525 per person","$1050 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-silver-150-2018.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0010002-06","Molina Marketplace Silver 100 Plan","94% AV Level Silver Plan",,"0.949265703364465","No","Yes","No","100%",,"$0","$152","$1,070","$60","$0","$395","$173","$55","$0","$125","$83","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-silver-100-2018.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0010003","Molina Marketplace Bronze Plan","40047MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0010003-00","Molina Marketplace Bronze Off Exchange Plan","Standard Bronze Off Exchange Plan",,"0.625077353580658","Yes","Yes","No","100%",,"$2,099","$384","$4,491","$60","$3,952","$1,780","$691","$5","$1,060","$447","$418","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-bronze-2018.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0010003","Molina Marketplace Bronze Plan","40047MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0010003-01","Molina Marketplace Bronze Plan","Standard Bronze On Exchange Plan",,"0.625077353580658","Yes","Yes","No","100%",,"$2,099","$384","$4,491","$60","$3,952","$1,780","$691","$5","$1,060","$447","$418","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-bronze-2018.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0010003","Molina Marketplace Bronze Plan","40047MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0010003-02","Molina Marketplace Bronze Zero Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-bronze-zero-2018.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0010003","Molina Marketplace Bronze Plan","40047MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0010003-03","Molina Marketplace Bronze LCS Plan","Limited Cost Sharing Plan Variation",,"0.625077353580658","Yes","Yes","No","100%",,"$2,099","$384","$4,491","$60","$3,952","$1,780","$691","$5","$1,060","$447","$418","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-bronze-2018.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0070001","Molina Marketplace Options Silver Plan","40047MI007",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0070001-05","Molina Marketplace Options Silver 150 Plan","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$700","$610","$113","$55","$700","$189","$209","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-150-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0070001","Molina Marketplace Options Silver Plan","40047MI007",,"MIN001","MIS001","MIF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0070001-06","Molina Marketplace Options Silver 100 Plan","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$22","$620","$60","$250","$218","$93","$55","$250","$105","$54","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-silver-100-2017.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0070002","Molina Marketplace Options Bronze Plan","40047MI007",,"MIN001","MIS001","MIF005","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0070002-00","Molina Marketplace Options Bronze Off Exchange Plan","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,930","$0","$4,960","$60","$3,445","$895","$1,998","$55","$645","$407","$430","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2018.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0070002","Molina Marketplace Options Bronze Plan","40047MI007",,"MIN001","MIS001","MIF005","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0070002-01","Molina Marketplace Options Bronze Plan","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,930","$0","$4,960","$60","$3,445","$895","$1,998","$55","$645","$407","$430","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2018.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0070002","Molina Marketplace Options Bronze Plan","40047MI007",,"MIN001","MIS001","MIF005","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0070002-02","Molina Marketplace Options Bronze Zero Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-zero-2018.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","40047","SERFF","2017-08-16 20:15:58","Individual","No","38-3341599","40047MI0070002","Molina Marketplace Options Bronze Plan","40047MI007",,"MIN001","MIS001","MIF005","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent is covered","Yes","Emergent is covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/formulary-2018.pdf","40047MI0070002-03","Molina Marketplace Options Bronze LCS Plan","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$2,930","$0","$4,960","$60","$3,445","$895","$1,998","$55","$645","$407","$430","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2018.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020008-06","Meridian Healthy Silver","94% AV Level Silver Plan",,"0.949671001346273","No","Yes","No","100%",,"$250","$0","$430","$60","$250","$190","$190","$60","$250","$30","$160","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=3QzY8K+3+GuP/8aZz0N7INb85i5/knTh2ysVDrOQW2AgKUY5RgdLV6DlnU8+X7xSn+2hg3u9xP+fhi6msJZKqw==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020009","Meridian Healthy Gold","58594MI002",,"MIN001","MIS001","MIF004","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020009-00","Meridian Healthy Gold","Standard Gold Off Exchange Plan",,"0.760098161899697","No","Yes","No","100%",,"$2,200","$0","$2,250","$60","$2,400","$910","$560","$60","$1,140","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,450","$4450 per person","$8900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,100","$1100 per person","$2200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=Wn0gNSWZHYwOt4xuIVN9Co007+0J6Q5I6bWp6a9Ba0Rxi8tYMzD8NmKUz6Zz72BM7j0DyUzULrRSmeCbn9lggA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","41183","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","93-0242990","41183MI0040002","EHB High PPO","41183MI004",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","41183MI0040002-00","EHB High PPO","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2018","MI","41183","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","93-0242990","41183MI0040001","EHB Low PPO","41183MI004",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","41183MI0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020014","Meridian Smart Silver","58594MI002",,"MIN001","MIS001","MIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020014-05","Meridian Smart Silver","87% AV Level Silver Plan",,"0.87953400913728","Yes","Yes","No","100%",,"$0","$970","$1,030","$60","$0","$1,300","$560","$60","$0","$270","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=BigEYM06aDR5nAH8x07TfZXLQwTAPZDTwLm2q1tV2a7REPeTOsmNTe8GJ3U/oMLc2ToOKOsmayxxgufGAYPxrw==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020014","Meridian Smart Silver","58594MI002",,"MIN001","MIS001","MIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020014-06","Meridian Smart Silver","94% AV Level Silver Plan",,"0.949694074818135","Yes","Yes","No","100%",,"$0","$230","$520","$60","$0","$520","$230","$60","$0","$110","$240","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=3iha6ABe7KLgjJtdVxtRk43c6T4FGMtgQIJK15h3df1ar28yopGpvIsXDzofUs7N4rFhihtU9iMBL0ZOB7xjKA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","41183","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","93-0242990","41183MI0030002","EHB High Passive","41183MI003",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","41183MI0030002-00","EHB High Passive","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2018","MI","41183","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","93-0242990","41183MI0030001","EHB Low Passive","41183MI003",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","41183MI0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com"
"2018","MI","46016","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","36-0883760","46016MI0040002","EHB High PPO","46016MI004",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","46016MI0040002-00","EHB High PPO","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2018","MI","46016","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","36-0883760","46016MI0040001","EHB Low PPO","46016MI004",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","46016MI0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2018","MI","46016","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","36-0883760","46016MI0030002","EHB High Passive","46016MI003",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","46016MI0030002-00","EHB High Passive","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2018","MI","46016","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","36-0883760","46016MI0030001","EHB Low Passive","46016MI003",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","46016MI0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com"
"2018","MI","47007","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","42-0127290","47007MI0040001","Principal Plan Dental 70","47007MI004",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"0.74","Estimated Rate","2018-01-01","2018-12-31","Yes","Same as any other","Yes","Same as any other","Yes",,"","47007MI0040001-00","Principal Plan Dental 70","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","47638","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","20-3805292","47638MI0010001","Retailers Insurance Company - EHB","47638MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","47638MI0010001-00","Retailers Insurance Company - EHB","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","47638","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","20-3805292","47638MI0010002","Retailers Insurance Company - EHB","47638MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","47638MI0010002-00","Retailers Insurance Company - EHB","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","53678","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","72-0977315","53678MI0040001","AlwaysCare Small Group – Child","53678MI004",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","53678MI0040001-00","AlwaysCare Small Group – Child","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",
"2018","MI","53678","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","72-0977315","53678MI0040002","AlwaysCare Small Group – Child","53678MI004",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"1","Estimated Rate","2017-01-01","2017-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","53678MI0040002-00","AlwaysCare Small Group – Child","Standard Low Off Exchange Plan","68.03%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",
"2018","MI","53678","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","72-0977315","53678MI0030001","AlwaysCare Small Group Dental – Adults","53678MI003",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","53678MI0030001-00","AlwaysCare Small Group Dental – Adults","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",
"2018","MI","53678","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","72-0977315","53678MI0030002","AlwaysCare Small Group Dental – Adults","53678MI003",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","53678MI0030002-00","AlwaysCare Small Group Dental – Adults","Standard Low Off Exchange Plan","68.03%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020001","Meridian Catastrophic","58594MI002",,"MIN001","MIS001","MIF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020001-00","Meridian Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,180","$0","$0","$60","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","100.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=MhWw5u3bgoYG4naeKCoWJtVj6tvn9mmT/4Eh7YnfUtKFPKna2UZGrreVcoNvGTM9+ha51BAPdTobNudTbUIDAg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020001","Meridian Catastrophic","58594MI002",,"MIN001","MIS001","MIF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020001-01","Meridian Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,180","$0","$0","$60","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","100.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=CR040QtZt57A1lLSgOI/73E0tjU0ygvVBjOQ7MGLzLd27rKbbU7hZ+NXETbR2axjeKOB9XOVeRFmb1+cMPHCwQ==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020007","Meridian Healthy Bronze","58594MI002",,"MIN001","MIS001","MIF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020007-00","Meridian Healthy Bronze","Standard Bronze Off Exchange Plan",,"0.605988734798367","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,390","$400","$0","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=Ez0Iz8M+gXW0oVFP8x5bHoJ9r4oQlu8zvLk/1nwGVlhHK1r3Xp/sKiKlxDMsbFEa2Nttofwkd7wMe7CAqzhY3g==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020007","Meridian Healthy Bronze","58594MI002",,"MIN001","MIS001","MIF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020007-01","Meridian Healthy Bronze","Standard Bronze On Exchange Plan",,"0.605988734798367","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,390","$400","$0","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=QmMMKMPHr31XwuBatogCWDAq87P4+CNm0C3ioUkRKpX2HFgmTCMeUI0BWiolyHXZNblf/QU0wb+grytS9IG1nQ==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020007","Meridian Healthy Bronze","58594MI002",,"MIN001","MIS001","MIF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020007-02","Meridian Healthy Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=Yg5hRS2enuLFbaiYlym9I+nq1R0AeftlosCshVgpUkJMoqx1Fgvy6Lz6y8Ppu4ti1X7qYOr+ezMHlkp28RN0fQ==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020007","Meridian Healthy Bronze","58594MI002",,"MIN001","MIS001","MIF002","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020007-03","Meridian Healthy Bronze","Limited Cost Sharing Plan Variation",,"0.605988734798367","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,390","$400","$0","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=xYCz6mcFgZy2LD6AEpyC7tLLfICz1zh+O1mu9CFLNFlAuMM0NFoSOy8l5RP5Yb+1elKVTzOj3yPrRzhqAawE1w==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020008-00","Meridian Healthy Silver","Standard Silver Off Exchange Plan",,"0.660058870207282","No","Yes","No","100%",,"$1,720","$0","$5,630","$60","$3,860","$1,170","$930","$60","$820","$150","$820","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=R0EMWAoahlRVZSULybrVJJn53GOHFtn57bWIAPrcpyenDsu4YiNjHZfaDF3ADlrLcOCDVQn+OuozhzwQQiwrTA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020008-01","Meridian Healthy Silver","Standard Silver On Exchange Plan",,"0.660058870207282","No","Yes","No","100%",,"$1,720","$0","$5,630","$60","$3,860","$1,170","$930","$60","$820","$150","$820","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=GNTVHnaNQsOcGhk0WU7ndfoGUSAjAT8lXijeQIMYDnwjc2g7XGO0MtvWnxT47VnWTfR64Qn9ts0wVIEHcQGmow==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020008-02","Meridian Healthy Silver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=eJ5Pg7NywF1LcqXHf/pQkO1yt/ozLvZEe55U3VtgAgs+QIYywOSYw7mUOFjzZqJUi4edGhgSRgjcI37tsf9CUg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020008-03","Meridian Healthy Silver","Limited Cost Sharing Plan Variation",,"0.660058870207282","No","Yes","No","100%",,"$1,720","$0","$5,630","$60","$3,860","$1,170","$930","$60","$820","$150","$820","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7FmtMgD5IF0VFfeEbBOp3nyIeeo34RjCe4GIsoE2uy8BfFWycwIAxc89UqQPiM4nUZjyLZpL/gY8JyeXUKMKGA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020008-04","Meridian Healthy Silver","73% AV Level Silver Plan",,"0.739753326262039","No","Yes","No","100%",,"$2,410","$0","$3,090","$60","$1,300","$980","$560","$60","$1,140","$120","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=bmxFGStvv3RB3NLsTPsp7sjvaolzbHQCT7ccgH5vwcufDuTyQcgaQppFaJjaiq3odse4LOZ3VeaHT7ReUCwRQA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020008-05","Meridian Healthy Silver","87% AV Level Silver Plan",,"0.879357161446414","No","Yes","No","100%",,"$700","$0","$1,400","$60","$700","$540","$280","$60","$700","$60","$240","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=OJ4GDBWhkV+Xuh5yAeVeRUBHA9xO3bN1eja92CwHfKF2XE5KuD+0JS88CRQdqXdwPj3XE7Wv5qmEQPJJdGftAQ==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020009","Meridian Healthy Gold","58594MI002",,"MIN001","MIS001","MIF004","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020009-01","Meridian Healthy Gold","Standard Gold On Exchange Plan",,"0.760098161899697","No","Yes","No","100%",,"$2,200","$0","$2,250","$60","$2,400","$910","$560","$60","$1,140","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,450","$4450 per person","$8900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,100","$1100 per person","$2200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=eMTLB5LL4PAWoFVR6UD0mrPTzShifrLCHzpYdLiG+wlKmGY2l1CYyFc/Ri1Xy99Z0rNytH6Snooaq0g/b+hBeg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020009","Meridian Healthy Gold","58594MI002",,"MIN001","MIS001","MIF004","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020009-02","Meridian Healthy Gold","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=aqK2rivF8PcV88y2ltIvyvGBeAFFhf3h6t3qkCofl26wiQSPSYd+ztjXFu1UYMKV4z6OvAwA78Wu39NungE9BQ==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020009","Meridian Healthy Gold","58594MI002",,"MIN001","MIS001","MIF004","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020009-03","Meridian Healthy Gold","Limited Cost Sharing Plan Variation",,"0.760098161899697","No","Yes","No","100%",,"$2,200","$0","$2,250","$60","$2,400","$910","$560","$60","$1,140","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,450","$4450 per person","$8900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,100","$1100 per person","$2200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=3046MDfk6YpAurLky7owX6YwdAGChcvE0WYLtHneCix0JgeuF/9eqTdtwsFh4kIwZiH/3us4wkyUOP8GWNBDFQ==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020014","Meridian Smart Silver","58594MI002",,"MIN001","MIS001","MIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020014-00","Meridian Smart Silver","Standard Silver Off Exchange Plan",,"0.680615260558943","Yes","Yes","No","100%",,"$0","$4,290","$1,720","$60","$0","$3,790","$930","$60","$0","$600","$820","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=KM8mHvgfiziUWSwstZP+ps/9hGN3DA6brnUYelUTjYDfOXFn+1S7G7pcs3PIxdUYITyjFtyT7fuOpsAcf9Se2g==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020014","Meridian Smart Silver","58594MI002",,"MIN001","MIS001","MIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020014-01","Meridian Smart Silver","Standard Silver On Exchange Plan",,"0.680615260558943","Yes","Yes","No","100%",,"$0","$4,290","$1,720","$60","$0","$3,790","$930","$60","$0","$600","$820","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=vFWN/48L5by9AnTduNa1H06YE5guz0p7maJUbAXW3snRYNn9sHiGChrsXqyPJNQex7OnSSTraLejBsVU+DnO4A==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020014","Meridian Smart Silver","58594MI002",,"MIN001","MIS001","MIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020014-02","Meridian Smart Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=m+8Zyjt8aL7vgK8LpIfRkiggZYRB9Xh4nWNRgvYLijGuXucfqRA3gtPSaMwxGa1/dRWAbqWbNKD+84b81O7POg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020014","Meridian Smart Silver","58594MI002",,"MIN001","MIS001","MIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020014-03","Meridian Smart Silver","Limited Cost Sharing Plan Variation",,"0.680615260558943","Yes","Yes","No","100%",,"$0","$4,290","$1,720","$60","$0","$3,790","$930","$60","$0","$600","$820","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=BukJrIL2WUQWM8nBM7qlCkCa7x52BCsZbI2ZvDolrrH8W2ejvfz3uFw9GKjbWWMW3Aq5eSz1mW3ymKBCK0cYeg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020014","Meridian Smart Silver","58594MI002",,"MIN001","MIS001","MIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020014-04","Meridian Smart Silver","73% AV Level Silver Plan",,"0.739757023690997","Yes","Yes","No","100%",,"$0","$2,960","$1,380","$60","$0","$2,890","$740","$60","$0","$450","$650","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=GfpO2LvMRv8xYYhttka3uvjz/qunh8nG17BjF3iN4UtewOlenBiIRlNqjN/sSYgW/DL2PZxjz5fEBSTYQz5CRw==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020034","Meridian HSA Savings Silver","58594MI002",,"MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020034-00","Meridian HSA Savings Silver","Standard Silver Off Exchange Plan",,"0.660443545160513","Yes","Yes","No","100%",,"$2,060","$0","$3,240","$60","$3,190","$580","$1,530","$60","$1,120","$150","$650","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=HxJtpzQP2om7i22jS7IWPemhHYduN2pf9QkT4AsvIv5pVnsRZVatbzarkiRvWywSOG4HePHsUhMyHuTzRv+QlA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020034","Meridian HSA Savings Silver","58594MI002",,"MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020034-01","Meridian HSA Savings Silver","Standard Silver On Exchange Plan",,"0.660443545160513","Yes","Yes","No","100%",,"$2,060","$0","$3,240","$60","$3,190","$580","$1,530","$60","$1,120","$150","$650","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=w2UwSeDn4vY89r5VANc4nTYGCX44bO63oA+9YKdma5rwCQvGgA69YtHEN05mfZiLveH1PqMeKJ6T7HWTn7r+Fg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020034","Meridian HSA Savings Silver","58594MI002",,"MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020034-02","Meridian HSA Savings Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=WEINpspznHh8JGP91qvaHgPm8AtQOU2Nl5RtQ6qZ4QQq51/0fak/fs9GYB+S0rGZiVquX/q4cJRGK68Vftk8Uw==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020034","Meridian HSA Savings Silver","58594MI002",,"MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020034-03","Meridian HSA Savings Silver","Limited Cost Sharing Plan Variation",,"0.660443545160513","Yes","Yes","No","100%",,"$2,060","$0","$3,240","$60","$3,190","$580","$1,530","$60","$1,120","$150","$650","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=BLigCOLjNZXJqAWOu1RzVL6ehye0nN2gKedIKuV/5cwkcWxEJKXC+llfYp836NZUirEfTMedIn+LwSs/qFuh+A==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020034","Meridian HSA Savings Silver","58594MI002",,"MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020034-04","Meridian HSA Savings Silver","73% AV Level Silver Plan",,"0.739356565290403","Yes","Yes","No","100%",,"$2,300","$0","$1,550","$60","$2,300","$570","$820","$60","$1,530","$150","$240","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=4UyEcsuurHAgC+4IOsi9g0UHZNbVwKM2C2tyJdjYpW6NvJY4wKuDPCL/APk3uncQY1QaIkYouBX6qjKgNOqZPA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020034","Meridian HSA Savings Silver","58594MI002",,"MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020034-05","Meridian HSA Savings Silver","87% AV Level Silver Plan",,"0.879799804319303","Yes","Yes","No","100%",,"$500","$40","$1,240","$60","$500","$300","$540","$60","$500","$90","$160","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=FZvfWT+IR4bORnV5liXWjthN+ejSwqoyasKlR+GOyf0VelWUx19u3iqATtD2/6tncjUZ+rQ/SvnX6jA/urpHrA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","58594","SERFF","2017-08-17 20:15:51","Individual","No","38-3253977","58594MI0020034","Meridian HSA Savings Silver","58594MI002",,"MIN001","MIS001","MIF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","All","0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergent","No",,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=7knpTkra5ffhVDICeaKpAhLMkbu4R7OnwCjI9CWoJmt3h2B+yTXtkllXs9uvyc4vPLTN1sQdA8oeBVD/SC5P8A==","58594MI0020034-06","Meridian HSA Savings Silver","94% AV Level Silver Plan",,"0.949343788313594","Yes","Yes","No","100%",,"$150","$0","$550","$60","$150","$70","$480","$60","$150","$50","$160","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=sv0clkMFwD6Kqdq4zOMMzxUtJLYE1VrbZuAq1oslgc0E9aSAE8lhJuG2g7us/9MGsfXwH7gD5PEu0Pq7mVdy2Q==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=ZmpYdNM83aq1aXvx0aMbpEF0bKtOcGRUcdVWRj2bsCzAf4W3cadBuBMIobips02tOzltLgo5OtPFFpW+TZrvKg=="
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190006","Sparrow PHP Platinum 250 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190006-00","Sparrow PHP Platinum 250 Exclusive","Standard Platinum Off Exchange Plan",,"0.905421321314341","No","Yes","No","100%",,"$250","$0","$1,250","$60","$98","$1,377","$25","$49","$250","$90","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190006_Ind2018S_Platinum250Exc_OffBase_PFN00100RX08F458.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190006_Ind2018C_Platinum250Exc_OffBase_PFN00100RX08F458.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190006","Sparrow PHP Platinum 250 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190006-01","Sparrow PHP Platinum 250 Exclusive","Standard Platinum On Exchange Plan",,"0.905421321314341","No","Yes","No","100%",,"$250","$0","$1,250","$60","$98","$1,377","$25","$49","$250","$90","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190006_Ind2018S_Platinum250Exc_OnBase_PNN00100RX08E458.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190006_Ind2018C_Platinum250Exc_OnBase_PNN00100RX08E458.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190006","Sparrow PHP Platinum 250 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190006-02","Sparrow PHP Platinum 250 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190006_Ind2018S_Platinum250Exc_OnNAZero_PNN00300RX08E366.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190006_Ind2018C_Platinum250Exc_OnNAZero_PNN00300RX08E366.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190006","Sparrow PHP Platinum 250 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190006-03","Sparrow PHP Platinum 250 Exclusive","Limited Cost Sharing Plan Variation",,"0.905421321314341","No","Yes","No","100%",,"$250","$0","$1,250","$60","$98","$1,377","$25","$49","$250","$90","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190006_Ind2018S_Platinum250Exc_OnNASpec_PNN00200RX08E427.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190006_Ind2018C_Platinum250Exc_OnNASpec_PNN00200RX08E427.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0200001","Sparrow PHP Platinum 250 HMO","60829MI020","7639172866","MIN001","MIS001","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200001-00","Sparrow PHP Platinum 250 HMO","Standard Platinum Off Exchange Plan",,"0.905421321314341","No","Yes","No","100%",,"$250","$0","$1,250","$60","$98","$1,377","$25","$49","$250","$90","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0200001_Ind2018S_Platinum250HMO_OffBase_PFA00100RX08F458.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0200001_Ind2018C_Platinum250HMO_OffBase_PFA00100RX08F458.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0200001","Sparrow PHP Platinum 250 HMO","60829MI020","7639172866","MIN001","MIS001","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200001-01","Sparrow PHP Platinum 250 HMO","Standard Platinum On Exchange Plan",,"0.905421321314341","No","Yes","No","100%",,"$250","$0","$1,250","$60","$98","$1,377","$25","$49","$250","$90","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0200001_Ind2018S_Platinum250HMO_OnBase_PNA00100RX08E458.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0200001_Ind2018C_Platinum250HMO_OnBase_PNA00100RX08E458.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0200001","Sparrow PHP Platinum 250 HMO","60829MI020","7639172866","MIN001","MIS001","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200001-02","Sparrow PHP Platinum 250 HMO","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0200001_Ind2018S_Platinum250HMO_OnNAZero_PNA00300RX08E366.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0200001_Ind2018C_Platinum250HMO_OnNAZero_PNA00300RX08E366.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0200001","Sparrow PHP Platinum 250 HMO","60829MI020","7639172866","MIN001","MIS001","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200001-03","Sparrow PHP Platinum 250 HMO","Limited Cost Sharing Plan Variation",,"0.905421321314341","No","Yes","No","100%",,"$250","$0","$1,250","$60","$98","$1,377","$25","$49","$250","$90","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0200001_Ind2018S_Platinum250HMO_OnNASpec_PNA00200RX08E427.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0200001_Ind2018C_Platinum250HMO_OnNASpec_PNA00200RX08E427.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190007","Sparrow PHP Platinum 500-100Percent Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190007-00","Sparrow PHP Platinum 500-100Percent Exclusive","Standard Platinum Off Exchange Plan",,"0.899785646854261","No","Yes","No","100%",,"$500","$80","$0","$60","$134","$1,790","$0","$49","$500","$105","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190007_Ind2018S_Platinum500-100PctExc_OffBase_PFN00700RX08F459.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190007_Ind2018C_Platinum500-100PctExc_OffBase_PFN00700RX08F459.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190007","Sparrow PHP Platinum 500-100Percent Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190007-01","Sparrow PHP Platinum 500-100Percent Exclusive","Standard Platinum On Exchange Plan",,"0.899785646854261","No","Yes","No","100%",,"$500","$80","$0","$60","$134","$1,790","$0","$49","$500","$105","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190007_Ind2018S_Platinum500-100PctExc_OnBase_PNN00700RX08E459.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190007_Ind2018C_Platinum500-100PctExc_OnBase_PNN00700RX08E459.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190007","Sparrow PHP Platinum 500-100Percent Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190007-02","Sparrow PHP Platinum 500-100Percent Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190007_Ind2018S_Platinum500-100PctExc_OnNAZero_PNN00800RX08E369.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190007_Ind2018C_Platinum500-100PctExc_OnNAZero_PNN00800RX08E369.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190007","Sparrow PHP Platinum 500-100Percent Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190007-03","Sparrow PHP Platinum 500-100Percent Exclusive","Limited Cost Sharing Plan Variation",,"0.899785646854261","No","Yes","No","100%",,"$500","$80","$0","$60","$134","$1,790","$0","$49","$500","$105","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190007_Ind2018S_Platinum500-100PctExc_OnNASpec_PNN00900RX08E461.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190007_Ind2018C_Platinum500-100PctExc_OnNASpec_PNN00900RX08E461.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190008","Sparrow PHP Gold 500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190008-00","Sparrow PHP Gold 500 Exclusive","Standard Gold Off Exchange Plan",,"0.81989163039507","No","Yes","No","100%",,"$500","$140","$2,480","$60","$107","$2,670","$27","$49","$500","$180","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190008_Ind2018S_Gold500Exc_OffBase_GFN00100RX08F425.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190008_Ind2018C_Gold500Exc_OffBase_GFN00100RX08F425.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190008","Sparrow PHP Gold 500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190008-01","Sparrow PHP Gold 500 Exclusive","Standard Gold On Exchange Plan",,"0.81989163039507","No","Yes","No","100%",,"$500","$140","$2,480","$60","$107","$2,670","$27","$49","$500","$180","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190008_Ind2018S_Gold500Exc_OnBase_GNN00100RX08E425.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190008_Ind2018C_Gold500Exc_OnBase_GNN00100RX08E425.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190008","Sparrow PHP Gold 500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190008-02","Sparrow PHP Gold 500 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190008_Ind2018S_Gold500Exc_OnNAZero_GNN00300RX08E372.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190008_Ind2018C_Gold500Exc_OnNAZero_GNN00300RX08E372.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190008","Sparrow PHP Gold 500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190008-03","Sparrow PHP Gold 500 Exclusive","Limited Cost Sharing Plan Variation",,"0.81989163039507","No","Yes","No","100%",,"$500","$140","$2,480","$60","$107","$2,670","$27","$49","$500","$180","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190008_Ind2018S_Gold500Exc_OnNASpec_GNN00200RX08E463.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190008_Ind2018C_Gold500Exc_OnNASpec_GNN00200RX08E463.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0200007","Sparrow PHP Gold 500 Basic HMO","60829MI020","7639172866","MIN001","MIS001","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200007-00","Sparrow PHP Gold 500 Basic HMO","Standard Gold Off Exchange Plan",,"0.79406180359728","No","Yes","No","100%",,"$500","$130","$3,720","$60","$94","$2,610","$40","$49","$500","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0200007_Ind2018S_Gold500BasicHMO_OffBase_GFA01000RX08F431.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0200007_Ind2018C_Gold500BasicHMO_OffBase_GFA01000RX08F431.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0200007","Sparrow PHP Gold 500 Basic HMO","60829MI020","7639172866","MIN001","MIS001","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200007-01","Sparrow PHP Gold 500 Basic HMO","Standard Gold On Exchange Plan",,"0.79406180359728","No","Yes","No","100%",,"$500","$130","$3,720","$60","$94","$2,610","$40","$49","$500","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0200007_Ind2018S_Gold500BasicHMO_OnBase_GNA01000RX08E431.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0200007_Ind2018C_Gold500BasicHMO_OnBase_GNA01000RX08E431.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0200007","Sparrow PHP Gold 500 Basic HMO","60829MI020","7639172866","MIN001","MIS001","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200007-02","Sparrow PHP Gold 500 Basic HMO","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0200007_Ind2018S_Gold500BasicHMO_OnNAZero_GNA01100RX08E375.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0200007_Ind2018C_Gold500BasicHMO_OnNAZero_GNA01100RX08E375.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0200007","Sparrow PHP Gold 500 Basic HMO","60829MI020","7639172866","MIN001","MIS001","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200007-03","Sparrow PHP Gold 500 Basic HMO","Limited Cost Sharing Plan Variation",,"0.79406180359728","No","Yes","No","100%",,"$500","$130","$3,720","$60","$94","$2,610","$40","$49","$500","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0200007_Ind2018S_Gold500BasicHMO_OnNASpec_GNA01200RX08E432.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0200007_Ind2018C_Gold500BasicHMO_OnNASpec_GNA01200RX08E432.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190009","Sparrow PHP Gold 500 Basic Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190009-00","Sparrow PHP Gold 500 Basic Exclusive","Standard Gold Off Exchange Plan",,"0.79406180359728","No","Yes","No","100%",,"$500","$130","$3,720","$60","$94","$2,610","$40","$49","$500","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190009_Ind2018S_Gold500BasicExc_OffBase_GFN01000RX08F431.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190009_Ind2018C_Gold500BasicExc_OffBase_GFN01000RX08F431.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190009","Sparrow PHP Gold 500 Basic Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190009-01","Sparrow PHP Gold 500 Basic Exclusive","Standard Gold On Exchange Plan",,"0.79406180359728","No","Yes","No","100%",,"$500","$130","$3,720","$60","$94","$2,610","$40","$49","$500","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190009_Ind2018S_Gold500BasicExc_OnBase_GNN01000RX08E431.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190009_Ind2018C_Gold500BasicExc_OnBase_GNN01000RX08E431.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190009","Sparrow PHP Gold 500 Basic Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190009-02","Sparrow PHP Gold 500 Basic Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190009_Ind2018S_Gold500BasicExc_OnNAZero_GNN01100RX08E375.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190009_Ind2018C_Gold500BasicExc_OnNAZero_GNN01100RX08E375.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190009","Sparrow PHP Gold 500 Basic Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190009-03","Sparrow PHP Gold 500 Basic Exclusive","Limited Cost Sharing Plan Variation",,"0.79406180359728","No","Yes","No","100%",,"$500","$130","$3,720","$60","$94","$2,610","$40","$49","$500","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190009_Ind2018S_Gold500BasicExc_OnNASpec_GNN01200RX08E432.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190009_Ind2018C_Gold500BasicExc_OnNASpec_GNN01200RX08E432.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190001","Sparrow PHP Gold 1000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190001-00","Sparrow PHP Gold 1000 Exclusive","Standard Gold Off Exchange Plan",,"0.816352902288737","No","Yes","No","100%",,"$1,000","$130","$2,480","$60","$107","$2,610","$27","$49","$1,000","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190001_Ind2018S_Gold1000Exc_OffBase_GFN01900RX08F377.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190001_Ind2018C_Gold1000Exc_OffBase_GFN01900RX08F377.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190001","Sparrow PHP Gold 1000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190001-01","Sparrow PHP Gold 1000 Exclusive","Standard Gold On Exchange Plan",,"0.816352902288737","No","Yes","No","100%",,"$1,000","$130","$2,480","$60","$107","$2,610","$27","$49","$1,000","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190001_Ind2018S_Gold1000Exc_OnBase_GNN01900RX08E377.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190001_Ind2018C_Gold1000Exc_OnBase_GNN01900RX08E377.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190001","Sparrow PHP Gold 1000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190001-02","Sparrow PHP Gold 1000 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190001_Ind2018S_Gold1000Exc_OnNAZero_GNN02000RX08E378.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190001_Ind2018C_Gold1000Exc_OnNAZero_GNN02000RX08E378.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220001-04","Sparrow PHP Silver HDHP Exclusive","73% AV Level Silver Plan",,"0.739175367979777","Yes","Yes","No","100%",,"$1,950","$0","$2,050","$60","$1,950","$1,834","$216","$49","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0220001_Ind2018S_SilverHDHPExc_OnCSR73_SNR01200RX09E547.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220001_Ind2018C_SilverHDHPExc_OnCSR73_SNR01200RX09E547.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220001-05","Sparrow PHP Silver HDHP Exclusive","87% AV Level Silver Plan",,"0.872527357436787","Yes","Yes","No","100%",,"$500","$100","$1,020","$60","$500","$2,550","$120","$49","$500","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0220001_Ind2018S_SilverHDHPExc_OnCSR87_SNR01100RX09E548.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220001_Ind2018C_SilverHDHPExc_OnCSR87_SNR01100RX09E548.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220001-06","Sparrow PHP Silver HDHP Exclusive","94% AV Level Silver Plan",,"0.939212093852126","Yes","Yes","No","100%",,"$250","$40","$0","$60","$250","$1,155","$0","$49","$250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0220001_Ind2018S_SilverHDHPExc_OnCSR94_SNR01000RX09E534.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220001_Ind2018C_SilverHDHPExc_OnCSR94_SNR01000RX09E534.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220004","Sparrow PHP Bronze 5500 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220004-00","Sparrow PHP Bronze 5500 H.S.A. Exclusive","Standard Bronze Off Exchange Plan",,"0.609600935335944","Yes","Yes","No","100%",,"$2,064","$0","$4,436","$60","$3,108","$2,960","$432","$49","$1,155","$0","$770","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0220004_Ind2018S_Bronze5500HSAExc_OffBase_BFR00100RX09F537.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220004_Ind2018C_Bronze5500HSAExc_OffBase_BFR00100RX09F537.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220004","Sparrow PHP Bronze 5500 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220004-01","Sparrow PHP Bronze 5500 H.S.A. Exclusive","Standard Bronze On Exchange Plan",,"0.609600935335944","Yes","Yes","No","100%",,"$2,064","$0","$4,436","$60","$3,108","$2,960","$432","$49","$1,155","$0","$770","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI220004_Ind2018S_Bronze5500HSAExc_OnBase_BNR00100RX09E537.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220004_Ind2018C_Bronze5500HSAExc_OnBase_BNR00100RX09E537.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220004","Sparrow PHP Bronze 5500 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220004-02","Sparrow PHP Bronze 5500 H.S.A. Exclusive","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI220004_Ind2018S_Bronze5500HSAExc_OnNAZero_BNR00500RX08E422.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220004_Ind2018C_Bronze5500HSAExc_OnNAZero_BNR00500RX08E422.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190001","Sparrow PHP Gold 1000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190001-03","Sparrow PHP Gold 1000 Exclusive","Limited Cost Sharing Plan Variation",,"0.816352902288737","No","Yes","No","100%",,"$1,000","$130","$2,480","$60","$107","$2,610","$27","$49","$1,000","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190001_Ind2018S_Gold1000Exc_OnNASpec_GNN02100RX08E379.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190001_Ind2018C_Gold1000Exc_OnNASpec_GNN02100RX08E379.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190016","Sparrow PHP Gold 2000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190016-00","Sparrow PHP Gold 2000 Exclusive","Standard Gold Off Exchange Plan",,"0.762014676864753","No","Yes","No","100%",,"$2,000","$140","$3,720","$60","$94","$2,670","$40","$49","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190016_Ind2018S_Gold2000Exc_OffBase_GFN02200RX08F464.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190016_Ind2018C_Gold2000Exc_OffBase_GFN02200RX08F464.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190016","Sparrow PHP Gold 2000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190016-01","Sparrow PHP Gold 2000 Exclusive","Standard Gold On Exchange Plan",,"0.762014676864753","No","Yes","No","100%",,"$2,000","$140","$3,720","$60","$94","$2,670","$40","$49","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190016_Ind2018S_Gold2000Exc_OnBase_GNN02200RX08E464.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190016_Ind2018C_Gold2000Exc_OnBase_GNN02200RX08E464.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190016","Sparrow PHP Gold 2000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190016-02","Sparrow PHP Gold 2000 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190016_Ind2018S_Gold2000Exc_OnNAZero_GNN02400RX08E434.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190016_Ind2018C_Gold2000Exc_OnNAZero_GNN02400RX08E434.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190016","Sparrow PHP Gold 2000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190016-03","Sparrow PHP Gold 2000 Exclusive","Limited Cost Sharing Plan Variation",,"0.762014676864753","No","Yes","No","100%",,"$2,000","$140","$3,720","$60","$94","$2,670","$40","$49","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190016_Ind2018S_Gold2000Exc_OnNASpec_GNN02300RX08E433.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190016_Ind2018C_Gold2000Exc_OnNASpec_GNN02300RX08E433.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190010","Sparrow PHP Gold 1400 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF008","Existing","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190010-00","Sparrow PHP Gold 1400 Exclusive","Standard Gold Off Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$80","$2,480","$60","$107","$1,820","$27","$49","$1,305","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190010_Ind2018S_Gold1400Exc_OffBase_GFN01600RX09F545.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190010_Ind2018C_Gold1400Exc_OffBase_GFN01600RX09F545.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190010","Sparrow PHP Gold 1400 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF008","Existing","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190010-01","Sparrow PHP Gold 1400 Exclusive","Standard Gold On Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$80","$2,480","$60","$107","$1,820","$27","$49","$1,305","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190010_Ind2018S_Gold1400Exc_OnBase_GNN01600RX09E545.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190010_Ind2018C_Gold1400Exc_OnBase_GNN01600RX09E545.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190010","Sparrow PHP Gold 1400 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF008","Existing","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190010-02","Sparrow PHP Gold 1400 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190010_Ind2018S_Gold1400Exc_OnNAZero_GNN01700RX08E381.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190010_Ind2018C_Gold1400Exc_OnNAZero_GNN01700RX08E381.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190010","Sparrow PHP Gold 1400 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF008","Existing","HMO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190010-03","Sparrow PHP Gold 1400 Exclusive","Limited Cost Sharing Plan Variation",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$80","$2,480","$60","$107","$1,820","$27","$49","$1,305","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190010_Ind2018S_Gold1400Exc_OnNASpec_GNN01800RX09E546.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190010_Ind2018C_Gold1400Exc_OnNASpec_GNN01800RX09E546.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190015","Sparrow PHP Bronze 6650 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF010","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190015-00","Sparrow PHP Bronze 6650 Exclusive","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$2,929","$2,110","$1,587","$49","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190015_Ind2018S_Bronze6650Exc_OffBase_BFN00100RX09F549.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190015_Ind2018C_Bronze6650Exc_OffBase_BFN00100RX09F549.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190015","Sparrow PHP Bronze 6650 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF010","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190015-01","Sparrow PHP Bronze 6650 Exclusive","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$2,929","$2,110","$1,587","$49","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190015_Ind2018S_Bronze6650Exc_OnBase_BNN00100RX09E549.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190015_Ind2018C_Bronze6650Exc_OnBase_BNN00100RX09E549.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190015","Sparrow PHP Bronze 6650 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF010","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190015-02","Sparrow PHP Bronze 6650 Exclusive","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190015_Ind2018S_Bronze6650Exc_OnNAZero_BNN00200RX08E420.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190015_Ind2018C_Bronze6650Exc_OnNAZero_BNN00200RX08E420.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190015","Sparrow PHP Bronze 6650 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF010","Existing","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190015-03","Sparrow PHP Bronze 6650 Exclusive","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$2,929","$2,110","$1,587","$49","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190015_Ind2018S_Bronze6650Exc_OnNASpec_BNN00300RX09E550.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190015_Ind2018C_Bronze6650Exc_OnNASpec_BNN00300RX09E550.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190013","Sparrow PHP Silver 3500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF009","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190013-00","Sparrow PHP Silver 3500 Exclusive","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$107","$2,440","$27","$49","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190013_Ind2018S_Silver3500Exc_OffBase_SFN05000RX08F451.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190013_Ind2018C_Silver3500Exc_OffBase_SFN05000RX08F451.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190013","Sparrow PHP Silver 3500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF009","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190013-01","Sparrow PHP Silver 3500 Exclusive","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$107","$2,440","$27","$49","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190013_Ind2018S_Silver3500Exc_OnBase_SNN05000RX08E451.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190013_Ind2018C_Silver3500Exc_OnBase_SNN05000RX08E451.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190013","Sparrow PHP Silver 3500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF009","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190013-02","Sparrow PHP Silver 3500 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190013_Ind2018S_Silver3500Exc_OnNAZero_SNN05100RX08E402.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190013_Ind2018C_Silver3500Exc_OnNAZero_SNN05100RX08E402.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190013","Sparrow PHP Silver 3500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF009","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190013-03","Sparrow PHP Silver 3500 Exclusive","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$107","$2,440","$27","$49","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190013_Ind2018S_Silver3500Exc_OnNASpec_SNN05200RX08E452.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190013_Ind2018C_Silver3500Exc_OnNASpec_SNN05200RX08E452.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190013","Sparrow PHP Silver 3500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF009","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190013-04","Sparrow PHP Silver 3500 Exclusive","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$120","$2,480","$60","$107","$2,440","$27","$49","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190013_Ind2018S_Silver3500Exc_OnCSR73_SNN05500RX08E453.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190013_Ind2018C_Silver3500Exc_OnCSR73_SNN05500RX08E453.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190013","Sparrow PHP Silver 3500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF009","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190013-05","Sparrow PHP Silver 3500 Exclusive","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$107","$1,045","$27","$49","$700","$75","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190013_Ind2018S_Silver3500Exc_OnCSR87_SNN05400RX08E454.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190013_Ind2018C_Silver3500Exc_OnCSR87_SNN05400RX08E454.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190013","Sparrow PHP Silver 3500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF009","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190013-06","Sparrow PHP Silver 3500 Exclusive","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$22","$620","$60","$127","$339","$7","$49","$250","$30","$82","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190013_Ind2018S_Silver3500Exc_OnCSR94_SNN05300RX08E404.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190013_Ind2018C_Silver3500Exc_OnCSR94_SNN05300RX08E404.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220006","Sparrow PHP Gold 1400 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF003","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220006-00","Sparrow PHP Gold 1400 H.S.A. Exclusive","Standard Gold Off Exchange Plan",,"0.809750299789602","Yes","Yes","No","100%",,"$1,400","$80","$0","$60","$1,400","$2,310","$0","$49","$1,400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6650 per person","$6650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0220006_Ind2018S_Gold1400HSAExc_OffBase_GFP00400RX09F343.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220006_Ind2018C_Gold1400HSAExc_OffBase_GFP00400RX09F343.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220006","Sparrow PHP Gold 1400 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF003","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220006-01","Sparrow PHP Gold 1400 H.S.A. Exclusive","Standard Gold On Exchange Plan",,"0.809750299789602","Yes","Yes","No","100%",,"$1,400","$80","$0","$60","$1,400","$2,310","$0","$49","$1,400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6650 per person","$6650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0220006_Ind2018S_Gold1400HSAExc_OnBase_GNP00400RX09E343.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220006_Ind2018C_Gold1400HSAExc_OnBase_GNP00400RX09E343.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220006","Sparrow PHP Gold 1400 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF003","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220006-02","Sparrow PHP Gold 1400 H.S.A. Exclusive","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0220006_Ind2018S_Gold1400HSAExc_OnNAZero_GNP00600RX08E436.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220006_Ind2018C_Gold1400HSAExc_OnNAZero_GNP00600RX08E436.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220006","Sparrow PHP Gold 1400 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF003","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220006-03","Sparrow PHP Gold 1400 H.S.A. Exclusive","Limited Cost Sharing Plan Variation",,"0.809750299789602","Yes","Yes","No","100%",,"$1,400","$80","$0","$60","$1,400","$2,310","$0","$49","$1,400","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6650 per person","$6650 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0220006_Ind2018S_Gold1400HSAExc_OnNASpec_GNP00500RX09E344.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220006_Ind2018C_Gold1400HSAExc_OnNASpec_GNP00500RX09E344.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0210006","Sparrow PHP Bronze 6550 H.S.A. HMO","60829MI021","7639172866","MIN001","MIS001","MIF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210006-03","Sparrow PHP Bronze 6550 H.S.A. HMO","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$49","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI210006_Ind2018S_Bronze6550HSAHMO_OnNASpec_BNY01000RX09E540.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0210006_Ind2018C_Bronze6550HSAHMO_OnNASpec_BNY01000RX09E540.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver 2000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190002-00","Sparrow PHP Silver 2000 Exclusive","Standard Silver Off Exchange Plan",,"0.719581435207385","No","Yes","No","100%",,"$2,000","$200","$3,720","$60","$237","$3,645","$40","$49","$1,241","$195","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190002_Ind2018S_Silver2000Exc_OffBase_SFN02600RX08F429.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190002_Ind2018C_Silver2000Exc_OffBase_SFN02600RX08F429.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220001-00","Sparrow PHP Silver HDHP Exclusive","Standard Silver Off Exchange Plan",,"0.717711257628649","Yes","Yes","No","100%",,"$2,700","$100","$1,340","$60","$2,700","$2,550","$240","$49","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0220001_Ind2018S_SilverHDHPExc_OffBase_SFR00700RX09F532.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220001_Ind2018C_SilverHDHPExc_OffBase_SFR00700RX09F532.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220001-01","Sparrow PHP Silver HDHP Exclusive","Standard Silver On Exchange Plan",,"0.717711257628649","Yes","Yes","No","100%",,"$2,700","$100","$1,340","$60","$2,700","$2,550","$240","$49","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0220001_Ind2018S_SilverHDHPExc_OnBase_SNR00700RX09E532.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220001_Ind2018C_SilverHDHPExc_OnBase_SNR00700RX09E532.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220001-02","Sparrow PHP Silver HDHP Exclusive","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0220001_Ind2018S_SilverHDHPExc_OnNAZero_SNR00800RX08E418.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220001_Ind2018C_SilverHDHPExc_OnNAZero_SNR00800RX08E418.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220001-03","Sparrow PHP Silver HDHP Exclusive","Limited Cost Sharing Plan Variation",,"0.717711257628649","Yes","Yes","No","100%",,"$2,700","$100","$1,340","$60","$2,700","$2,550","$240","$49","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0220001_Ind2018S_SilverHDHPExc_OnNASpec_SNR00900RX09E533.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220001_Ind2018C_SilverHDHPExc_OnNASpec_SNR00900RX09E533.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220004","Sparrow PHP Bronze 5500 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220004-03","Sparrow PHP Bronze 5500 H.S.A. Exclusive","Limited Cost Sharing Plan Variation",,"0.609600935335944","Yes","Yes","No","100%",,"$2,064","$0","$4,436","$60","$3,108","$2,960","$432","$49","$1,155","$0","$770","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI220004_Ind2018S_Bronze5500HSAExc_OnNASpec_BNR00200RX09E538.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220004_Ind2018C_Bronze5500HSAExc_OnNASpec_BNR00200RX09E538.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220005","Sparrow PHP Bronze 6000 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF011","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220005-00","Sparrow PHP Bronze 6000 H.S.A. Exclusive","Standard Bronze Off Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$49","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0220005_Ind2018S_Bronze6000HSAExc_OffBase_BFR01100RX09F552.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220005_Ind2018C_Bronze6000HSAExc_OffBase_BFR01100RX09F552.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220005","Sparrow PHP Bronze 6000 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF011","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220005-01","Sparrow PHP Bronze 6000 H.S.A. Exclusive","Standard Bronze On Exchange Plan",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$49","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI220005_Ind2018S_Bronze6000HSAExc_OnBase_BNR01100RX09E552.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220005_Ind2018C_Bronze6000HSAExc_OnBase_BNR01100RX09E552.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220005","Sparrow PHP Bronze 6000 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF011","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220005-02","Sparrow PHP Bronze 6000 H.S.A. Exclusive","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI220005_Ind2018S_Bronze6000HSAExc_OnNAZero_BNR01300RX08E435.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220005_Ind2018C_Bronze6000HSAExc_OnNAZero_BNR01300RX08E435.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220005","Sparrow PHP Bronze 6000 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF011","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220005-03","Sparrow PHP Bronze 6000 H.S.A. Exclusive","Limited Cost Sharing Plan Variation",,"0.619720552738105","Yes","Yes","No","100%",,"$6,000","$0","$0","$60","$6,000","$0","$0","$49","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI220005_Ind2018S_Bronze6000HSAExc_OnNASpec_BNR01200RX09E553.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220005_Ind2018C_Bronze6000HSAExc_OnNASpec_BNR01200RX09E553.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220002","Sparrow PHP Bronze 6550 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220002-00","Sparrow PHP Bronze 6550 H.S.A. Exclusive","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$49","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0220002_Ind2018S_Bronze6550HSAExc_OffBase_BFR00800RX09F539.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220002_Ind2018C_Bronze6550HSAExc_OffBase_BFR00800RX09F539.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220002","Sparrow PHP Bronze 6550 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220002-01","Sparrow PHP Bronze 6550 H.S.A. Exclusive","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$49","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI220002_Ind2018S_Bronze6550HSAExc_OnBase_BNR00800RX09E539.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220002_Ind2018C_Bronze6550HSAExc_OnBase_BNR00800RX09E539.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220002","Sparrow PHP Bronze 6550 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220002-02","Sparrow PHP Bronze 6550 H.S.A. Exclusive","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI220002_Ind2018S_Bronze6550HSAExc_OnNAZero_BNR00900RX08E423.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220002_Ind2018C_Bronze6550HSAExc_OnNAZero_BNR00900RX08E423.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0220002","Sparrow PHP Bronze 6550 H.S.A. Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0220002-03","Sparrow PHP Bronze 6550 H.S.A. Exclusive","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$49","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI220002_Ind2018S_Bronze6550HSAExc_OnNASpec_BNR01000RX09E540.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0220002_Ind2018C_Bronze6550HSAExc_OnNASpec_BNR01000RX09E540.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0210006","Sparrow PHP Bronze 6550 H.S.A. HMO","60829MI021","7639172866","MIN001","MIS001","MIF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210006-00","Sparrow PHP Bronze 6550 H.S.A. HMO","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$49","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0210006_Ind2018S_Bronze6550HSAHMO_OffBase_BFY00800RX09F539.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0210006_Ind2018C_Bronze6550HSAHMO_OffBase_BFY00800RX09F539.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0210006","Sparrow PHP Bronze 6550 H.S.A. HMO","60829MI021","7639172866","MIN001","MIS001","MIF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210006-01","Sparrow PHP Bronze 6550 H.S.A. HMO","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$49","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI210006_Ind2018S_Bronze6550HSAHMO_OnBase_BNY00800RX09E539.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0210006_Ind2018C_Bronze6550HSAHMO_OnBase_BNY00800RX09E539.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0210006","Sparrow PHP Bronze 6550 H.S.A. HMO","60829MI021","7639172866","MIN001","MIS001","MIF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0210006-02","Sparrow PHP Bronze 6550 H.S.A. HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI210006_Ind2018S_Bronze6550HSAHMO_OnNAZero_BNY00900RX08E423.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0210006_Ind2018C_Bronze6550HSAHMO_OnNAZero_BNY00900RX08E423.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver 2000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190002-01","Sparrow PHP Silver 2000 Exclusive","Standard Silver On Exchange Plan",,"0.719581435207385","No","Yes","No","100%",,"$2,000","$200","$3,720","$60","$237","$3,645","$40","$49","$1,241","$195","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190002_Ind2018S_Silver2000Exc_OnBase_SNN02600RX08E429.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190002_Ind2018C_Silver2000Exc_OnBase_SNN02600RX08E429.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver 2000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190002-02","Sparrow PHP Silver 2000 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190002_Ind2018S_Silver2000Exc_OnNAZero_SNN02700RX08E384.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190002_Ind2018C_Silver2000Exc_OnNAZero_SNN02700RX08E384.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver 2000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190002-03","Sparrow PHP Silver 2000 Exclusive","Limited Cost Sharing Plan Variation",,"0.719581435207385","No","Yes","No","100%",,"$2,000","$200","$3,720","$60","$237","$3,645","$40","$49","$1,241","$195","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190002_Ind2018S_Silver2000Exc_OnNASpec_SNN02800RX08E449.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190002_Ind2018C_Silver2000Exc_OnNASpec_SNN02800RX08E449.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver 2000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190002-04","Sparrow PHP Silver 2000 Exclusive","73% AV Level Silver Plan",,"0.739907717111101","No","Yes","No","100%",,"$2,000","$130","$3,720","$60","$247","$3,635","$40","$49","$1,256","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,575","$5575 per person","$11150 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190002_Ind2018S_Silver2000Exc_OnCSR73_SNN03100RX08E438.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190002_Ind2018C_Silver2000Exc_OnCSR73_SNN03100RX08E438.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver 2000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190002-05","Sparrow PHP Silver 2000 Exclusive","87% AV Level Silver Plan",,"0.873508149807333","No","Yes","No","100%",,"$1,000","$0","$1,000","$60","$107","$1,866","$27","$49","$1,000","$90","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190002_Ind2018S_Silver2000Exc_OnCSR87_SNN03000RX08E387.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190002_Ind2018C_Silver2000Exc_OnCSR87_SNN03000RX08E387.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver 2000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190002-06","Sparrow PHP Silver 2000 Exclusive","94% AV Level Silver Plan",,"0.937946490125623","No","Yes","No","100%",,"$500","$30","$0","$60","$134","$570","$0","$49","$500","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190002_Ind2018S_Silver2000Exc_OnCSR94_SNN02900RX08E386.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190002_Ind2018C_Silver2000Exc_OnCSR94_SNN02900RX08E386.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190011","Sparrow PHP Silver 2500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190011-00","Sparrow PHP Silver 2500 Exclusive","Standard Silver Off Exchange Plan",,"0.715624730486608","No","Yes","No","100%",,"$2,500","$200","$3,720","$60","$94","$3,935","$40","$49","$1,142","$225","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190011_Ind2018S_Silver2500Exc_OffBase_SFN00100RX08F428.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190011_Ind2018C_Silver2500Exc_OffBase_SFN00100RX08F428.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190011","Sparrow PHP Silver 2500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190011-01","Sparrow PHP Silver 2500 Exclusive","Standard Silver On Exchange Plan",,"0.715624730486608","No","Yes","No","100%",,"$2,500","$200","$3,720","$60","$94","$3,935","$40","$49","$1,142","$225","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190011_Ind2018S_Silver2500Exc_OnBase_SNN00100RX08E428.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190011_Ind2018C_Silver2500Exc_OnBase_SNN00100RX08E428.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190011","Sparrow PHP Silver 2500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190011-02","Sparrow PHP Silver 2500 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190011_Ind2018S_Silver2500Exc_OnNAZero_SNN00300RX08E390.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190011_Ind2018C_Silver2500Exc_OnNAZero_SNN00300RX08E390.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190011","Sparrow PHP Silver 2500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190011-03","Sparrow PHP Silver 2500 Exclusive","Limited Cost Sharing Plan Variation",,"0.715624730486608","No","Yes","No","100%",,"$2,500","$200","$3,720","$60","$94","$3,935","$40","$49","$1,142","$225","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190011_Ind2018S_Silver2500Exc_OnNASpec_SNN00200RX08E442.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190011_Ind2018C_Silver2500Exc_OnNASpec_SNN00200RX08E442.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190011","Sparrow PHP Silver 2500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190011-04","Sparrow PHP Silver 2500 Exclusive","73% AV Level Silver Plan",,"0.73920338546314","No","Yes","No","100%",,"$2,408","$0","$3,442","$60","$94","$1,635","$40","$49","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190011_Ind2018S_Silver2500Exc_OnCSR73_SNN00400RX08E441.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190011_Ind2018C_Silver2500Exc_OnCSR73_SNN00400RX08E441.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190011","Sparrow PHP Silver 2500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190011-05","Sparrow PHP Silver 2500 Exclusive","87% AV Level Silver Plan",,"0.876921236030172","No","Yes","No","100%",,"$500","$0","$1,500","$60","$107","$1,866","$27","$49","$500","$120","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190011_Ind2018S_Silver2500Exc_OnCSR87_SNN00500RX08E393.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190011_Ind2018C_Silver2500Exc_OnCSR87_SNN00500RX08E393.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190011","Sparrow PHP Silver 2500 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190011-06","Sparrow PHP Silver 2500 Exclusive","94% AV Level Silver Plan",,"0.944571614662076","No","Yes","No","100%",,"$250","$40","$0","$60","$134","$630","$0","$49","$250","$60","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190011_Ind2018S_Silver2500Exc_OnCSR94_SNN00600RX08E392.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190011_Ind2018C_Silver2500Exc_OnCSR94_SNN00600RX08E392.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver 3000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200004-00","Sparrow PHP Silver 3000 HMO","Standard Silver Off Exchange Plan",,"0.708708622013202","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$80","$3,635","$53","$49","$979","$180","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$3,000","$3000 per person","$6000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0200004_Ind2018S_Silver3000HMO_OffBase_SFA01300RX08F429.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0200004_Ind2018C_Silver3000HMO_OffBase_SFA01300RX08F429.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver 3000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200004-01","Sparrow PHP Silver 3000 HMO","Standard Silver On Exchange Plan",,"0.708708622013202","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$80","$3,635","$53","$49","$979","$180","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$3,000","$3000 per person","$6000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0200004_Ind2018S_Silver3000HMO_OnBase_SNA01300RX08E429.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0200004_Ind2018C_Silver3000Exc_OnBase_SNA01300RX08E429.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver 3000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200004-02","Sparrow PHP Silver 3000 HMO","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0200004_Ind2018S_Silver3000Exc_OnNAZero_SNA01500RX08E396.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0200004_Ind2018C_Silver3000Exc_OnNAZero_SNA01500RX08E396.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver 3000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200004-03","Sparrow PHP Silver 3000 HMO","Limited Cost Sharing Plan Variation",,"0.708708622013202","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$80","$3,635","$53","$49","$979","$180","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$3,000","$3000 per person","$6000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0200004_Ind2018S_Silver3000HMO_OnNASpec_SNA01400RX08E444.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0200004_Ind2018C_Silver3000Exc_OnNASpec_SNA01400RX08E444.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver 3000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200004-04","Sparrow PHP Silver 3000 HMO","73% AV Level Silver Plan",,"0.739282722067588","No","Yes","No","100%",,"$2,408","$0","$3,442","$60","$94","$3,355","$40","$49","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0200004_Ind2018S_Silver3000HMO_OnCSR73_SNA01600RX08E443.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0200004_Ind2018C_Silver3000HMO_OnCSR73_SNA01600RX08E443.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver 3000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200004-05","Sparrow PHP Silver 3000 HMO","87% AV Level Silver Plan",,"0.874890869058496","No","Yes","No","100%",,"$1,000","$0","$1,000","$60","$107","$1,690","$27","$49","$1,000","$120","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0200004_Ind2018S_Silver3000HMO_OnCSR87_SNA01700RX08E399.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0200004_Ind2018C_Silver3000HMO_OnCSR87_SNA01700RX08E399.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver 3000 HMO","60829MI020","7639172866","MIN001","MIS001","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200004-06","Sparrow PHP Silver 3000 HMO","94% AV Level Silver Plan",,"0.941042761098475","No","Yes","No","100%",,"$250","$60","$0","$60","$134","$1,140","$0","$49","$250","$60","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0200004_Ind2018S_Silver3000HMO_OnCSR94_SNA01800RX08E398.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0200004_Ind2018C_Silver3000HMO_OnCSR94_SNA01800RX08E398.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver 4000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190005-00","Sparrow PHP Silver 4000 Exclusive","Standard Silver Off Exchange Plan",,"0.705727842740153","No","Yes","No","100%",,"$3,630","$0","$3,720","$60","$94","$3,595","$40","$49","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190005_Ind2018S_Silver4000Exc_OffBase_SFN04400RX08F429.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190005_Ind2018C_Silver4000Exc_OffBase_SFN04400RX08F429.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver 4000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190005-01","Sparrow PHP Silver 4000 Exclusive","Standard Silver On Exchange Plan",,"0.705727842740153","No","Yes","No","100%",,"$3,630","$0","$3,720","$60","$94","$3,595","$40","$49","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190005_Ind2018S_Silver4000Exc_OnBase_SNN04400RX08E429.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190005_Ind2018C_Silver4000Exc_OnBase_SNN04400RX08E429.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver 4000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190005-02","Sparrow PHP Silver 4000 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190005_Ind2018S_Silver4000Exc_OnNAZero_SNN04500RX08E407.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190005_Ind2018C_Silver4000Exc_OnNAZero_SNN04500RX08E407.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver 4000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190005-03","Sparrow PHP Silver 4000 Exclusive","Limited Cost Sharing Plan Variation",,"0.705727842740153","No","Yes","No","100%",,"$3,630","$0","$3,720","$60","$94","$3,595","$40","$49","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190005_Ind2018S_Silver4000Exc_OnNASpec_SNN04600RX08E446.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190005_Ind2018C_Silver4000Exc_OnNASpec_SNN04600RX08E446.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190012","Sparrow PHP Silver 3000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190012-00","Sparrow PHP Silver 3000 Exclusive","Standard Silver Off Exchange Plan",,"0.708708622013202","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$80","$3,635","$53","$49","$979","$180","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$3,000","$3000 per person","$6000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190012_Ind2018S_Silver3000Exc_OffBase_SFN01300RX08F429.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190012_Ind2018C_Silver3000Exc_OffBase_SFN01300RX08F429.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190012","Sparrow PHP Silver 3000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190012-01","Sparrow PHP Silver 3000 Exclusive","Standard Silver On Exchange Plan",,"0.708708622013202","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$80","$3,635","$53","$49","$979","$180","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$3,000","$3000 per person","$6000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190012_Ind2018S_Silver3000Exc_OnBase_SNN01300RX08E429.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190012_Ind2018C_Silver3000Exc_OnBase_SNN01300RX08E429.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190012","Sparrow PHP Silver 3000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190012-02","Sparrow PHP Silver 3000 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190012_Ind2018S_Silver3000Exc_OnNAZero_SNN01500RX08E396.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190012_Ind2018C_Silver3000Exc_OnNAZero_SNN01500RX08E396.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190012","Sparrow PHP Silver 3000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190012-03","Sparrow PHP Silver 3000 Exclusive","Limited Cost Sharing Plan Variation",,"0.708708622013202","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$80","$3,635","$53","$49","$979","$180","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$3,000","$3000 per person","$6000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190012_Ind2018S_Silver3000Exc_OnNASpec_SNN01400RX08E444.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190012_Ind2018C_Silver3000Exc_OnNASpec_SNN01400RX08E444.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190012","Sparrow PHP Silver 3000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190012-04","Sparrow PHP Silver 3000 Exclusive","73% AV Level Silver Plan",,"0.739282722067588","No","Yes","No","100%",,"$2,408","$0","$3,442","$60","$94","$3,355","$40","$49","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190012_Ind2018S_Silver3000Exc_OnCSR73_SNN01600RX08E443.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190012_Ind2018C_Silver3000Exc_OnCSR73_SNN01600RX08E443.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190012","Sparrow PHP Silver 3000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190012-05","Sparrow PHP Silver 3000 Exclusive","87% AV Level Silver Plan",,"0.874890869058496","No","Yes","No","100%",,"$1,000","$0","$1,000","$60","$107","$1,690","$27","$49","$1,000","$120","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190012_Ind2018S_Silver3000Exc_OnCSR87_SNN01700RX08E399.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190012_Ind2018C_Silver3000Exc_OnCSR87_SNN01700RX08E399.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190012","Sparrow PHP Silver 3000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190012-06","Sparrow PHP Silver 3000 Exclusive","94% AV Level Silver Plan",,"0.941042761098475","No","Yes","No","100%",,"$250","$60","$0","$60","$134","$1,140","$0","$49","$250","$60","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190012_Ind2018S_Silver3000Exc_OnCSR94_SNN01800RX08E398.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190012_Ind2018C_Silver3000Exc_OnCSR94_SNN01800RX08E398.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver 4000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190005-04","Sparrow PHP Silver 4000 Exclusive","73% AV Level Silver Plan",,"0.729060246398843","No","Yes","No","100%",,"$2,408","$0","$2,442","$60","$94","$3,315","$40","$49","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190005_Ind2018S_Silver4000Exc_OnCSR73_SNN04900RX08E445.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190005_Ind2018C_Silver4000Exc_OnCSR73_SNN04900RX08E445.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver 4000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190005-05","Sparrow PHP Silver 4000 Exclusive","87% AV Level Silver Plan",,"0.87192656934596","No","Yes","No","100%",,"$1,000","$0","$1,350","$60","$107","$1,200","$27","$49","$1,000","$90","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190005_Ind2018S_Silver4000Exc_OnCSR87_SNN04800RX08E410.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190005_Ind2018C_Silver4000Exc_OnCSR87_SNN04800RX08E410.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver 4000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190005-06","Sparrow PHP Silver 4000 Exclusive","94% AV Level Silver Plan",,"0.947928096689576","No","Yes","No","100%",,"$250","$40","$0","$60","$134","$630","$0","$49","$250","$60","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190005_Ind2018S_Silver4000Exc_OnCSR94_SNN04700RX08E409.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190005_Ind2018C_Silver4000Exc_OnCSR94_SNN04700RX08E409.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190014","Sparrow PHP Silver 5000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190014-00","Sparrow PHP Silver 5000 Exclusive","Standard Silver Off Exchange Plan",,"0.713514797206039","No","Yes","No","100%",,"$3,630","$0","$3,720","$60","$94","$3,635","$40","$49","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190014_Ind2018S_Silver5000Exc_OffBase_SFN03800RX08F412.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190014_Ind2018C_Silver5000Exc_OffBase_SFN03800RX08F412.pdf"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030001","Total HMO Standard","67183MI003",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9987",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030001-03","Total HMO Standard","Limited Cost Sharing Plan Variation",,"0.818993536972329","No","Yes","No","100%",,"$1,000","$220","$0","$60","$134","$1,785","$0","$55","$253","$465","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030001-03.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-00","Totally You","Standard Silver Off Exchange Plan",,"0.715549126991836","No","Yes","No","100%",,"$4,250","$140","$2,001","$60","$107","$1,665","$27","$55","$226","$345","$57","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030002-00.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-01","Totally You","Standard Silver On Exchange Plan",,"0.715549126991836","No","Yes","No","100%",,"$4,250","$140","$2,001","$60","$107","$1,665","$27","$55","$226","$345","$57","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030002-01.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-02","Totally You","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030002-02.pdf","http://brochure.thcmi.com/"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190014","Sparrow PHP Silver 5000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190014-01","Sparrow PHP Silver 5000 Exclusive","Standard Silver On Exchange Plan",,"0.713514797206039","No","Yes","No","100%",,"$3,630","$0","$3,720","$60","$94","$3,635","$40","$49","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190014_Ind2018S_Silver5000Exc_OnBase_SNN03800RX08E412.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190014_Ind2018C_Silver5000Exc_OnBase_SNN03800RX08E412.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190014","Sparrow PHP Silver 5000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190014-02","Sparrow PHP Silver 5000 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190014_Ind2018S_Silver5000Exc_OnNAZero_SNN03900RX08E413.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190014_Ind2018C_Silver5000Exc_OnNAZero_SNN03900RX08E413.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190014","Sparrow PHP Silver 5000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190014-03","Sparrow PHP Silver 5000 Exclusive","Limited Cost Sharing Plan Variation",,"0.713514797206039","No","Yes","No","100%",,"$3,630","$0","$3,720","$60","$94","$3,635","$40","$49","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190014_Ind2018S_Silver5000Exc_OnNASpec_SNN04000RX08E414.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190014_Ind2018C_Silver5000Exc_OnNASpec_SNN04000RX08E414.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190014","Sparrow PHP Silver 5000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190014-04","Sparrow PHP Silver 5000 Exclusive","73% AV Level Silver Plan",,"0.739950689003464","No","Yes","No","100%",,"$2,408","$0","$3,442","$60","$94","$2,910","$40","$49","$1,142","$180","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190014_Ind2018S_Silver5000Exc_OnCSR73_SNN04300RX08E448.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190014_Ind2018C_Silver5000Exc_OnCSR73_SNN04300RX08E448.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190014","Sparrow PHP Silver 5000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190014-05","Sparrow PHP Silver 5000 Exclusive","87% AV Level Silver Plan",,"0.869054359386674","No","Yes","No","100%",,"$750","$0","$1,250","$60","$98","$1,844","$25","$49","$750","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190014_Ind2018S_Silver5000Exc_OnCSR87_SNN04200RX08E455.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190014_Ind2018C_Silver5000Exc_OnCSR87_SNN04200RX08E455.pdf"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030004","Totally You - Simple Choice","67183MI003",,"MIN001","MIS001","MIF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030004-01","Totally You - Simple Choice","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,001","$60","$107","$1,485","$27","$55","$226","$420","$57","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030004-01.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030004","Totally You - Simple Choice","67183MI003",,"MIN001","MIS001","MIF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030004-02","Totally You - Simple Choice","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030004-02.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030004","Totally You - Simple Choice","67183MI003",,"MIN001","MIS001","MIF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030004-03","Totally You - Simple Choice","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,001","$60","$107","$1,485","$27","$55","$226","$420","$57","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030004-03.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030004","Totally You - Simple Choice","67183MI003",,"MIN001","MIS001","MIF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030004-04","Totally You - Simple Choice","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$120","$2,001","$60","$107","$1,485","$27","$55","$226","$420","$57","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030004-04.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030004","Totally You - Simple Choice","67183MI003",,"MIN001","MIS001","MIF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030004-05","Totally You - Simple Choice","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$107","$610","$27","$55","$226","$300","$57","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030004-05.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030004","Totally You - Simple Choice","67183MI003",,"MIN001","MIS001","MIF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030004-06","Totally You - Simple Choice","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$22","$500","$60","$127","$218","$7","$55","$250","$255","$14","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030004-06.pdf","http://brochure.thcmi.com/"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190014","Sparrow PHP Silver 5000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190014-06","Sparrow PHP Silver 5000 Exclusive","94% AV Level Silver Plan",,"0.940471667241848","No","Yes","No","100%",,"$250","$60","$0","$60","$87","$663","$0","$49","$250","$90","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190014_Ind2018S_Silver5000Exc_OnCSR94_SNN04100RX08E439.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190014_Ind2018C_Silver5000Exc_OnCSR94_SNN04100RX08E439.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190017","Sparrow PHP Silver 7000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190017-00","Sparrow PHP Silver 7000 Exclusive","Standard Silver Off Exchange Plan",,"0.676677404862582","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$80","$3,555","$53","$49","$979","$180","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$7,000","$7000 per person","$14000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190017_Ind2018S_Silver7000Exc_OffBase_SFN05600RX08F429.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190017_Ind2018C_Silver7000Exc_OffBase_SFN05600RX08F429.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190017","Sparrow PHP Silver 7000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190017-01","Sparrow PHP Silver 7000 Exclusive","Standard Silver On Exchange Plan",,"0.676677404862582","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$80","$3,555","$53","$49","$979","$180","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$7,000","$7000 per person","$14000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190017_Ind2018S_Silver7000Exc_OnBase_SNN05600RX08E429.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190017_Ind2018C_Silver7000Exc_OnBase_SNN05600RX08E429.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190017","Sparrow PHP Silver 7000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190017-02","Sparrow PHP Silver 7000 Exclusive","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190017_Ind2018S_Silver7000Exc_OnNAZero_SNN05800RX08E437.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190017_Ind2018C_Silver7000Exc_OnNAZero_SNN05800RX08E437.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190017","Sparrow PHP Silver 7000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190017-03","Sparrow PHP Silver 7000 Exclusive","Limited Cost Sharing Plan Variation",,"0.676677404862582","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$80","$3,555","$53","$49","$979","$180","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$7,000","$7000 per person","$14000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190017_Ind2018S_Silver7000Exc_OnNASpec_SNN05700RX08E450.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190017_Ind2018C_Silver7000Exc_OnNASpec_SNN05700RX08E450.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190017","Sparrow PHP Silver 7000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190017-04","Sparrow PHP Silver 7000 Exclusive","73% AV Level Silver Plan",,"0.738053838959916","No","Yes","No","100%",,"$2,064","$0","$3,786","$60","$80","$3,555","$53","$49","$979","$180","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$4,500","$4500 per person","$9000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190017_Ind2018S_Silver7000Exc_OnCSR73_SNN06100RX08E457.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190017_Ind2018C_Silver7000Exc_OnCSR73_SNN06100RX08E457.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190017","Sparrow PHP Silver 7000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190017-05","Sparrow PHP Silver 7000 Exclusive","87% AV Level Silver Plan",,"0.871484059518526","No","Yes","No","100%",,"$1,000","$60","$1,240","$60","$120","$1,700","$13","$49","$1,000","$90","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190017_Ind2018S_Silver7000Exc_OnCSR87_SNN06000RX08E456.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190017_Ind2018C_Silver7000Exc_OnCSR87_SNN06000RX08E456.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0190017","Sparrow PHP Silver 7000 Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0190017-06","Sparrow PHP Silver 7000 Exclusive","94% AV Level Silver Plan",,"0.932895363649975","No","Yes","No","100%",,"$250","$60","$0","$60","$90","$910","$0","$49","$250","$90","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0190017_Ind2018S_Silver7000Exc_OnCSR94_SNN05900RX08E440.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0190017_Ind2018C_Silver7000Exc_OnCSR94_SNN05900RX08E440.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0200005","Sparrow PHP Healthy HMO","60829MI020","7639172866","MIN001","MIS001","MIF011","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200005-00","Sparrow PHP Healthy HMO","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,377","$0","$0","$157","$1,925","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0200005_Ind2018S_HealthyHMO_OffBase_XFY00100RX09F551.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0200005_Ind2018C_HealthyHMO_OffBase_XFY00100RX09F551.pdf"
"2018","MI","60829","SERFF","2017-08-16 20:15:58","Individual","No","38-2356288","60829MI0200005","Sparrow PHP Healthy HMO","60829MI020","7639172866","MIN001","MIS001","MIF011","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Physicians%20Health%20Plan%20Custom%20Commercial%20Member%20Prescription%20Drug%20List.pdf","60829MI0200005-01","Sparrow PHP Healthy HMO","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,377","$0","$0","$49","$1,925","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2018Plans/60829MI0200005_Ind2018S_HealthyHMO_OnBase_XNY00100RX09E551.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/2018Plans/60829MI0200005_Ind2018C_HealthyHMO_OnBase_XNY00100RX09E551.pdf"
"2018","MI","62294","SERFF","2017-08-14 20:15:51","Individual","Yes","39-1263473","62294MI0420001","Humana Dental Smart Choice","62294MI042",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9713","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","62294MI0420001-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110354"
"2018","MI","66587","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","13-5123390","66587MI0010004","Guardian Pediatric Advantage","66587MI001",,"MIN001","MIS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","66587MI0010004-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","66587","SERFF","2017-08-14 20:15:51","Individual","Yes","13-5123390","66587MI0070003","Guardian Essentials for Families and Individuals","66587MI007",,"MIN002","MIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","66587MI0070003-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","68.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/michigan/","https://dentalexchange.guardianlife.com/our-plans/michigan/"
"2018","MI","66587","SERFF","2017-08-14 20:15:51","Individual","Yes","13-5123390","66587MI0070003","Guardian Essentials for Families and Individuals","66587MI007",,"MIN002","MIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","66587MI0070003-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","68.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/michigan/","https://dentalexchange.guardianlife.com/our-plans/michigan/"
"2018","MI","66587","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","13-5123390","66587MI0020004","Guardian Pediatric Essentials","66587MI002",,"MIN001","MIS002",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","66587MI0020004-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","66587","SERFF","2017-08-14 20:15:51","Individual","Yes","13-5123390","66587MI0080002","Guardian Select for Families and Individuals","66587MI008",,"MIN002","MIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","66587MI0080002-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","68.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/michigan/","https://dentalexchange.guardianlife.com/our-plans/michigan/"
"2018","MI","66587","SERFF","2017-08-14 20:15:51","Individual","Yes","13-5123390","66587MI0080002","Guardian Select for Families and Individuals","66587MI008",,"MIN002","MIS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","66587MI0080002-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","68.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/michigan/","https://dentalexchange.guardianlife.com/our-plans/michigan/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030001","Total HMO Standard","67183MI003",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9987",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030001-00","Total HMO Standard","Standard Gold Off Exchange Plan",,"0.818993536972329","No","Yes","No","100%",,"$1,000","$220","$0","$60","$134","$1,785","$0","$55","$253","$465","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030001-00.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030001","Total HMO Standard","67183MI003",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9987",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030001-01","Total HMO Standard","Standard Gold On Exchange Plan",,"0.818993536972329","No","Yes","No","100%",,"$1,000","$220","$0","$60","$134","$1,785","$0","$55","$253","$465","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030001-01.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030001","Total HMO Standard","67183MI003",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9987",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030001-02","Total HMO Standard","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030001-02.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-03","Totally You","Limited Cost Sharing Plan Variation",,"0.715549126991836","No","Yes","No","100%",,"$4,250","$140","$2,001","$60","$107","$1,665","$27","$55","$226","$345","$57","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030002-03.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-04","Totally You","73% AV Level Silver Plan",,"0.738365890120824","No","Yes","No","100%",,"$3,750","$99","$2,001","$60","$107","$1,665","$27","$55","$226","$345","$57","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030002-04.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-05","Totally You","87% AV Level Silver Plan",,"0.876805622590408","No","Yes","No","100%",,"$750","$80","$1,001","$60","$120","$845","$13","$55","$255","$285","$28","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030002-05.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-06","Totally You","94% AV Level Silver Plan",,"0.93933965754152","No","Yes","No","100%",,"$0","$0","$500","$60","$0","$300","$7","$55","$0","$285","$14","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030002-06.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030003","Totally You - Complete","67183MI003",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030003-00","Totally You - Complete","Standard Silver Off Exchange Plan",,"0.683550267136209","Yes","Yes","No","100%",,"$3,750","$140","$2,001","$60","$3,191","$935","$798","$55","$461","$225","$115","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030003-00.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030003","Totally You - Complete","67183MI003",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030003-01","Totally You - Complete","Standard Silver On Exchange Plan",,"0.683550267136209","Yes","Yes","No","100%",,"$3,750","$140","$2,001","$60","$3,191","$935","$798","$55","$461","$225","$115","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030003-01.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030003","Totally You - Complete","67183MI003",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030003-02","Totally You - Complete","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030003-02.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030003","Totally You - Complete","67183MI003",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030003-03","Totally You - Complete","Limited Cost Sharing Plan Variation",,"0.683550267136209","Yes","Yes","No","100%",,"$3,750","$140","$2,001","$60","$3,191","$935","$798","$55","$461","$225","$115","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030003-03.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030003","Totally You - Complete","67183MI003",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030003-04","Totally You - Complete","73% AV Level Silver Plan",,"0.733686572607209","Yes","Yes","No","100%",,"$2,500","$110","$2,001","$60","$2,500","$740","$798","$55","$461","$225","$115","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030003-04.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030003","Totally You - Complete","67183MI003",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030003-05","Totally You - Complete","87% AV Level Silver Plan",,"0.870511162266071","Yes","Yes","No","100%",,"$750","$60","$1,001","$60","$750","$390","$399","$55","$519","$225","$58","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030003-05.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030003","Totally You - Complete","67183MI003",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030003-06","Totally You - Complete","94% AV Level Silver Plan",,"0.948870682260874","Yes","Yes","No","100%",,"$150","$0","$500","$60","$150","$0","$199","$55","$150","$225","$29","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030003-06.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030004","Totally You - Simple Choice","67183MI003",,"MIN001","MIS001","MIF004","Existing","HMO","Silver","Design 1","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030004-00","Totally You - Simple Choice","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,001","$60","$107","$1,485","$27","$55","$226","$420","$57","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030004-00.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030005","Total Saver Plus","67183MI003",,"MIN001","MIS001","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9988",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030005-00","Total Saver Plus","Standard Bronze Off Exchange Plan",,"0.610756034035118","Yes","Yes","No","100%",,"$4,148","$0","$3,002","$60","$3,365","$765","$1,115","$55","$342","$375","$85","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030005-00.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030005","Total Saver Plus","67183MI003",,"MIN001","MIS001","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9988",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030005-01","Total Saver Plus","Standard Bronze On Exchange Plan",,"0.610756034035118","Yes","Yes","No","100%",,"$4,148","$0","$3,002","$60","$3,365","$765","$1,115","$55","$342","$375","$85","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030005-01.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030005","Total Saver Plus","67183MI003",,"MIN001","MIS001","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9988",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030005-02","Total Saver Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030005-02.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030005","Total Saver Plus","67183MI003",,"MIN001","MIS001","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9988",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030005-03","Total Saver Plus","Limited Cost Sharing Plan Variation",,"0.610756034035118","Yes","Yes","No","100%",,"$4,148","$0","$3,002","$60","$3,365","$765","$1,115","$55","$342","$375","$85","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030005-03.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030006","Total Saver Complete","67183MI003",,"MIN001","MIS001","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9988",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030006-00","Total Saver Complete","Standard Bronze Off Exchange Plan",,"0.590027899945481","Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$5,456","$0","$0","$55","$576","$225","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030006-00.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030006","Total Saver Complete","67183MI003",,"MIN001","MIS001","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9988",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030006-01","Total Saver Complete","Standard Bronze On Exchange Plan",,"0.590027899945481","Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$5,456","$0","$0","$55","$576","$225","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030006-01.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030006","Total Saver Complete","67183MI003",,"MIN001","MIS001","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9988",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030006-02","Total Saver Complete","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030006-02.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030006","Total Saver Complete","67183MI003",,"MIN001","MIS001","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9988",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030006-03","Total Saver Complete","Limited Cost Sharing Plan Variation",,"0.590027899945481","Yes","Yes","No","100%",,"$7,150","$0","$0","$60","$5,456","$0","$0","$55","$576","$225","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030006-03.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030007","Totally You - Value","67183MI003",,"MIN001","MIS001","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030007-00","Totally You - Value","Standard Silver Off Exchange Plan",,"0.661702438671909","Yes","Yes","No","100%",,"$4,348","$0","$3,002","$60","$3,346","$990","$122","$55","$404","$225","$173","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030007-00.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030007","Totally You - Value","67183MI003",,"MIN001","MIS001","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030007-01","Totally You - Value","Standard Silver On Exchange Plan",,"0.661702438671909","Yes","Yes","No","100%",,"$4,348","$0","$3,002","$60","$3,346","$990","$122","$55","$404","$225","$173","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030007-01.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030007","Totally You - Value","67183MI003",,"MIN001","MIS001","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030007-02","Totally You - Value","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030007-02.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030007","Totally You - Value","67183MI003",,"MIN001","MIS001","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030007-03","Totally You - Value","Limited Cost Sharing Plan Variation",,"0.661702438671909","Yes","Yes","No","100%",,"$4,348","$0","$3,002","$60","$3,346","$990","$122","$55","$404","$225","$173","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030007-03.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030007","Totally You - Value","67183MI003",,"MIN001","MIS001","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030007-04","Totally You - Value","73% AV Level Silver Plan",,"0.732986698712698","Yes","Yes","No","100%",,"$2,999","$0","$2,001","$60","$3,000","$990","$81","$55","$461","$225","$115","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030007-04.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030007","Totally You - Value","67183MI003",,"MIN001","MIS001","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030007-05","Totally You - Value","87% AV Level Silver Plan",,"0.870946274382976","Yes","Yes","No","100%",,"$850","$40","$1,001","$60","$850","$495","$41","$55","$519","$225","$58","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030007-05.pdf","http://brochure.thcmi.com/"
"2018","MI","67183","SERFF","2017-10-31 20:15:29","Individual","No","38-3240485","67183MI0030007","Totally You - Value","67183MI003",,"MIN001","MIS001","MIF007","New","HMO","Silver","Not Applicable","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030007-06","Totally You - Value","94% AV Level Silver Plan",,"0.936662788608692","Yes","Yes","No","100%",,"$250","$10","$500","$60","$250","$40","$199","$55","$250","$225","$29","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030007-06.pdf","http://brochure.thcmi.com/"
"2018","MI","74917","SERFF","2017-08-17 20:15:51","SHOP (Small Group)","No","27-2204037","74917MI0010001","McLaren Rewards Platinum","74917MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010001-00","McLaren Rewards Platinum","Standard Platinum Off Exchange Plan",,"0.91488276822409","No","Yes","Yes","64%","36%","$500","$70","$1,240","$60","$500","$845","$486","$55","$500","$900","$107","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$500","$500 per person","$1000 per group","10.00%","$0","$0 per person","$0 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/SBC_Platinum_Rewards_SG.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","SHOP (Small Group)","No","27-2204037","74917MI0010001","McLaren Rewards Platinum","74917MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010001-01","McLaren Rewards Platinum","Standard Platinum On Exchange Plan",,"0.91488276822409","No","Yes","Yes","64%","36%","$500","$70","$1,240","$60","$500","$845","$486","$55","$500","$900","$107","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$500","$500 per person","$1000 per group","10.00%","$0","$0 per person","$0 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/SBC_Platinum_Rewards_SG.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","Individual","No","27-2204037","74917MI0020011","McLaren Bronze","74917MI002",,"MIN001","MIS001","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0020011-00","McLaren Bronze","Standard Bronze Off Exchange Plan",,"0.619929194838711","No","Yes","No","100%",,"$1,720","$0","$5,630","$60","$1,463","$1,840","$1,463","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$5,500","$5500 per person","$11000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/bronze_ind_off.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","Individual","No","27-2204037","74917MI0020011","McLaren Bronze","74917MI002",,"MIN001","MIS001","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0020011-01","McLaren Bronze","Standard Bronze On Exchange Plan",,"0.619929194838711","No","Yes","No","100%",,"$1,720","$0","$5,630","$60","$1,463","$1,840","$1,463","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$5,500","$5500 per person","$11000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/bronze_ind_on.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","SHOP (Small Group)","No","27-2204037","74917MI0010002","McLaren Rewards Gold","74917MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010002-00","McLaren Rewards Gold","Standard Gold Off Exchange Plan",,"0.819816607123859","No","Yes","Yes","64%","36%","$1,800","$160","$3,100","$60","$1,396","$1,840","$465","$55","$806","$1,380","$269","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$1,800","$1800 per person","$3600 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/SBC_Gold_Rewards_SG.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","SHOP (Small Group)","No","27-2204037","74917MI0010002","McLaren Rewards Gold","74917MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010002-01","McLaren Rewards Gold","Standard Gold On Exchange Plan",,"0.819816607123859","No","Yes","Yes","64%","36%","$1,800","$160","$3,100","$60","$1,396","$1,840","$465","$55","$806","$1,380","$269","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$1,800","$1800 per person","$3600 per group","25.00%","$0","$0 per person","$0 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/SBC_Gold_Rewards_SG.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","Individual","No","27-2204037","74917MI0020011","McLaren Bronze","74917MI002",,"MIN001","MIS001","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0020011-02","McLaren Bronze","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/bronze_zcs_ind_on.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","Individual","No","27-2204037","74917MI0020011","McLaren Bronze","74917MI002",,"MIN001","MIS001","MIF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0020011-03","McLaren Bronze","Limited Cost Sharing Plan Variation",,"0.619929194838711","No","Yes","No","100%",,"$1,720","$0","$5,630","$60","$1,463","$1,840","$1,463","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$5,500","$5500 per person","$11000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/bronze_lcs_ind_on.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","SHOP (Small Group)","No","27-2204037","74917MI0010003","McLaren Rewards Silver","74917MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010003-00","McLaren Rewards Silver","Standard Silver Off Exchange Plan",,"0.719485369201538","No","Yes","Yes","64%","36%","$3,630","$0","$3,720","$60","$2,048","$2,230","$878","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$6,000","$6000 per person","$12000 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/SBC_Silver_Rewards_SG.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","SHOP (Small Group)","No","27-2204037","74917MI0010003","McLaren Rewards Silver","74917MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010003-01","McLaren Rewards Silver","Standard Silver On Exchange Plan",,"0.719485369201538","No","Yes","Yes","64%","36%","$3,630","$0","$3,720","$60","$2,048","$2,230","$878","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$6,000","$6000 per person","$12000 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/SBC_Silver_Rewards_SG.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","Individual","No","27-2204037","74917MI0020006","McLaren Gold Standard","74917MI002",,"MIN001","MIS001","MIF006","Existing","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0020006-00","McLaren Gold Standard","Standard Gold Off Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$80","$2,480","$60","$1,400","$1,090","$372","$55","$1,305","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/gold_std_ind_off.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","SHOP (Small Group)","No","27-2204037","74917MI0010004","McLaren Platinum","74917MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010004-00","McLaren Platinum","Standard Platinum Off Exchange Plan",,"0.891712867763943","No","Yes","No","100%",,"$750","$0","$750","$60","$750","$627","$123","$55","$675","$750","$75","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/Platinum_SBC_SG_nonreward.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","SHOP (Small Group)","No","27-2204037","74917MI0010004","McLaren Platinum","74917MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010004-01","McLaren Platinum","Standard Platinum On Exchange Plan",,"0.891712867763943","No","Yes","No","100%",,"$750","$0","$750","$60","$750","$627","$123","$55","$675","$750","$75","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/Platinum_SBC_SG_nonreward.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","Individual","No","27-2204037","74917MI0020006","McLaren Gold Standard","74917MI002",,"MIN001","MIS001","MIF006","Existing","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0020006-01","McLaren Gold Standard","Standard Gold On Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$80","$2,480","$60","$1,400","$1,090","$372","$55","$1,305","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/gold_std_ind_on.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","Individual","No","27-2204037","74917MI0020006","McLaren Gold Standard","74917MI002",,"MIN001","MIS001","MIF006","Existing","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0020006-02","McLaren Gold Standard","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/gold_std_zcs_ind_on.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","SHOP (Small Group)","No","27-2204037","74917MI0010005","McLaren Gold","74917MI001",,"MIN001","MIS001","MIF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010005-00","McLaren Gold","Standard Gold Off Exchange Plan",,"0.806842193304364","No","Yes","No","100%",,"$1,250","$140","$2,480","$60","$1,250","$1,500","$372","$55","$859","$930","$215","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,800","$4800 per person","$9600 per group","$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/Gold_SBC_SG_nonreward.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","SHOP (Small Group)","No","27-2204037","74917MI0010005","McLaren Gold","74917MI001",,"MIN001","MIS001","MIF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010005-01","McLaren Gold","Standard Gold On Exchange Plan",,"0.806842193304364","No","Yes","No","100%",,"$1,250","$140","$2,480","$60","$1,250","$1,500","$372","$55","$859","$930","$215","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,800","$4800 per person","$9600 per group","$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/Gold_SBC_SG_nonreward.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","Individual","No","27-2204037","74917MI0020006","McLaren Gold Standard","74917MI002",,"MIN001","MIS001","MIF006","Existing","HMO","Gold","Design 2","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0020006-03","McLaren Gold Standard","Limited Cost Sharing Plan Variation",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$80","$2,480","$60","$1,400","$1,090","$372","$55","$1,305","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/gold_std_lcs_ind_on.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","SHOP (Small Group)","No","27-2204037","74917MI0010006","McLaren Silver","74917MI001",,"MIN001","MIS001","MIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010006-00","McLaren Silver","Standard Silver Off Exchange Plan",,"0.718999096922007","No","Yes","No","100%",,"$3,630","$0","$3,720","$60","$1,303","$1,880","$558","$55","$752","$1,440","$322","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/Silver_SBC_SG_nonreward.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","Individual","No","27-2204037","74917MI0020005","McLaren Silver Standard","74917MI002",,"MIN001","MIS001","MIF007","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0020005-00","McLaren Silver Standard","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/silver_std_ind_off.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","Individual","No","27-2204037","74917MI0020005","McLaren Silver Standard","74917MI002",,"MIN001","MIS001","MIF007","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0020005-01","McLaren Silver Standard","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/silver_std_ind_on.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","SHOP (Small Group)","No","27-2204037","74917MI0010006","McLaren Silver","74917MI001",,"MIN001","MIS001","MIF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010006-01","McLaren Silver","Standard Silver On Exchange Plan",,"0.718999096922007","No","Yes","No","100%",,"$3,630","$0","$3,720","$60","$1,303","$1,880","$558","$55","$752","$1,440","$322","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/Silver_SBC_SG_nonreward.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","SHOP (Small Group)","No","27-2204037","74917MI0010007","McLaren Bronze","74917MI001",,"MIN001","MIS001","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010007-00","McLaren Bronze","Standard Bronze Off Exchange Plan",,"0.619929194838711","No","Yes","No","100%",,"$1,720","$0","$5,630","$60","$1,463","$1,840","$1,463","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$5,500","$5500 per person","$11000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/Bronze_SBC_SG_nonreward.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","Individual","No","27-2204037","74917MI0020005","McLaren Silver Standard","74917MI002",,"MIN001","MIS001","MIF007","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0020005-02","McLaren Silver Standard","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/silver_std_zcs_ind_on.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","Individual","No","27-2204037","74917MI0020005","McLaren Silver Standard","74917MI002",,"MIN001","MIS001","MIF007","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0020005-03","McLaren Silver Standard","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/silver_std_lcs_ind_on.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","SHOP (Small Group)","No","27-2204037","74917MI0010007","McLaren Bronze","74917MI001",,"MIN001","MIS001","MIF006","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0010007-01","McLaren Bronze","Standard Bronze On Exchange Plan",,"0.619929194838711","No","Yes","No","100%",,"$1,720","$0","$5,630","$60","$1,463","$1,840","$1,463","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$5,500","$5500 per person","$11000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/Bronze_SBC_SG_nonreward.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","Individual","No","27-2204037","74917MI0020005","McLaren Silver Standard","74917MI002",,"MIN001","MIS001","MIF007","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0020005-04","McLaren Silver Standard","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/silver_73_std_ind_on.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","Individual","No","27-2204037","74917MI0020005","McLaren Silver Standard","74917MI002",,"MIN001","MIS001","MIF007","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0020005-05","McLaren Silver Standard","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$700","$610","$372","$55","$700","$75","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/silver_87_std_ind_on.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","Individual","No","27-2204037","74917MI0020005","McLaren Silver Standard","74917MI002",,"MIN001","MIS001","MIF007","Existing","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0020005-06","McLaren Silver Standard","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$22","$620","$60","$250","$218","$93","$55","$250","$30","$82","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/silver_94_std_ind_on.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","Individual","No","27-2204037","74917MI0020004","McLaren Young Adult/Catastrophic","74917MI002",,"MIN001","MIS001","MIF010","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0020004-00","McLaren Young Adult/Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/young_adult_ind_off.pdf",
"2018","MI","74917","SERFF","2017-08-17 20:15:51","Individual","No","27-2204037","74917MI0020004","McLaren Young Adult/Catastrophic","74917MI002",,"MIN001","MIS001","MIF010","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9985",,,"2018-01-01",,"Yes","Emergency","Yes","Emergency","Yes",,"http://www.mclarenhealthplan.org/community-member/marketplace-mhp.aspx","74917MI0020004-01","McLaren Young Adult/Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/Exchange/2018/young_adult_ind_on.pdf",
"2018","MI","75936","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0397286","75936MI0010001","Delta Dental Individual PPO, EHB Certified","75936MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","75936MI0010001-00","Delta Dental Individual PPO, EHB Certified","Standard High Off Exchange Plan","84.84%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","75936","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0397286","75936MI0010002","Delta Dental Individual PPO, EHB Certified","75936MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","75936MI0010002-00","Delta Dental Individual PPO, EHB Certified","Standard Low Off Exchange Plan","71.66%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MI","94523","SERFF","2017-08-14 20:15:51","Individual","Yes","75-1233841","94523MI0010001","Dentegra Dental PPO Pediatric Basic Plan","94523MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","94523MI0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","$70 per person","per group not applicable",,,,,,"$70","$70 per person","per group not applicable","$70","$70 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mi/94523mi0010001-18"
"2018","MI","94523","SERFF","2017-08-14 20:15:51","Individual","Yes","75-1233841","94523MI0010007","Dentegra Dental PPO Family Basic Plan","94523MI001",,"MIN001","MIS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","94523MI0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","$70 per person","per group not applicable",,,,,,"$70","$70 per person","per group not applicable","$70","$70 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mi/94523mi0010007-18"
"2018","MI","94523","SERFF","2017-08-14 20:15:51","Individual","Yes","75-1233841","94523MI0010008","Dentegra Dental PPO Family Preferred Plan","94523MI001",,"MIN001","MIS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","94523MI0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mi/94523mi0010008-18"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180001","Blue Cross® Select HMO Value","98185MI018",,"MIN006","MIS004","MIF031","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180001-00","Blue Cross® Select HMO Value","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,300","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-value-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/catastrophic/select-hmo.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180001","Blue Cross® Select HMO Value","98185MI018",,"MIN006","MIS004","MIF031","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180001-01","Blue Cross® Select HMO Value","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,300","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-value-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/catastrophic/select-hmo.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180004-00","Blue Cross® Select HMO Silver","Standard Silver Off Exchange Plan","70.60%","0.712575728162737","Yes","Yes","No","100%",,"$2,000","$100","$3,500","$60","$2,000","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180004-01","Blue Cross® Select HMO Silver","Standard Silver On Exchange Plan","70.60%","0.712575728162737","Yes","Yes","No","100%",,"$2,000","$100","$3,500","$60","$2,000","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180004-02","Blue Cross® Select HMO Silver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180004-03","Blue Cross® Select HMO Silver","Limited Cost Sharing Plan Variation","70.60%","0.712575728162737","Yes","Yes","No","100%",,"$2,000","$100","$3,500","$60","$2,000","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180004-04","Blue Cross® Select HMO Silver","73% AV Level Silver Plan","73.46%","0.745928124638034","Yes","Yes","No","100%",,"$1,700","$100","$3,500","$60","$1,700","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo.html?costshare=73"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180004-05","Blue Cross® Select HMO Silver","87% AV Level Silver Plan","87.53%","0.88410676250357","Yes","Yes","No","100%",,"$500","$0","$1,100","$60","$500","$500","$600","$60","$500","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo.html?costshare=87"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180004-06","Blue Cross® Select HMO Silver","94% AV Level Silver Plan","94.78%","0.950517161120372","Yes","Yes","No","100%",,"$200","$0","$300","$60","$200","$200","$100","$60","$200","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo.html?costshare=94"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred HMO Silver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180005-00","Blue Cross® Preferred HMO Silver","Standard Silver Off Exchange Plan","70.60%","0.712575728162737","Yes","Yes","No","100%",,"$2,000","$100","$3,500","$60","$2,000","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/preferred-hmo.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180009","Blue Cross® Preferred HMO Gold","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180009-01","Blue Cross® Preferred HMO Gold","Standard Gold On Exchange Plan","79.91%","0.818280092447157","Yes","Yes","No","100%",,"$500","$100","$2,300","$60","$500","$1,000","$1,200","$60","$500","$400","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/gold/preferred-hmo.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180009","Blue Cross® Preferred HMO Gold","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180009-02","Blue Cross® Preferred HMO Gold","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-gold-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-gold-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180014-04","Blue Cross® Metro Detroit HMO Silver Saver","73% AV Level Silver Plan","72.99%","0.738434982821348","Yes","Yes","No","100%",,"$1,800","$0","$3,200","$60","$2,000","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-saver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/metro-detroit-hmo-saver.html?costshare=73"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180014-05","Blue Cross® Metro Detroit HMO Silver Saver","87% AV Level Silver Plan","87.53%","0.881945450147425","Yes","Yes","No","100%",,"$600","$0","$900","$60","$600","$500","$400","$60","$600","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-saver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/metro-detroit-hmo-saver.html?costshare=87"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180014-06","Blue Cross® Metro Detroit HMO Silver Saver","94% AV Level Silver Plan","93.51%","0.93793461164824","Yes","Yes","No","100%",,"$300","$0","$350","$60","$300","$200","$150","$60","$300","$200","$150","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-saver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/metro-detroit-hmo-saver.html?costshare=94"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180015","Blue Cross® Preferred HMO Silver Saver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180015-03","Blue Cross® Preferred HMO Silver Saver","Limited Cost Sharing Plan Variation","68.65%","0.68666394406015","Yes","Yes","No","100%",,"$3,100","$0","$3,500","$60","$3,250","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-saver-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180015","Blue Cross® Preferred HMO Silver Saver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180015-04","Blue Cross® Preferred HMO Silver Saver","73% AV Level Silver Plan","72.99%","0.738434982821348","Yes","Yes","No","100%",,"$1,800","$0","$3,200","$60","$2,000","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-saver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/preferred-hmo-saver.html?costshare=73"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180015","Blue Cross® Preferred HMO Silver Saver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180015-05","Blue Cross® Preferred HMO Silver Saver","87% AV Level Silver Plan","87.53%","0.881945450147425","Yes","Yes","No","100%",,"$600","$0","$900","$60","$600","$500","$400","$60","$600","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-saver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/preferred-hmo-saver.html?costshare=87"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440011","Blue Cross® Select HMO Bronze Saver HSA","98185MI044",,"MIN006","MIS007","MIF031","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440011-03","Blue Cross® Select HMO Bronze Saver","Limited Cost Sharing Plan Variation","60.22%","0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-saver-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180009","Blue Cross® Preferred HMO Gold","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180009-03","Blue Cross® Preferred HMO Gold","Limited Cost Sharing Plan Variation","79.91%","0.818280092447157","Yes","Yes","No","100%",,"$500","$100","$2,300","$60","$500","$1,000","$1,200","$60","$500","$400","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-gold-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-gold-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred HMO Silver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180005-01","Blue Cross® Preferred HMO Silver","Standard Silver On Exchange Plan","70.60%","0.712575728162737","Yes","Yes","No","100%",,"$2,000","$100","$3,500","$60","$2,000","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/preferred-hmo.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred HMO Silver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180005-02","Blue Cross® Preferred HMO Silver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred HMO Silver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180005-03","Blue Cross® Preferred HMO Silver","Limited Cost Sharing Plan Variation","70.60%","0.712575728162737","Yes","Yes","No","100%",,"$2,000","$100","$3,500","$60","$2,000","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred HMO Silver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180005-04","Blue Cross® Preferred HMO Silver","73% AV Level Silver Plan","73.46%","0.745928124638034","Yes","Yes","No","100%",,"$1,700","$100","$3,500","$60","$1,700","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/preferred-hmo.html?costshare=73"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred HMO Silver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180005-05","Blue Cross® Preferred HMO Silver","87% AV Level Silver Plan","87.53%","0.88410676250357","Yes","Yes","No","100%",,"$500","$0","$1,100","$60","$500","$500","$600","$60","$500","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/preferred-hmo.html?costshare=87"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred HMO Silver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180005-06","Blue Cross® Preferred HMO Silver","94% AV Level Silver Plan","94.78%","0.950517161120372","Yes","Yes","No","100%",,"$200","$0","$300","$60","$200","$200","$100","$60","$200","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/preferred-hmo.html?costshare=94"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180009","Blue Cross® Preferred HMO Gold","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180009-00","Blue Cross® Preferred HMO Gold","Standard Gold Off Exchange Plan","79.91%","0.818280092447157","Yes","Yes","No","100%",,"$500","$100","$2,300","$60","$500","$1,000","$1,200","$60","$500","$400","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/gold/preferred-hmo.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180011-00","Blue Cross® Metro Detroit HMO Silver","Standard Silver Off Exchange Plan","70.60%","0.712575728162737","Yes","Yes","No","100%",,"$2,000","$100","$3,500","$60","$2,000","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/metro-detroit-hmo.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180011-01","Blue Cross® Metro Detroit HMO Silver","Standard Silver On Exchange Plan","70.60%","0.712575728162737","Yes","Yes","No","100%",,"$2,000","$100","$3,500","$60","$2,000","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/metro-detroit-hmo.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180011-02","Blue Cross® Metro Detroit HMO Silver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180011-03","Blue Cross® Metro Detroit HMO Silver","Limited Cost Sharing Plan Variation","70.60%","0.712575728162737","Yes","Yes","No","100%",,"$2,000","$100","$3,500","$60","$2,000","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180011-04","Blue Cross® Metro Detroit HMO Silver","73% AV Level Silver Plan","73.46%","0.745928124638034","Yes","Yes","No","100%",,"$1,700","$100","$3,500","$60","$1,700","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/metro-detroit-hmo.html?costshare=73"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180011-05","Blue Cross® Metro Detroit HMO Silver","87% AV Level Silver Plan","87.53%","0.88410676250357","Yes","Yes","No","100%",,"$500","$0","$1,100","$60","$500","$500","$600","$60","$500","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/metro-detroit-hmo.html?costshare=87"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180011-06","Blue Cross® Metro Detroit HMO Silver","94% AV Level Silver Plan","94.78%","0.950517161120372","Yes","Yes","No","100%",,"$200","$0","$300","$60","$200","$200","$100","$60","$200","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/metro-detroit-hmo.html?costshare=94"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180012-00","Blue Cross® Select HMO Silver Saver","Standard Silver Off Exchange Plan","68.65%","0.68666394406015","Yes","Yes","No","100%",,"$3,100","$0","$3,500","$60","$3,250","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-saver.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180012-01","Blue Cross® Select HMO Silver Saver","Standard Silver On Exchange Plan","68.65%","0.68666394406015","Yes","Yes","No","100%",,"$3,100","$0","$3,500","$60","$3,250","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-saver.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180012-02","Blue Cross® Select HMO Silver Saver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-saver-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180012-03","Blue Cross® Select HMO Silver Saver","Limited Cost Sharing Plan Variation","68.65%","0.68666394406015","Yes","Yes","No","100%",,"$3,100","$0","$3,500","$60","$3,250","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-saver-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180012-04","Blue Cross® Select HMO Silver Saver","73% AV Level Silver Plan","72.99%","0.738434982821348","Yes","Yes","No","100%",,"$1,800","$0","$3,200","$60","$2,000","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-saver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-saver.html?costshare=73"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180012-05","Blue Cross® Select HMO Silver Saver","87% AV Level Silver Plan","87.53%","0.881945450147425","Yes","Yes","No","100%",,"$600","$0","$900","$60","$600","$500","$400","$60","$600","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-saver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-saver.html?costshare=87"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180015","Blue Cross® Preferred HMO Silver Saver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180015-00","Blue Cross® Preferred HMO Silver Saver","Standard Silver Off Exchange Plan","68.65%","0.68666394406015","Yes","Yes","No","100%",,"$3,100","$0","$3,500","$60","$3,250","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/preferred-hmo-saver.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180015","Blue Cross® Preferred HMO Silver Saver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180015-01","Blue Cross® Preferred HMO Silver Saver","Standard Silver On Exchange Plan","68.65%","0.68666394406015","Yes","Yes","No","100%",,"$3,100","$0","$3,500","$60","$3,250","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/preferred-hmo-saver.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180015","Blue Cross® Preferred HMO Silver Saver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180015-02","Blue Cross® Preferred HMO Silver Saver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-saver-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS004","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180012-06","Blue Cross® Select HMO Silver Saver","94% AV Level Silver Plan","93.51%","0.93793461164824","Yes","Yes","No","100%",,"$300","$0","$350","$60","$300","$200","$150","$60","$300","$200","$150","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-saver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-saver.html?costshare=94"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180014-00","Blue Cross® Metro Detroit HMO Silver Saver","Standard Silver Off Exchange Plan","68.65%","0.68666394406015","Yes","Yes","No","100%",,"$3,100","$0","$3,500","$60","$3,250","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/metro-detroit-hmo-saver.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180014-01","Blue Cross® Metro Detroit HMO Silver Saver","Standard Silver On Exchange Plan","68.65%","0.68666394406015","Yes","Yes","No","100%",,"$3,100","$0","$3,500","$60","$3,250","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/metro-detroit-hmo-saver.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180014-02","Blue Cross® Metro Detroit HMO Silver Saver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-saver-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180014-03","Blue Cross® Metro Detroit HMO Silver Saver","Limited Cost Sharing Plan Variation","68.65%","0.68666394406015","Yes","Yes","No","100%",,"$3,100","$0","$3,500","$60","$3,250","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-saver-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS004","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550001-00","Blue Cross® Select HMO Silver Extra","Standard Silver Off Exchange Plan","71.05%","0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-extra.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS004","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550001-01","Blue Cross® Select HMO Silver Extra","Standard Silver On Exchange Plan","71.05%","0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-extra.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS004","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550001-02","Blue Cross® Select HMO Silver Extra","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-extra-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS004","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550001-03","Blue Cross® Select HMO Silver Extra","Limited Cost Sharing Plan Variation","71.05%","0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-extra-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180015","Blue Cross® Preferred HMO Silver Saver","98185MI018",,"MIN005","MIS001","MIF030","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180015-06","Blue Cross® Preferred HMO Silver Saver","94% AV Level Silver Plan","93.51%","0.93793461164824","Yes","Yes","No","100%",,"$300","$0","$350","$60","$300","$200","$150","$60","$300","$200","$150","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-saver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/preferred-hmo-saver.html?costshare=94"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180016","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS007","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180016-00","Blue Cross® Select HMO Silver","Standard Silver Off Exchange Plan","70.60%","0.712575728162737","Yes","Yes","No","100%",,"$2,000","$100","$3,500","$60","$2,000","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180016","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS007","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180016-01","Blue Cross® Select HMO Silver","Standard Silver On Exchange Plan","70.60%","0.712575728162737","Yes","Yes","No","100%",,"$2,000","$100","$3,500","$60","$2,000","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440008","Blue Cross® Metro Detroit HMO Bronze Saver HSA","98185MI044",,"MIN004","MIS006","MIF031","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440008-03","Blue Cross® Metro Detroit HMO Bronze Saver","Limited Cost Sharing Plan Variation","60.22%","0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-bronze-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-bronze-saver-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180016","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS007","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180016-02","Blue Cross® Select HMO Silver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180016","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS007","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180016-03","Blue Cross® Select HMO Silver","Limited Cost Sharing Plan Variation","70.60%","0.712575728162737","Yes","Yes","No","100%",,"$2,000","$100","$3,500","$60","$2,000","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180016","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS007","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180016-04","Blue Cross® Select HMO Silver","73% AV Level Silver Plan","73.46%","0.745928124638034","Yes","Yes","No","100%",,"$1,700","$100","$3,500","$60","$1,700","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo.html?costshare=73"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180016","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS007","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180016-05","Blue Cross® Select HMO Silver","87% AV Level Silver Plan","87.53%","0.88410676250357","Yes","Yes","No","100%",,"$500","$0","$1,100","$60","$500","$500","$600","$60","$500","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo.html?costshare=87"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180016","Blue Cross® Select HMO Silver","98185MI018",,"MIN006","MIS007","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180016-06","Blue Cross® Select HMO Silver","94% AV Level Silver Plan","94.78%","0.950517161120372","Yes","Yes","No","100%",,"$200","$0","$300","$60","$200","$200","$100","$60","$200","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo.html?costshare=94"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180017","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS007","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180017-00","Blue Cross® Select HMO Silver Saver","Standard Silver Off Exchange Plan","68.65%","0.68666394406015","Yes","Yes","No","100%",,"$3,100","$0","$3,500","$60","$3,250","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-saver.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180017","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS007","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180017-01","Blue Cross® Select HMO Silver Saver","Standard Silver On Exchange Plan","68.65%","0.68666394406015","Yes","Yes","No","100%",,"$3,100","$0","$3,500","$60","$3,250","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-saver.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180017","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS007","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180017-02","Blue Cross® Select HMO Silver Saver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-saver-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180017","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS007","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180017-03","Blue Cross® Select HMO Silver Saver","Limited Cost Sharing Plan Variation","68.65%","0.68666394406015","Yes","Yes","No","100%",,"$3,100","$0","$3,500","$60","$3,250","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-saver-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180017","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS007","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180017-04","Blue Cross® Select HMO Silver Saver","73% AV Level Silver Plan","72.99%","0.738434982821348","Yes","Yes","No","100%",,"$1,800","$0","$3,200","$60","$2,000","$1,000","$1,400","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-saver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-saver.html?costshare=73"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180017","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS007","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180017-05","Blue Cross® Select HMO Silver Saver","87% AV Level Silver Plan","87.53%","0.881945450147425","Yes","Yes","No","100%",,"$600","$0","$900","$60","$600","$500","$400","$60","$600","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-saver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-saver.html?costshare=87"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180017","Blue Cross® Select HMO Silver Saver","98185MI018",,"MIN006","MIS007","MIF030","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180017-06","Blue Cross® Select HMO Silver Saver","94% AV Level Silver Plan","93.51%","0.93793461164824","Yes","Yes","No","100%",,"$300","$0","$350","$60","$300","$200","$150","$60","$300","$200","$150","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-saver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-saver.html?costshare=94"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180018","Blue Cross® Select HMO Value","98185MI018",,"MIN006","MIS007","MIF031","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180018-00","Blue Cross® Select HMO Value","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,300","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-value-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/catastrophic/select-hmo.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0180018","Blue Cross® Select HMO Value","98185MI018",,"MIN006","MIS007","MIF031","New","HMO","Catastrophic","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0180018-01","Blue Cross® Select HMO Value","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,300","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-value-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/catastrophic/select-hmo.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440001","Blue Cross® Select HMO Bronze","98185MI044",,"MIN006","MIS004","MIF031","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440001-00","Blue Cross® Select HMO Bronze","Standard Bronze Off Exchange Plan","62.38%","0.628922897127818","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,300","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/select-hmo.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440001","Blue Cross® Select HMO Bronze","98185MI044",,"MIN006","MIS004","MIF031","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440001-01","Blue Cross® Select HMO Bronze","Standard Bronze On Exchange Plan","62.38%","0.628922897127818","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,300","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/select-hmo.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440001","Blue Cross® Select HMO Bronze","98185MI044",,"MIN006","MIS004","MIF031","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440001-02","Blue Cross® Select HMO Bronze","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440001","Blue Cross® Select HMO Bronze","98185MI044",,"MIN006","MIS004","MIF031","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440001-03","Blue Cross® Select HMO Bronze","Limited Cost Sharing Plan Variation","62.38%","0.628922897127818","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,300","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440005","Blue Cross® Metro Detroit HMO Bronze","98185MI044",,"MIN004","MIS006","MIF031","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440005-00","Blue Cross® Metro Detroit HMO Bronze","Standard Bronze Off Exchange Plan","62.38%","0.628922897127818","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,300","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/metro-detroit-hmo.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440005","Blue Cross® Metro Detroit HMO Bronze","98185MI044",,"MIN004","MIS006","MIF031","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440005-01","Blue Cross® Metro Detroit HMO Bronze","Standard Bronze On Exchange Plan","62.38%","0.628922897127818","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,300","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/metro-detroit-hmo.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440005","Blue Cross® Metro Detroit HMO Bronze","98185MI044",,"MIN004","MIS006","MIF031","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440005-02","Blue Cross® Metro Detroit HMO Bronze","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-bronze-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-bronze-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440005","Blue Cross® Metro Detroit HMO Bronze","98185MI044",,"MIN004","MIS006","MIF031","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440005-03","Blue Cross® Metro Detroit HMO Bronze","Limited Cost Sharing Plan Variation","62.38%","0.628922897127818","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,300","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-bronze-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-bronze-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440006","Blue Cross® Select HMO Bronze Saver HSA","98185MI044",,"MIN006","MIS004","MIF031","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440006-00","Blue Cross® Select HMO Bronze Saver HSA","Standard Bronze Off Exchange Plan","60.22%","0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/select-hmo-saver.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440006","Blue Cross® Select HMO Bronze Saver HSA","98185MI044",,"MIN006","MIS004","MIF031","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440006-01","Blue Cross® Select HMO Bronze Saver HSA","Standard Bronze On Exchange Plan","60.22%","0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/select-hmo-saver.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440006","Blue Cross® Select HMO Bronze Saver HSA","98185MI044",,"MIN006","MIS004","MIF031","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440006-02","Blue Cross® Select HMO Bronze Saver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-saver-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440006","Blue Cross® Select HMO Bronze Saver HSA","98185MI044",,"MIN006","MIS004","MIF031","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440006-03","Blue Cross® Select HMO Bronze Saver","Limited Cost Sharing Plan Variation","60.22%","0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-saver-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440008","Blue Cross® Metro Detroit HMO Bronze Saver HSA","98185MI044",,"MIN004","MIS006","MIF031","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440008-00","Blue Cross® Metro Detroit HMO Bronze Saver HSA","Standard Bronze Off Exchange Plan","60.22%","0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/metro-detroit-hmo-saver.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440008","Blue Cross® Metro Detroit HMO Bronze Saver HSA","98185MI044",,"MIN004","MIS006","MIF031","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440008-01","Blue Cross® Metro Detroit HMO Bronze Saver HSA","Standard Bronze On Exchange Plan","60.22%","0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/metro-detroit-hmo-saver.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440008","Blue Cross® Metro Detroit HMO Bronze Saver HSA","98185MI044",,"MIN004","MIS006","MIF031","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440008-02","Blue Cross® Metro Detroit HMO Bronze Saver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-bronze-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-bronze-saver-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440009","Blue Cross® Preferred HMO Bronze Saver HSA","98185MI044",,"MIN005","MIS001","MIF031","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440009-00","Blue Cross® Preferred HMO Bronze Saver HSA","Standard Bronze Off Exchange Plan","60.22%","0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/preferred-hmo-saver.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440009","Blue Cross® Preferred HMO Bronze Saver HSA","98185MI044",,"MIN005","MIS001","MIF031","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440009-01","Blue Cross® Preferred HMO Bronze Saver HSA","Standard Bronze On Exchange Plan","60.22%","0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/preferred-hmo-saver.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440009","Blue Cross® Preferred HMO Bronze Saver HSA","98185MI044",,"MIN005","MIS001","MIF031","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440009-02","Blue Cross® Preferred HMO Bronze Saver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-bronze-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-bronze-saver-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440009","Blue Cross® Preferred HMO Bronze Saver HSA","98185MI044",,"MIN005","MIS001","MIF031","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440009-03","Blue Cross® Preferred HMO Bronze Saver","Limited Cost Sharing Plan Variation","60.22%","0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-bronze-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-bronze-saver-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440010","Blue Cross® Select HMO Bronze","98185MI044",,"MIN006","MIS007","MIF031","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440010-00","Blue Cross® Select HMO Bronze","Standard Bronze Off Exchange Plan","62.38%","0.628922897127818","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,300","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/select-hmo.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440010","Blue Cross® Select HMO Bronze","98185MI044",,"MIN006","MIS007","MIF031","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440010-01","Blue Cross® Select HMO Bronze","Standard Bronze On Exchange Plan","62.38%","0.628922897127818","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,300","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/select-hmo.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440010","Blue Cross® Select HMO Bronze","98185MI044",,"MIN006","MIS007","MIF031","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440010-02","Blue Cross® Select HMO Bronze","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440010","Blue Cross® Select HMO Bronze","98185MI044",,"MIN006","MIS007","MIF031","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440010-03","Blue Cross® Select HMO Bronze","Limited Cost Sharing Plan Variation","62.38%","0.628922897127818","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,300","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440011","Blue Cross® Select HMO Bronze Saver HSA","98185MI044",,"MIN006","MIS007","MIF031","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440011-00","Blue Cross® Select HMO Bronze Saver HSA","Standard Bronze Off Exchange Plan","60.22%","0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/select-hmo-saver.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440011","Blue Cross® Select HMO Bronze Saver HSA","98185MI044",,"MIN006","MIS007","MIF031","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440011-01","Blue Cross® Select HMO Bronze Saver HSA","Standard Bronze On Exchange Plan","60.22%","0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/bronze/select-hmo-saver.html"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0440011","Blue Cross® Select HMO Bronze Saver HSA","98185MI044",,"MIN006","MIS007","MIF031","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0440011-02","Blue Cross® Select HMO Bronze Saver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-bronze-saver-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS004","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550001-04","Blue Cross® Select HMO Silver Extra","73% AV Level Silver Plan","73.95%","0.739471608611116","No","Yes","No","100%",,"$3,000","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-extra-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-extra.html?costshare=73"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS004","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550001-05","Blue Cross® Select HMO Silver Extra","87% AV Level Silver Plan","87.61%","0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$700","$600","$400","$60","$700","$80","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-extra-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-extra.html?costshare=87"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290004","PSN Bronze HSA 6550","23603MT029",,"MTN001","MTS004","MTF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290004-00","PSN Bronze HSA 6550","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2018/SBC/23603MT0290004-00.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290004","PSN Bronze HSA 6550","23603MT029",,"MTN001","MTS004","MTF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290004-01","PSN Bronze HSA 6550","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2018/SBC/23603MT0290004-01.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300004","PSN Silver HSA 3600","23603MT030",,"MTN001","MTS001","MTF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300004-01","PSN Silver HSA 3600","Standard Silver On Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,600","$0","$0","$60","$3,600","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2018/SBC/23603MT0300004-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS004","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550001-06","Blue Cross® Select HMO Silver Extra","94% AV Level Silver Plan","94.69%","0.946922790208574","No","Yes","No","100%",,"$250","$20","$600","$60","$250","$200","$90","$60","$250","$30","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-extra-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-extra.html?costshare=94"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred HMO Silver Extra","98185MI055",,"MIN005","MIS001","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550002-00","Blue Cross® Preferred HMO Silver Extra","Standard Silver Off Exchange Plan","71.05%","0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/preferred-hmo-extra.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred HMO Silver Extra","98185MI055",,"MIN005","MIS001","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550002-01","Blue Cross® Preferred HMO Silver Extra","Standard Silver On Exchange Plan","71.05%","0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/preferred-hmo-extra.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred HMO Silver Extra","98185MI055",,"MIN005","MIS001","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550002-02","Blue Cross® Preferred HMO Silver Extra","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-extra-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred HMO Silver Extra","98185MI055",,"MIN005","MIS001","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550002-03","Blue Cross® Preferred HMO Silver Extra","Limited Cost Sharing Plan Variation","71.05%","0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-extra-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred HMO Silver Extra","98185MI055",,"MIN005","MIS001","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550002-04","Blue Cross® Preferred HMO Silver Extra","73% AV Level Silver Plan","73.95%","0.739471608611116","No","Yes","No","100%",,"$3,000","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-extra-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/preferred-hmo-extra.html?costshare=73"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred HMO Silver Extra","98185MI055",,"MIN005","MIS001","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550002-05","Blue Cross® Preferred HMO Silver Extra","87% AV Level Silver Plan","87.61%","0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$700","$600","$400","$60","$700","$80","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-extra-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/preferred-hmo-extra.html?costshare=87"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred HMO Silver Extra","98185MI055",,"MIN005","MIS001","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550002-06","Blue Cross® Preferred HMO Silver Extra","94% AV Level Silver Plan","94.69%","0.946922790208574","No","Yes","No","100%",,"$250","$20","$600","$60","$250","$200","$90","$60","$250","$30","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/preferred-silver-extra-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/preferred-hmo-extra.html?costshare=94"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550004-00","Blue Cross® Metro Detroit HMO Silver Extra","Standard Silver Off Exchange Plan","71.05%","0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/metro-detroit-hmo-extra.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550004-01","Blue Cross® Metro Detroit HMO Silver Extra","Standard Silver On Exchange Plan","71.05%","0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/metro-detroit-hmo-extra.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550004-02","Blue Cross® Metro Detroit HMO Silver Extra","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-extra-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550004-03","Blue Cross® Metro Detroit HMO Silver Extra","Limited Cost Sharing Plan Variation","71.05%","0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-extra-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550004-04","Blue Cross® Metro Detroit HMO Silver Extra","73% AV Level Silver Plan","73.95%","0.739471608611116","No","Yes","No","100%",,"$3,000","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-extra-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/metro-detroit-hmo-extra.html?costshare=73"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550004-05","Blue Cross® Metro Detroit HMO Silver Extra","87% AV Level Silver Plan","87.61%","0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$700","$600","$400","$60","$700","$80","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-extra-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/metro-detroit-hmo-extra.html?costshare=87"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF032","Existing","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550004-06","Blue Cross® Metro Detroit HMO Silver Extra","94% AV Level Silver Plan","94.69%","0.946922790208574","No","Yes","No","100%",,"$250","$20","$600","$60","$250","$200","$90","$60","$250","$30","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/metro-detroit-hmo-silver-extra-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/metro-detroit-hmo-extra.html?costshare=94"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550017","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS007","MIF032","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550017-00","Blue Cross® Select HMO Silver Extra","Standard Silver Off Exchange Plan","71.05%","0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-extra.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550017","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS007","MIF032","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550017-01","Blue Cross® Select HMO Silver Extra","Standard Silver On Exchange Plan","71.05%","0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-extra.html?costshare=70"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550017","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS007","MIF032","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550017-02","Blue Cross® Select HMO Silver Extra","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-extra-na-less-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550017","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS007","MIF032","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550017-03","Blue Cross® Select HMO Silver Extra","Limited Cost Sharing Plan Variation","71.05%","0.710476913884508","No","Yes","No","100%",,"$3,500","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-extra-na-more-than-300-sbc.pdf"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550017","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS007","MIF032","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550017-04","Blue Cross® Select HMO Silver Extra","73% AV Level Silver Plan","73.95%","0.739471608611116","No","Yes","No","100%",,"$3,000","$100","$2,500","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-extra-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-extra.html?costshare=73"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550017","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS007","MIF032","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550017-05","Blue Cross® Select HMO Silver Extra","87% AV Level Silver Plan","87.61%","0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$700","$600","$400","$60","$700","$80","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-extra-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-extra.html?costshare=87"
"2018","MI","98185","SERFF","2017-08-16 20:15:58","Individual","No","38-2359234","98185MI0550017","Blue Cross® Select HMO Silver Extra","98185MI055",,"MIN006","MIS007","MIF032","New","HMO","Silver","Design 1","Yes","Both","No","Yes","All except routine OB/GYN & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Accidential Injury and Emergency Only","Yes","Accidential Injury and Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/2018selectdruglist","98185MI0550017-06","Blue Cross® Select HMO Silver Extra","94% AV Level Silver Plan","94.69%","0.946922790208574","No","Yes","No","100%",,"$250","$20","$600","$60","$250","$200","$90","$60","$250","$30","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2018-individual/sbc/select-silver-extra-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/2018/silver/select-hmo-extra.html?costshare=94"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300001","PSN Bronze HSA 6550","23603MT030",,"MTN001","MTS001","MTF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300001-00","PSN Bronze HSA 6550","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2018/SBC/23603MT0300001-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","Yes","93-0245545","23603MT0320001","Dental Choice 0-20-50","23603MT032",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency care only","Yes","This plan covers services when performed by an eligible provider.","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","","23603MT0320001-00","Dental Choice 0-20-50","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/individual-dental-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","Yes","93-0245545","23603MT0330001","Dental Choice Core","23603MT033",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes",,"","23603MT0330001-00","Dental Choice Core","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290001","SmartHealth Bronze HSA 6550","23603MT029",,"MTN002","MTS003","MTF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290001-00","SmartHealth Bronze HSA 6550","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2018/SBC/23603MT0290001-00.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290001","SmartHealth Bronze HSA 6550","23603MT029",,"MTN002","MTS003","MTF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290001-01","SmartHealth Bronze HSA 6550","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2018/SBC/23603MT0290001-01.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","Yes","93-0245545","23603MT0320001","Dental Choice 0-20-50","23603MT032",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency care only","Yes","This plan covers services when performed by an eligible provider.","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","","23603MT0320001-01","Dental Choice 0-20-50","Standard High On Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/individual-dental-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300001","PSN Bronze HSA 6550","23603MT030",,"MTN001","MTS001","MTF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300001-01","PSN Bronze HSA 6550","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2018/SBC/23603MT0300001-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300002","PSN Bronze HSA 4000","23603MT030",,"MTN001","MTS001","MTF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300002-00","PSN Bronze HSA 4000","Standard Bronze Off Exchange Plan",,"0.618651277477805","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2018/SBC/23603MT0300002-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290001","SmartHealth Bronze HSA 6550","23603MT029",,"MTN002","MTS003","MTF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290001-02","SmartHealth Bronze 6550 (0)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://pacificsource.com/2018/SBC/23603MT0290001-02.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290001","SmartHealth Bronze HSA 6550","23603MT029",,"MTN002","MTS003","MTF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290001-03","SmartHealth Bronze 6550 (AI)","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/23603MT0290001-03.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300002","PSN Bronze HSA 4000","23603MT030",,"MTN001","MTS001","MTF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300002-01","PSN Bronze HSA 4000","Standard Bronze On Exchange Plan",,"0.618651277477805","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2018/SBC/23603MT0300002-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300004","PSN Silver HSA 3600","23603MT030",,"MTN001","MTS001","MTF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300004-00","PSN Silver HSA 3600","Standard Silver Off Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,600","$0","$0","$60","$3,600","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2018/SBC/23603MT0300004-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300005","PSN Silver HSA 2700","23603MT030",,"MTN001","MTS001","MTF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300005-01","PSN Silver HSA 2700","Standard Silver On Exchange Plan",,"0.686974259589508","Yes","Yes","No","100%",,"$2,700","$0","$2,527","$60","$2,700","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2018/SBC/23603MT0300005-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290004","PSN Bronze HSA 6550","23603MT029",,"MTN001","MTS004","MTF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290004-03","PSN Bronze 6550 (AI)","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/23603MT0290004-03.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290002","SmartHealth Silver HSA 3000","23603MT029",,"MTN002","MTS003","MTF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290002-00","SmartHealth Silver HSA 3000","Standard Silver Off Exchange Plan",,"0.690541502382479","Yes","Yes","No","100%",,"$2,580","$0","$2,420","$60","$3,000","$0","$1,796","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2018/SBC/23603MT0290002-00.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300003","PSN Bronze 7350","23603MT030",,"MTN001","MTS001","MTF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300003-00","PSN Bronze 7350","Standard Bronze Off Exchange Plan",,"0.618504916568646","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,393","$160","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300003-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300003","PSN Bronze 7350","23603MT030",,"MTN001","MTS001","MTF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300003-01","PSN Bronze 7350","Standard Bronze On Exchange Plan",,"0.618504916568646","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,393","$160","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300003-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290002","SmartHealth Silver HSA 3000","23603MT029",,"MTN002","MTS003","MTF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290002-01","SmartHealth Silver HSA 3000","Standard Silver On Exchange Plan",,"0.690541502382479","Yes","Yes","No","100%",,"$2,580","$0","$2,420","$60","$3,000","$0","$1,796","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2018/SBC/23603MT0290002-01.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290004","PSN Bronze HSA 6550","23603MT029",,"MTN001","MTS004","MTF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290004-02","PSN Bronze 6550 (0)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://pacificsource.com/2018/SBC/23603MT0290004-02.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300005","PSN Silver HSA 2700","23603MT030",,"MTN001","MTS001","MTF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300005-00","PSN Silver HSA 2700","Standard Silver Off Exchange Plan",,"0.686974259589508","Yes","Yes","No","100%",,"$2,700","$0","$2,527","$60","$2,700","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2018/SBC/23603MT0300005-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300008","PSN Gold 1000","23603MT030",,"MTN001","MTS001","MTF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300008-01","PSN Gold 1000","Standard Gold On Exchange Plan",,"0.814709871581639","Yes","Yes","No","100%",,"$1,000","$80","$2,480","$60","$1,000","$1,155","$261","$55","$1,000","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300008-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290005","PSN Silver HSA 3000","23603MT029",,"MTN001","MTS004","MTF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290005-04","PSN Silver 3000 (73)","73% AV Level Silver Plan",,"0.728856965968866","Yes","Yes","No","100%",,"$1,800","$0","$3,158","$60","$1,800","$0","$1,796","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","25.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/23603MT0290005-04.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290005","PSN Silver HSA 3000","23603MT029",,"MTN001","MTS004","MTF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290005-05","PSN Silver 3000 (87)","87% AV Level Silver Plan",,"0.863396104253386","Yes","Yes","No","100%",,"$750","$0","$750","$60","$750","$0","$750","$55","$750","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/23603MT0290005-05.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300010","SmartHealth Bronze HSA 6550","23603MT030",,"MTN002","MTS003","MTF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300010-00","SmartHealth Bronze HSA 6550","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2018/SBC/23603MT0300010-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300010","SmartHealth Bronze HSA 6550","23603MT030",,"MTN002","MTS003","MTF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300010-01","SmartHealth Bronze HSA 6550","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2018/SBC/23603MT0300010-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290005","PSN Silver HSA 3000","23603MT029",,"MTN001","MTS004","MTF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290005-06","PSN Silver 3000 (94)","94% AV Level Silver Plan",,"0.936681559474985","Yes","Yes","No","100%",,"$142","$0","$458","$60","$250","$0","$350","$55","$250","$0","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/23603MT0290005-06.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300011","SmartHealth Bronze HSA 4000","23603MT030",,"MTN002","MTS003","MTF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300011-00","SmartHealth Bronze HSA 4000","Standard Bronze Off Exchange Plan",,"0.618651277477805","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2018/SBC/23603MT0300011-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290002","SmartHealth Silver HSA 3000","23603MT029",,"MTN002","MTS003","MTF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290002-02","SmartHealth Silver 3000 (0)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://pacificsource.com/2018/SBC/23603MT0290002-02.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300007","PSN Silver 5000","23603MT030",,"MTN001","MTS001","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300007-00","PSN Silver 5000","Standard Silver Off Exchange Plan",,"0.696250447952952","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300007-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300007","PSN Silver 5000","23603MT030",,"MTN001","MTS001","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300007-01","PSN Silver 5000","Standard Silver On Exchange Plan",,"0.696250447952952","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300007-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290002","SmartHealth Silver HSA 3000","23603MT029",,"MTN002","MTS003","MTF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290002-03","SmartHealth Silver 3000 (AI)","Limited Cost Sharing Plan Variation",,"0.690541502382479","Yes","Yes","No","100%",,"$2,580","$0","$2,420","$60","$3,000","$0","$1,796","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/23603MT0290002-03.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290002","SmartHealth Silver HSA 3000","23603MT029",,"MTN002","MTS003","MTF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290002-04","SmartHealth Silver 3000 (73)","73% AV Level Silver Plan",,"0.728856965968866","Yes","Yes","No","100%",,"$1,800","$0","$3,158","$60","$1,800","$0","$1,796","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","25.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/23603MT0290002-04.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300006","PSN Silver 4000","23603MT030",,"MTN001","MTS001","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300006-00","PSN Silver 4000","Standard Silver Off Exchange Plan",,"0.705741497195771","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300006-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300006","PSN Silver 4000","23603MT030",,"MTN001","MTS001","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300006-01","PSN Silver 4000","Standard Silver On Exchange Plan",,"0.705741497195771","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300006-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290002","SmartHealth Silver HSA 3000","23603MT029",,"MTN002","MTS003","MTF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290002-05","SmartHealth Silver 3000 (87)","87% AV Level Silver Plan",,"0.863396104253386","Yes","Yes","No","100%",,"$750","$0","$750","$60","$750","$0","$750","$55","$750","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/23603MT0290002-05.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290002","SmartHealth Silver HSA 3000","23603MT029",,"MTN002","MTS003","MTF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290002-06","SmartHealth Silver 3000 (94)","94% AV Level Silver Plan",,"0.936681559474985","Yes","Yes","No","100%",,"$142","$0","$458","$60","$250","$0","$350","$55","$250","$0","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/23603MT0290002-06.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300019","PSN Silver 3000","23603MT030",,"MTN001","MTS001","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300019-00","PSN Silver 3000","Standard Silver Off Exchange Plan",,"0.719790518482752","Yes","Yes","No","100%",,"$3,000","$100","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300019-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300019","PSN Silver 3000","23603MT030",,"MTN001","MTS001","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300019-01","PSN Silver 3000","Standard Silver On Exchange Plan",,"0.719790518482752","Yes","Yes","No","100%",,"$3,000","$100","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300019-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290005","PSN Silver HSA 3000","23603MT029",,"MTN001","MTS004","MTF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290005-00","PSN Silver HSA 3000","Standard Silver Off Exchange Plan",,"0.690541502382479","Yes","Yes","No","100%",,"$2,580","$0","$2,420","$60","$3,000","$0","$1,796","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2018/SBC/23603MT0290005-00.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290005","PSN Silver HSA 3000","23603MT029",,"MTN001","MTS004","MTF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290005-01","PSN Silver HSA 3000","Standard Silver On Exchange Plan",,"0.690541502382479","Yes","Yes","No","100%",,"$2,580","$0","$2,420","$60","$3,000","$0","$1,796","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2018/SBC/23603MT0290005-01.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300009","PSN Gold 2000","23603MT030",,"MTN001","MTS001","MTF010","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300009-00","PSN Gold 2000","Standard Gold Off Exchange Plan",,"0.783516365493793","Yes","Yes","No","100%",,"$2,000","$80","$2,480","$60","$1,046","$1,155","$261","$55","$1,305","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300009-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300009","PSN Gold 2000","23603MT030",,"MTN001","MTS001","MTF010","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300009-01","PSN Gold 2000","Standard Gold On Exchange Plan",,"0.783516365493793","Yes","Yes","No","100%",,"$2,000","$80","$2,480","$60","$1,046","$1,155","$261","$55","$1,305","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300009-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290005","PSN Silver HSA 3000","23603MT029",,"MTN001","MTS004","MTF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290005-02","PSN Silver 3000 (0)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://pacificsource.com/2018/SBC/23603MT0290005-02.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290005","PSN Silver HSA 3000","23603MT029",,"MTN001","MTS004","MTF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290005-03","PSN Silver 3000 (AI)","Limited Cost Sharing Plan Variation",,"0.690541502382479","Yes","Yes","No","100%",,"$2,580","$0","$2,420","$60","$3,000","$0","$1,796","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/23603MT0290005-03.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300008","PSN Gold 1000","23603MT030",,"MTN001","MTS001","MTF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300008-00","PSN Gold 1000","Standard Gold Off Exchange Plan",,"0.814709871581639","Yes","Yes","No","100%",,"$1,000","$80","$2,480","$60","$1,000","$1,155","$261","$55","$1,000","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300008-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290003","SmartHealth Gold 1500","23603MT029",,"MTN002","MTS003","MTF011","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290003-00","SmartHealth Gold 1500","Standard Gold Off Exchange Plan",,"0.780422164822697","Yes","Yes","No","100%",,"$1,500","$60","$1,260","$60","$1,500","$1,310","$237","$55","$1,500","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/23603MT0290003-00.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300011","SmartHealth Bronze HSA 4000","23603MT030",,"MTN002","MTS003","MTF007","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300011-01","SmartHealth Bronze HSA 4000","Standard Bronze On Exchange Plan",,"0.618651277477805","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2018/SBC/23603MT0300011-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290003","SmartHealth Gold 1500","23603MT029",,"MTN002","MTS003","MTF011","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290003-01","SmartHealth Gold 1500","Standard Gold On Exchange Plan",,"0.780422164822697","Yes","Yes","No","100%",,"$1,500","$60","$1,260","$60","$1,500","$1,310","$237","$55","$1,500","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/23603MT0290003-01.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290003","SmartHealth Gold 1500","23603MT029",,"MTN002","MTS003","MTF011","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290003-02","SmartHealth Gold 1500 (0)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://pacificsource.com/2018/SBC/23603MT0290003-02.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300013","SmartHealth Silver HSA 3600","23603MT030",,"MTN002","MTS003","MTF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300013-00","SmartHealth Silver HSA 3600","Standard Silver Off Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,600","$0","$0","$60","$3,600","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2018/SBC/23603MT0300013-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300013","SmartHealth Silver HSA 3600","23603MT030",,"MTN002","MTS003","MTF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300013-01","SmartHealth Silver HSA 3600","Standard Silver On Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,600","$0","$0","$60","$3,600","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2018/SBC/23603MT0300013-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290003","SmartHealth Gold 1500","23603MT029",,"MTN002","MTS003","MTF011","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290003-03","SmartHealth Gold 1500 (AI)","Limited Cost Sharing Plan Variation",,"0.780422164822697","Yes","Yes","No","100%",,"$1,500","$60","$1,260","$60","$1,500","$1,310","$237","$55","$1,500","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/23603MT0290003-03.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290006","PSN Gold 1500","23603MT029",,"MTN001","MTS004","MTF011","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290006-00","PSN Gold 1500","Standard Gold Off Exchange Plan",,"0.780422164822697","Yes","Yes","No","100%",,"$1,500","$60","$1,260","$60","$1,500","$1,310","$237","$55","$1,500","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/23603MT0290006-00.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300014","SmartHealth Silver HSA 2700","23603MT030",,"MTN002","MTS003","MTF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300014-00","SmartHealth Silver HSA 2700","Standard Silver Off Exchange Plan",,"0.686974259589508","Yes","Yes","No","100%",,"$2,700","$0","$2,527","$60","$2,700","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2018/SBC/23603MT0300014-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300014","SmartHealth Silver HSA 2700","23603MT030",,"MTN002","MTS003","MTF008","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300014-01","SmartHealth Silver HSA 2700","Standard Silver On Exchange Plan",,"0.686974259589508","Yes","Yes","No","100%",,"$2,700","$0","$2,527","$60","$2,700","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://pacificsource.com/2018/SBC/23603MT0300014-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290006","PSN Gold 1500","23603MT029",,"MTN001","MTS004","MTF011","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290006-01","PSN Gold 1500","Standard Gold On Exchange Plan",,"0.780422164822697","Yes","Yes","No","100%",,"$1,500","$60","$1,260","$60","$1,500","$1,310","$237","$55","$1,500","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/23603MT0290006-01.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290006","PSN Gold 1500","23603MT029",,"MTN001","MTS004","MTF011","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290006-02","PSN Gold 1500 (0)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://pacificsource.com/2018/SBC/23603MT0290006-02.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300012","SmartHealth Bronze 7350","23603MT030",,"MTN002","MTS003","MTF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300012-00","SmartHealth Bronze 7350","Standard Bronze Off Exchange Plan",,"0.618504916568646","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,393","$160","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300012-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300012","SmartHealth Bronze 7350","23603MT030",,"MTN002","MTS003","MTF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300012-01","SmartHealth Bronze 7350","Standard Bronze On Exchange Plan",,"0.618504916568646","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,393","$160","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300012-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","No","93-0245545","23603MT0290006","PSN Gold 1500","23603MT029",,"MTN001","MTS004","MTF011","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","23603MT0290006-03","PSN Gold 1500 (AI)","Limited Cost Sharing Plan Variation",,"0.780422164822697","Yes","Yes","No","100%",,"$1,500","$60","$1,260","$60","$1,500","$1,310","$237","$55","$1,500","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/23603MT0290006-03.pdf","https://pacificsource.com/montana/individual-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300016","SmartHealth Silver 5000","23603MT030",,"MTN002","MTS003","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300016-00","SmartHealth Silver 5000","Standard Silver Off Exchange Plan",,"0.696250447952952","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300016-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300016","SmartHealth Silver 5000","23603MT030",,"MTN002","MTS003","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300016-01","SmartHealth Silver 5000","Standard Silver On Exchange Plan",,"0.696250447952952","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300016-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300015","SmartHealth Silver 4000","23603MT030",,"MTN002","MTS003","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300015-00","SmartHealth Silver 4000","Standard Silver Off Exchange Plan",,"0.705741497195771","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300015-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300015","SmartHealth Silver 4000","23603MT030",,"MTN002","MTS003","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300015-01","SmartHealth Silver 4000","Standard Silver On Exchange Plan",,"0.705741497195771","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300015-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300020","SmartHealth Silver 3000","23603MT030",,"MTN002","MTS003","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300020-00","SmartHealth Silver 3000","Standard Silver Off Exchange Plan",,"0.719790518482752","Yes","Yes","No","100%",,"$3,000","$100","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300020-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300020","SmartHealth Silver 3000","23603MT030",,"MTN002","MTS003","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300020-01","SmartHealth Silver 3000","Standard Silver On Exchange Plan",,"0.719790518482752","Yes","Yes","No","100%",,"$3,000","$100","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300020-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300018","SmartHealth Gold 2000","23603MT030",,"MTN002","MTS003","MTF010","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300018-00","SmartHealth Gold 2000","Standard Gold Off Exchange Plan",,"0.783516365493793","Yes","Yes","No","100%",,"$2,000","$80","$2,480","$60","$1,046","$1,155","$261","$55","$1,305","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300018-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300018","SmartHealth Gold 2000","23603MT030",,"MTN002","MTS003","MTF010","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300018-01","SmartHealth Gold 2000","Standard Gold On Exchange Plan",,"0.783516365493793","Yes","Yes","No","100%",,"$2,000","$80","$2,480","$60","$1,046","$1,155","$261","$55","$1,305","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300018-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300017","SmartHealth Gold 1000","23603MT030",,"MTN002","MTS003","MTF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300017-00","SmartHealth Gold 1000","Standard Gold Off Exchange Plan",,"0.814709871581639","Yes","Yes","No","100%",,"$1,000","$80","$2,480","$60","$1,000","$1,155","$261","$55","$1,000","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300017-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0300017","SmartHealth Gold 1000","23603MT030",,"MTN002","MTS003","MTF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency  care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0300017-01","SmartHealth Gold 1000","Standard Gold On Exchange Plan",,"0.814709871581639","Yes","Yes","No","100%",,"$1,000","$80","$2,480","$60","$1,000","$1,155","$261","$55","$1,000","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0300017-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","Yes","93-0245545","23603MT0320002","Kids Dental Choice 0-20-50","23603MT032",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","","23603MT0320002-00","Kids Dental Choice 0-20-50","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/individual-dental-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","Yes","93-0245545","23603MT0330002","Dental Choice 0-20-50 750","23603MT033",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0330002-00","Dental Choice 0-20-50 750","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310002","PSN Silver 5000 VH","23603MT031",,"MTN001","MTS001","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9875",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310002-00","PSN Silver 5000 VH","Standard Silver Off Exchange Plan",,"0.696250447952952","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310002-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310002","PSN Silver 5000 VH","23603MT031",,"MTN001","MTS001","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9875",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310002-01","PSN Silver 5000 VH","Standard Silver On Exchange Plan",,"0.696250447952952","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310002-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","Yes","93-0245545","23603MT0330002","Dental Choice 0-20-50 750","23603MT033",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0330002-01","Dental Choice 0-20-50 750","Standard High On Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","Individual","Yes","93-0245545","23603MT0320002","Kids Dental Choice 0-20-50","23603MT032",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","","23603MT0320002-01","Kids Dental Choice 0-20-50","Standard High On Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/individual-dental-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310001","PSN Silver 4000 VH","23603MT031",,"MTN001","MTS001","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9878",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310001-00","PSN Silver 4000 VH","Standard Silver Off Exchange Plan",,"0.705741497195771","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310001-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310001","PSN Silver 4000 VH","23603MT031",,"MTN001","MTS001","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9878",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310001-01","PSN Silver 4000 VH","Standard Silver On Exchange Plan",,"0.705741497195771","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310001-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310009","PSN Silver 3000 VH","23603MT031",,"MTN001","MTS001","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9881",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310009-00","PSN Silver 3000 VH","Standard Silver Off Exchange Plan",,"0.719790518482752","Yes","Yes","No","100%",,"$3,000","$100","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310009-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310009","PSN Silver 3000 VH","23603MT031",,"MTN001","MTS001","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9881",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310009-01","PSN Silver 3000 VH","Standard Silver On Exchange Plan",,"0.719790518482752","Yes","Yes","No","100%",,"$3,000","$100","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310009-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310004","PSN Gold 2000 VH","23603MT031",,"MTN001","MTS001","MTF010","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9895",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310004-00","PSN Gold 2000 VH","Standard Gold Off Exchange Plan",,"0.783516365493793","Yes","Yes","No","100%",,"$2,000","$80","$2,480","$60","$1,046","$1,155","$261","$55","$1,305","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310004-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310004","PSN Gold 2000 VH","23603MT031",,"MTN001","MTS001","MTF010","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9895",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310004-01","PSN Gold 2000 VH","Standard Gold On Exchange Plan",,"0.783516365493793","Yes","Yes","No","100%",,"$2,000","$80","$2,480","$60","$1,046","$1,155","$261","$55","$1,305","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310004-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310003","PSN Gold 1000 VH","23603MT031",,"MTN001","MTS001","MTF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9903",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310003-00","PSN Gold 1000 VH","Standard Gold Off Exchange Plan",,"0.814709871581639","Yes","Yes","No","100%",,"$1,000","$80","$2,480","$60","$1,000","$1,155","$261","$55","$1,000","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310003-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310003","PSN Gold 1000 VH","23603MT031",,"MTN001","MTS001","MTF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9903",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310003-01","PSN Gold 1000 VH","Standard Gold On Exchange Plan",,"0.814709871581639","Yes","Yes","No","100%",,"$1,000","$80","$2,480","$60","$1,000","$1,155","$261","$55","$1,000","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310003-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310006","SmartHealth Silver 5000 VH","23603MT031",,"MTN002","MTS003","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9875",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310006-00","SmartHealth Silver 5000 VH","Standard Silver Off Exchange Plan",,"0.696250447952952","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310006-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310006","SmartHealth Silver 5000 VH","23603MT031",,"MTN002","MTS003","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9875",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310006-01","SmartHealth Silver 5000 VH","Standard Silver On Exchange Plan",,"0.696250447952952","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310006-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310005","SmartHealth Silver 4000 VH","23603MT031",,"MTN002","MTS003","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9878",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310005-00","SmartHealth Silver 4000 VH","Standard Silver Off Exchange Plan",,"0.705741497195771","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310005-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310005","SmartHealth Silver 4000 VH","23603MT031",,"MTN002","MTS003","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9878",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310005-01","SmartHealth Silver 4000 VH","Standard Silver On Exchange Plan",,"0.705741497195771","Yes","Yes","No","100%",,"$3,630","$0","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310005-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310010","SmartHealth Silver 3000 VH","23603MT031",,"MTN002","MTS003","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9881",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310010-00","SmartHealth Silver 3000 VH","Standard Silver Off Exchange Plan",,"0.719790518482752","Yes","Yes","No","100%",,"$3,000","$100","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310010-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310010","SmartHealth Silver 3000 VH","23603MT031",,"MTN002","MTS003","MTF009","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9881",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310010-01","SmartHealth Silver 3000 VH","Standard Silver On Exchange Plan",,"0.719790518482752","Yes","Yes","No","100%",,"$3,000","$100","$3,720","$60","$915","$1,700","$392","$55","$1,142","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310010-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310008","SmartHealth Gold 2000 VH","23603MT031",,"MTN002","MTS003","MTF010","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9895",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310008-00","SmartHealth Gold 2000 VH","Standard Gold Off Exchange Plan",,"0.783516365493793","Yes","Yes","No","100%",,"$2,000","$80","$2,480","$60","$1,046","$1,155","$261","$55","$1,305","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310008-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310008","SmartHealth Gold 2000 VH","23603MT031",,"MTN002","MTS003","MTF010","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9895",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310008-01","SmartHealth Gold 2000 VH","Standard Gold On Exchange Plan",,"0.783516365493793","Yes","Yes","No","100%",,"$2,000","$80","$2,480","$60","$1,046","$1,155","$261","$55","$1,305","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310008-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310007","SmartHealth Gold 1000 VH","23603MT031",,"MTN002","MTS003","MTF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9903",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310007-00","SmartHealth Gold 1000 VH","Standard Gold Off Exchange Plan",,"0.814709871581639","Yes","Yes","No","100%",,"$1,000","$80","$2,480","$60","$1,000","$1,155","$261","$55","$1,000","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310007-00.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","93-0245545","23603MT0310007","SmartHealth Gold 1000 VH","23603MT031",,"MTN002","MTS003","MTF010","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9903",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Employer/","https://www.pacificsource.com/drug-list/","23603MT0310007-01","SmartHealth Gold 1000 VH","Standard Gold On Exchange Plan",,"0.814709871581639","Yes","Yes","No","100%",,"$1,000","$80","$2,480","$60","$1,000","$1,155","$261","$55","$1,000","$150","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://pacificsource.com/2018/SBC/23603MT0310007-01.pdf","https://pacificsource.com/montana/small-group-medical-brochure-2018.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550049","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","30751MT055",,"MTN001","MTS021","MTF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550049-03","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.595366581194293","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","50.00%","$2,850","$2850 per person","$5700 per group","50.00%","$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550040-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550052","Blue Preferred Bronze PPO? 202","30751MT055",,"MTN001","MTS021","MTF010","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550052-00","Blue Preferred Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.606722416425318","Yes","Yes","Yes","43%","57%","$2,700","$900","$2,700","$60","$2,700","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%","$2,700","$2700 per person","$5400 per group","30.00%","$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/sbc/2018/MT0550041-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550038","Blue Preferred Gold PPO?204 - Two $10 PCP Visits","30751MT055",,"MTN001","MTS011","MTF008","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550038-03","Blue Preferred Gold PPO?204 - Two $10 PCP Visits","Limited Cost Sharing Plan Variation",,"0.788288551039278","No","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","30.00%","$450","$450 per person","$900 per group","30.00%","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0550038-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","Yes","93-0245545","23603MT0330003","Dental Choice 0-20-50 1000","23603MT033",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes",,"","23603MT0330003-00","Dental Choice 0-20-50 1000","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","Yes","93-0245545","23603MT0330004","Dental Choice 0-20-50 1500","23603MT033",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes",,"","23603MT0330004-00","Dental Choice 0-20-50 1500","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","Yes","93-0245545","23603MT0330005","Dental Choice Plus 0-20-50 25-1000","23603MT033",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes",,"","23603MT0330005-00","Dental Choice Plus 0-20-50 25-1000","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","Yes","93-0245545","23603MT0330006","Dental Choice Plus 0-20-50 50-1000","23603MT033",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes",,"","23603MT0330006-00","Dental Choice Plus 0-20-50 50-1000","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2018.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550050","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","30751MT055",,"MTN001","MTS031","MTF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550050-03","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.595366581194293","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","50.00%","$2,850","$2850 per person","$5700 per group","50.00%","$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550040-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","Yes","93-0245545","23603MT0330007","Dental Choice Plus 0-20-50 25-1500","23603MT033",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes",,"","23603MT0330007-00","Dental Choice Plus 0-20-50 25-1500","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","Yes","93-0245545","23603MT0330008","Dental Choice Plus 0-20-50 50-1500","23603MT033",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes",,"","23603MT0330008-00","Dental Choice Plus 0-20-50 50-1500","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","Yes","93-0245545","23603MT0330009","Kids Dental Choice 0-20-50","23603MT033",,"MTN003","MTS002",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes",,"","23603MT0330009-00","Kids Dental Choice 0-20-50","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2018.pdf"
"2018","MT","23603","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","Yes","93-0245545","23603MT0330010","Kids Dental Choice 20-40-50","23603MT033",,"MTN003","MTS002",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes",,"","23603MT0330010-00","Kids Dental Choice 20-40-50","Standard Low Off Exchange Plan","68.18%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/montana/small-group-dental-brochure-2018.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","Yes","36-1236610","30751MT0580001","BlueCare Dental? 1A","30751MT058",,"MTN003","MTS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580001-00","BlueCare Dental? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsmt.com/static/mt/pdf/dental/2018/bluecare-dental-individuals-and-families-mt2018.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550042","Blue Preferred Security PPO? 200","30751MT055",,"MTN001","MTS011","MTF006","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550042-00","Blue Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,300","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550042-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550042","Blue Preferred Security PPO? 200","30751MT055",,"MTN001","MTS011","MTF006","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550042-01","Blue Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,300","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550042-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","Yes","36-1236610","30751MT0580001","BlueCare Dental? 1A","30751MT058",,"MTN003","MTS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580001-01","BlueCare Dental? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsmt.com/static/mt/pdf/dental/2018/bluecare-dental-individuals-and-families-mt2018.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550055","Blue Preferred Security PPO? 200","30751MT055",,"MTN001","MTS021","MTF006","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550055-00","Blue Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,300","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550042-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550055","Blue Preferred Security PPO? 200","30751MT055",,"MTN001","MTS021","MTF006","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550055-01","Blue Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,300","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550042-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550056","Blue Preferred Security PPO? 200","30751MT055",,"MTN001","MTS031","MTF006","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550056-00","Blue Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,300","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550042-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550056","Blue Preferred Security PPO? 200","30751MT055",,"MTN001","MTS031","MTF006","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550056-01","Blue Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,300","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550042-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550057","Blue Preferred Security PPO? 200","30751MT055",,"MTN001","MTS041","MTF006","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550057-00","Blue Preferred Security PPO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,300","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550042-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550057","Blue Preferred Security PPO? 200","30751MT055",,"MTN001","MTS041","MTF006","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550057-01","Blue Preferred Security PPO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,300","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550042-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550040","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","30751MT055",,"MTN001","MTS011","MTF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550040-00","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","Standard Bronze Off Exchange Plan",,"0.595366581194293","Yes","Yes","Yes","43%","57%","$2,850","$900","$3,600","$60","$2,850","$200","$1,100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","50.00%","$2,850","$2850 per person","$5700 per group","50.00%","$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550040-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","Yes","36-1236610","30751MT0580003","BlueCare Dental 4 Kids? 1A","30751MT058",,"MTN003","MTS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580003-00","BlueCare Dental 4 Kids? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsmt.com/static/mt/pdf/dental/2018/bluecare-dental-individuals-and-families-mt2018.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","Yes","36-1236610","30751MT0580003","BlueCare Dental 4 Kids? 1A","30751MT058",,"MTN003","MTS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580003-01","BlueCare Dental 4 Kids? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsmt.com/static/mt/pdf/dental/2018/bluecare-dental-individuals-and-families-mt2018.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550040","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","30751MT055",,"MTN001","MTS011","MTF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550040-01","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","Standard Bronze On Exchange Plan",,"0.595366581194293","Yes","Yes","Yes","43%","57%","$2,850","$900","$3,600","$60","$2,850","$200","$1,100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","50.00%","$2,850","$2850 per person","$5700 per group","50.00%","$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550040-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550040","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","30751MT055",,"MTN001","MTS011","MTF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550040-02","Blue Preferred Bronze PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550040-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550040","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","30751MT055",,"MTN001","MTS011","MTF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550040-03","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.595366581194293","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","50.00%","$2,850","$2850 per person","$5700 per group","50.00%","$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550040-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550049","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","30751MT055",,"MTN001","MTS021","MTF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550049-00","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","Standard Bronze Off Exchange Plan",,"0.595366581194293","Yes","Yes","Yes","43%","57%","$2,850","$900","$3,600","$60","$2,850","$200","$1,100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","50.00%","$2,850","$2850 per person","$5700 per group","50.00%","$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550040-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550049","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","30751MT055",,"MTN001","MTS021","MTF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550049-01","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","Standard Bronze On Exchange Plan",,"0.595366581194293","Yes","Yes","Yes","43%","57%","$2,850","$900","$3,600","$60","$2,850","$200","$1,100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","50.00%","$2,850","$2850 per person","$5700 per group","50.00%","$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550040-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550049","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","30751MT055",,"MTN001","MTS021","MTF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550049-02","Blue Preferred Bronze PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550040-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550050","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","30751MT055",,"MTN001","MTS031","MTF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550050-00","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","Standard Bronze Off Exchange Plan",,"0.595366581194293","Yes","Yes","Yes","43%","57%","$2,850","$900","$3,600","$60","$2,850","$200","$1,100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","50.00%","$2,850","$2850 per person","$5700 per group","50.00%","$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550040-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550050","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","30751MT055",,"MTN001","MTS031","MTF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550050-01","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","Standard Bronze On Exchange Plan",,"0.595366581194293","Yes","Yes","Yes","43%","57%","$2,850","$900","$3,600","$60","$2,850","$200","$1,100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","50.00%","$2,850","$2850 per person","$5700 per group","50.00%","$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550040-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550050","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","30751MT055",,"MTN001","MTS031","MTF009","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550050-02","Blue Preferred Bronze PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550040-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550051","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","30751MT055",,"MTN001","MTS041","MTF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550051-00","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","Standard Bronze Off Exchange Plan",,"0.595366581194293","Yes","Yes","Yes","43%","57%","$2,850","$900","$3,600","$60","$2,850","$200","$1,100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","50.00%","$2,850","$2850 per person","$5700 per group","50.00%","$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550040-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550051","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","30751MT055",,"MTN001","MTS041","MTF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550051-01","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","Standard Bronze On Exchange Plan",,"0.595366581194293","Yes","Yes","Yes","43%","57%","$2,850","$900","$3,600","$60","$2,850","$200","$1,100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","50.00%","$2,850","$2850 per person","$5700 per group","50.00%","$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550040-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550051","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","30751MT055",,"MTN001","MTS041","MTF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550051-02","Blue Preferred Bronze PPO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550040-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550051","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","30751MT055",,"MTN001","MTS041","MTF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550051-03","Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.595366581194293","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","50.00%","$2,850","$2850 per person","$5700 per group","50.00%","$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550040-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650013","Blue Focus Bronze POS?  205 - Two $40 PCP Visits","30751MT065",,"MTN002","MTS012","MTF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650013-00","Blue Focus Bronze POS?  205 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564718180418055","Yes","Yes","Yes","43%","57%","$4,000","$900","$2,500","$60","$4,000","$300","$700","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%","$4,000","$4000 per person","$8000 per group","50.00%","$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0650013-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550053","Blue Preferred Bronze PPO? 202","30751MT055",,"MTN001","MTS031","MTF010","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550053-00","Blue Preferred Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.606722416425318","Yes","Yes","Yes","43%","57%","$2,700","$900","$2,700","$60","$2,700","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%","$2,700","$2700 per person","$5400 per group","30.00%","$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/sbc/2018/MT0550041-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550053","Blue Preferred Bronze PPO? 202","30751MT055",,"MTN001","MTS031","MTF010","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550053-01","Blue Preferred Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.606722416425318","Yes","Yes","Yes","43%","57%","$2,700","$900","$2,700","$60","$2,700","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%","$2,700","$2700 per person","$5400 per group","30.00%","$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/sbc/2018/MT0550041-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550053","Blue Preferred Bronze PPO? 202","30751MT055",,"MTN001","MTS031","MTF010","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550053-02","Blue Preferred Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550041-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","Yes","36-1236610","30751MT0580002","BlueCare Dental? 1B","30751MT058",,"MTN003","MTS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580002-00","BlueCare Dental? 1B","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsmt.com/static/mt/pdf/dental/2018/bluecare-dental-individuals-and-families-mt2018.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","Yes","36-1236610","30751MT0580002","BlueCare Dental? 1B","30751MT058",,"MTN003","MTS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580002-01","BlueCare Dental? 1B","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsmt.com/static/mt/pdf/dental/2018/bluecare-dental-individuals-and-families-mt2018.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650013","Blue Focus Bronze POS?  205 - Two $40 PCP Visits","30751MT065",,"MTN002","MTS012","MTF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650013-01","Blue Focus Bronze POS?  205 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564718180418055","Yes","Yes","Yes","43%","57%","$4,000","$900","$2,500","$60","$4,000","$300","$700","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%","$4,000","$4000 per person","$8000 per group","50.00%","$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0650013-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650013","Blue Focus Bronze POS?  205 - Two $40 PCP Visits","30751MT065",,"MTN002","MTS012","MTF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650013-02","Blue Focus Bronze POS?  205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/sbc/2018/MT0650013-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650013","Blue Focus Bronze POS?  205 - Two $40 PCP Visits","30751MT065",,"MTN002","MTS012","MTF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650013-03","Blue Focus Bronze POS?  205 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564718180418055","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%","$4,000","$4000 per person","$8000 per group","50.00%","$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0650013-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650018","Blue Focus Bronze POS?  205 - Two $40 PCP Visits","30751MT065",,"MTN002","MTS032","MTF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650018-00","Blue Focus Bronze POS?  205 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564718180418055","Yes","Yes","Yes","43%","57%","$4,000","$900","$2,500","$60","$4,000","$300","$700","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%","$4,000","$4000 per person","$8000 per group","50.00%","$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0650013-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650018","Blue Focus Bronze POS?  205 - Two $40 PCP Visits","30751MT065",,"MTN002","MTS032","MTF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650018-01","Blue Focus Bronze POS?  205 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564718180418055","Yes","Yes","Yes","43%","57%","$4,000","$900","$2,500","$60","$4,000","$300","$700","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%","$4,000","$4000 per person","$8000 per group","50.00%","$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0650013-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650018","Blue Focus Bronze POS?  205 - Two $40 PCP Visits","30751MT065",,"MTN002","MTS032","MTF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650018-02","Blue Focus Bronze POS?  205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/sbc/2018/MT0650013-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650018","Blue Focus Bronze POS?  205 - Two $40 PCP Visits","30751MT065",,"MTN002","MTS032","MTF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650018-03","Blue Focus Bronze POS?  205 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564718180418055","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%","$4,000","$4000 per person","$8000 per group","50.00%","$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0650013-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550041","Blue Preferred Bronze PPO? 202","30751MT055",,"MTN001","MTS011","MTF010","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550041-00","Blue Preferred Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.606722416425318","Yes","Yes","Yes","43%","57%","$2,700","$900","$2,700","$60","$2,700","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%","$2,700","$2700 per person","$5400 per group","30.00%","$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/sbc/2018/MT0550041-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","Yes","36-1236610","30751MT0580004","BlueCare Dental 4 Kids? 1B","30751MT058",,"MTN003","MTS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580004-00","BlueCare Dental 4 Kids? 1B","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsmt.com/static/mt/pdf/dental/2018/bluecare-dental-individuals-and-families-mt2018.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","Yes","36-1236610","30751MT0580004","BlueCare Dental 4 Kids? 1B","30751MT058",,"MTN003","MTS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580004-01","BlueCare Dental 4 Kids? 1B","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsmt.com/static/mt/pdf/dental/2018/bluecare-dental-individuals-and-families-mt2018.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550041","Blue Preferred Bronze PPO? 202","30751MT055",,"MTN001","MTS011","MTF010","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550041-01","Blue Preferred Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.606722416425318","Yes","Yes","Yes","43%","57%","$2,700","$900","$2,700","$60","$2,700","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%","$2,700","$2700 per person","$5400 per group","30.00%","$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/sbc/2018/MT0550041-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550041","Blue Preferred Bronze PPO? 202","30751MT055",,"MTN001","MTS011","MTF010","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550041-02","Blue Preferred Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550041-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550041","Blue Preferred Bronze PPO? 202","30751MT055",,"MTN001","MTS011","MTF010","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550041-03","Blue Preferred Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.606722416425318","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%","$2,700","$2700 per person","$5400 per group","30.00%","$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/sbc/2018/MT0550041-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550052","Blue Preferred Bronze PPO? 202","30751MT055",,"MTN001","MTS021","MTF010","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550052-01","Blue Preferred Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.606722416425318","Yes","Yes","Yes","43%","57%","$2,700","$900","$2,700","$60","$2,700","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%","$2,700","$2700 per person","$5400 per group","30.00%","$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/sbc/2018/MT0550041-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550052","Blue Preferred Bronze PPO? 202","30751MT055",,"MTN001","MTS021","MTF010","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550052-02","Blue Preferred Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550041-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550052","Blue Preferred Bronze PPO? 202","30751MT055",,"MTN001","MTS021","MTF010","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550052-03","Blue Preferred Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.606722416425318","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%","$2,700","$2700 per person","$5400 per group","30.00%","$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/sbc/2018/MT0550041-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550053","Blue Preferred Bronze PPO? 202","30751MT055",,"MTN001","MTS031","MTF010","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550053-03","Blue Preferred Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.606722416425318","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%","$2,700","$2700 per person","$5400 per group","30.00%","$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/sbc/2018/MT0550041-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550054","Blue Preferred Bronze PPO? 202","30751MT055",,"MTN001","MTS041","MTF010","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550054-00","Blue Preferred Bronze PPO? 202","Standard Bronze Off Exchange Plan",,"0.606722416425318","Yes","Yes","Yes","43%","57%","$2,700","$900","$2,700","$60","$2,700","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%","$2,700","$2700 per person","$5400 per group","30.00%","$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/sbc/2018/MT0550041-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550043","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","30751MT055",,"MTN001","MTS021","MTF008","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550043-03","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","Limited Cost Sharing Plan Variation",,"0.788288551039278","No","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","30.00%","$450","$450 per person","$900 per group","30.00%","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0550038-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550044","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","30751MT055",,"MTN001","MTS031","MTF008","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550044-00","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","Standard Gold Off Exchange Plan",,"0.788288551039278","No","Yes","Yes","43%","57%","$450","$900","$3,400","$60","$450","$900","$700","$60","$450","$0","$400","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","30.00%","$450","$450 per person","$900 per group","30.00%","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0550038-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550044","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","30751MT055",,"MTN001","MTS031","MTF008","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550044-01","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","Standard Gold On Exchange Plan",,"0.788288551039278","No","Yes","Yes","43%","57%","$450","$900","$3,400","$60","$450","$900","$700","$60","$450","$0","$400","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","30.00%","$450","$450 per person","$900 per group","30.00%","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0550038-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550044","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","30751MT055",,"MTN001","MTS031","MTF008","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550044-02","Blue Preferred Gold PPO? 204","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0550038-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550047","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS031","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550047-06","Blue Preferred Silver PPO? 203","94% AV Level Silver Plan",,"0.938395159820657","Yes","Yes","Yes","43%","57%","$0","$300","$700","$60","$0","$0","$1,000","$60","$0","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-06.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0110002","Access Care Silver","32225MT011",,"MTN002","MTS003","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0110002-00","Access Care Silver","Standard Silver Off Exchange Plan",,"0.694780569471957","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$2,750","$400","$1,887","$55","$978","$420","$566","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40.00%",,,,,"$8,250","$8250 per person","$16500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Access_Care_Grp_SIL_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550054","Blue Preferred Bronze PPO? 202","30751MT055",,"MTN001","MTS041","MTF010","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550054-01","Blue Preferred Bronze PPO? 202","Standard Bronze On Exchange Plan",,"0.606722416425318","Yes","Yes","Yes","43%","57%","$2,700","$900","$2,700","$60","$2,700","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%","$2,700","$2700 per person","$5400 per group","30.00%","$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/sbc/2018/MT0550041-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550054","Blue Preferred Bronze PPO? 202","30751MT055",,"MTN001","MTS041","MTF010","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550054-02","Blue Preferred Bronze PPO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550041-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550054","Blue Preferred Bronze PPO? 202","30751MT055",,"MTN001","MTS041","MTF010","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550054-03","Blue Preferred Bronze PPO? 202","Limited Cost Sharing Plan Variation",,"0.606722416425318","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%","$2,700","$2700 per person","$5400 per group","30.00%","$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/sbc/2018/MT0550041-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650009","Blue Focus Gold POS? 207","30751MT065",,"MTN002","MTS012","MTF005","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650009-00","Blue Focus Gold POS? 207","Standard Gold Off Exchange Plan",,"0.78682468930793","Yes","Yes","Yes","43%","57%","$0","$900","$4,200","$60","$0","$0","$2,100","$60","$0","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0650009-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650009","Blue Focus Gold POS? 207","30751MT065",,"MTN002","MTS012","MTF005","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650009-01","Blue Focus Gold POS? 207","Standard Gold On Exchange Plan",,"0.78682468930793","Yes","Yes","Yes","43%","57%","$0","$900","$4,200","$60","$0","$0","$2,100","$60","$0","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0650009-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650009","Blue Focus Gold POS? 207","30751MT065",,"MTN002","MTS012","MTF005","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650009-02","Blue Focus Gold POS? 207","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/sbc/2018/MT0650009-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650009","Blue Focus Gold POS? 207","30751MT065",,"MTN002","MTS012","MTF005","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650009-03","Blue Focus Gold POS? 207","Limited Cost Sharing Plan Variation",,"0.78682468930793","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0650009-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650014","Blue Focus Gold POS? 207","30751MT065",,"MTN002","MTS032","MTF005","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650014-00","Blue Focus Gold POS? 207","Standard Gold Off Exchange Plan",,"0.78682468930793","Yes","Yes","Yes","43%","57%","$0","$900","$4,200","$60","$0","$0","$2,100","$60","$0","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0650009-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650014","Blue Focus Gold POS? 207","30751MT065",,"MTN002","MTS032","MTF005","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650014-01","Blue Focus Gold POS? 207","Standard Gold On Exchange Plan",,"0.78682468930793","Yes","Yes","Yes","43%","57%","$0","$900","$4,200","$60","$0","$0","$2,100","$60","$0","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0650009-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650014","Blue Focus Gold POS? 207","30751MT065",,"MTN002","MTS032","MTF005","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650014-02","Blue Focus Gold POS? 207","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/sbc/2018/MT0650009-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650014","Blue Focus Gold POS? 207","30751MT065",,"MTN002","MTS032","MTF005","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650014-03","Blue Focus Gold POS? 207","Limited Cost Sharing Plan Variation",,"0.78682468930793","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40.00%","$0","$0 per person","$0 per group","40.00%","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0650009-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550038","Blue Preferred Gold PPO?204 - Two $10 PCP Visits","30751MT055",,"MTN001","MTS011","MTF008","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550038-00","Blue Preferred Gold PPO?204 - Two $10 PCP Visits","Standard Gold Off Exchange Plan",,"0.788288551039278","No","Yes","Yes","43%","57%","$450","$900","$3,400","$60","$450","$900","$700","$60","$450","$0","$400","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","30.00%","$450","$450 per person","$900 per group","30.00%","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0550038-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550038","Blue Preferred Gold PPO?204 - Two $10 PCP Visits","30751MT055",,"MTN001","MTS011","MTF008","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550038-01","Blue Preferred Gold PPO?204 - Two $10 PCP Visits","Standard Gold On Exchange Plan",,"0.788288551039278","No","Yes","Yes","43%","57%","$450","$900","$3,400","$60","$450","$900","$700","$60","$450","$0","$400","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","30.00%","$450","$450 per person","$900 per group","30.00%","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0550038-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550038","Blue Preferred Gold PPO?204 - Two $10 PCP Visits","30751MT055",,"MTN001","MTS011","MTF008","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550038-02","Blue Preferred Gold PPO?204","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0550038-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550043","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","30751MT055",,"MTN001","MTS021","MTF008","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550043-00","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","Standard Gold Off Exchange Plan",,"0.788288551039278","No","Yes","Yes","43%","57%","$450","$900","$3,400","$60","$450","$900","$700","$60","$450","$0","$400","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","30.00%","$450","$450 per person","$900 per group","30.00%","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0550038-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550043","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","30751MT055",,"MTN001","MTS021","MTF008","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550043-01","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","Standard Gold On Exchange Plan",,"0.788288551039278","No","Yes","Yes","43%","57%","$450","$900","$3,400","$60","$450","$900","$700","$60","$450","$0","$400","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","30.00%","$450","$450 per person","$900 per group","30.00%","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0550038-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0110001","Access Care Gold","32225MT011",,"MTN002","MTS003","MTF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0110001-01","Access Care Gold","Standard Gold On Exchange Plan",,"0.798851214419172","Yes","Yes","No","100%",,"$950","$60","$3,724","$60","$950","$320","$1,522","$55","$950","$280","$425","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"$17,250","$17250 per person","$34500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","30.00%",,,,,"$2,850","$2850 per person","$5700 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Access_Care_Grp_GLD_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090001","Connected Care Gold","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090001-02","Connected Care Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Connected_Care_GLD_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090001","Connected Care Gold","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090001-03","Connected Care Gold","Limited Cost Sharing Plan Variation",,"0.819092416792304","Yes","Yes","No","100%",,"$750","$70","$3,724","$60","$750","$360","$1,522","$55","$750","$280","$425","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Connected_Care_GLD_NALCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0110002","Access Care Silver","32225MT011",,"MTN002","MTS003","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0110002-01","Access Care Silver","Standard Silver On Exchange Plan",,"0.694780569471957","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$2,750","$400","$1,887","$55","$978","$420","$566","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40.00%",,,,,"$8,250","$8250 per person","$16500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Access_Care_Grp_SIL_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0110003","Access Care Bronze","32225MT011",,"MTN002","MTS003","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0110003-00","Access Care Bronze","Standard Bronze Off Exchange Plan",,"0.585578390902469","Yes","Yes","No","100%",,"$1,376","$0","$5,974","$60","$3,422","$2,720","$1,117","$55","$637","$525","$850","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group","60.00%",,,,,"$21,600","$21600 per person","$43200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Access_Care_Grp_BRZ_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090002","Connected Care Silver","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090002-00","Connected Care Silver","Standard Silver Off Exchange Plan",,"0.702881228244828","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$1,731","$450","$1,708","$55","$958","$455","$566","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","40.00%",,,,,"$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Connected_Care_Ind_SIL_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090002","Connected Care Silver","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090002-01","Connected Care Silver","Standard Silver On Exchange Plan",,"0.702881228244828","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$1,731","$450","$1,708","$55","$958","$455","$566","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","40.00%",,,,,"$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Connected_Care_Ind_SIL_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550043","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","30751MT055",,"MTN001","MTS021","MTF008","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550043-02","Blue Preferred Gold PPO? 204","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0550038-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550044","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","30751MT055",,"MTN001","MTS031","MTF008","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550044-03","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","Limited Cost Sharing Plan Variation",,"0.788288551039278","No","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","30.00%","$450","$450 per person","$900 per group","30.00%","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0550038-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550045","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","30751MT055",,"MTN001","MTS041","MTF008","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550045-00","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","Standard Gold Off Exchange Plan",,"0.788288551039278","No","Yes","Yes","43%","57%","$450","$900","$3,400","$60","$450","$900","$700","$60","$450","$0","$400","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","30.00%","$450","$450 per person","$900 per group","30.00%","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0550038-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550045","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","30751MT055",,"MTN001","MTS041","MTF008","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550045-01","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","Standard Gold On Exchange Plan",,"0.788288551039278","No","Yes","Yes","43%","57%","$450","$900","$3,400","$60","$450","$900","$700","$60","$450","$0","$400","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","30.00%","$450","$450 per person","$900 per group","30.00%","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0550038-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550045","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","30751MT055",,"MTN001","MTS041","MTF008","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550045-02","Blue Preferred Gold PPO? 204","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0550038-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550045","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","30751MT055",,"MTN001","MTS041","MTF008","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550045-03","Blue Preferred Gold PPO? 204 - Two $10 PCP Visits","Limited Cost Sharing Plan Variation",,"0.788288551039278","No","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","30.00%","$450","$450 per person","$900 per group","30.00%","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0550038-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550039","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS011","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550039-00","Blue Preferred Silver PPO? 203","Standard Silver Off Exchange Plan",,"0.691080085175031","Yes","Yes","Yes","43%","57%","$1,000","$900","$5,200","$60","$1,000","$0","$2,200","$60","$1,000","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550039","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS011","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550039-01","Blue Preferred Silver PPO? 203","Standard Silver On Exchange Plan",,"0.691080085175031","Yes","Yes","Yes","43%","57%","$1,000","$900","$5,200","$60","$1,000","$0","$2,200","$60","$1,000","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550039","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS011","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550039-02","Blue Preferred Silver PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550039","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS011","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550039-03","Blue Preferred Silver PPO? 203","Limited Cost Sharing Plan Variation",,"0.691080085175031","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550039","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS011","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550039-04","Blue Preferred Silver PPO? 203","73% AV Level Silver Plan",,"0.72850010086413","Yes","Yes","Yes","43%","57%","$700","$900","$4,300","$60","$700","$0","$2,300","$60","$700","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","$23,400","$23400 per person","$46800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","50.00%","$700","$700 per person","$1400 per group","50.00%","$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-04.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550039","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS011","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550039-05","Blue Preferred Silver PPO? 203","87% AV Level Silver Plan",,"0.87163364587435","Yes","Yes","Yes","43%","57%","$50","$300","$2,200","$60","$50","$0","$2,000","$60","$50","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","$9,800","$9800 per person","$19600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","30.00%","$50","$50 per person","$100 per group","30.00%","$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-05.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550039","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS011","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550039-06","Blue Preferred Silver PPO? 203","94% AV Level Silver Plan",,"0.938395159820657","Yes","Yes","Yes","43%","57%","$0","$300","$700","$60","$0","$0","$1,000","$60","$0","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-06.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550046","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS021","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550046-00","Blue Preferred Silver PPO? 203","Standard Silver Off Exchange Plan",,"0.691080085175031","Yes","Yes","Yes","43%","57%","$1,000","$900","$5,200","$60","$1,000","$0","$2,200","$60","$1,000","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550046","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS021","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550046-01","Blue Preferred Silver PPO? 203","Standard Silver On Exchange Plan",,"0.691080085175031","Yes","Yes","Yes","43%","57%","$1,000","$900","$5,200","$60","$1,000","$0","$2,200","$60","$1,000","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550046","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS021","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550046-02","Blue Preferred Silver PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550046","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS021","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550046-03","Blue Preferred Silver PPO? 203","Limited Cost Sharing Plan Variation",,"0.691080085175031","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550046","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS021","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550046-04","Blue Preferred Silver PPO? 203","73% AV Level Silver Plan",,"0.72850010086413","Yes","Yes","Yes","43%","57%","$700","$900","$4,300","$60","$700","$0","$2,300","$60","$700","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","$23,400","$23400 per person","$46800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","50.00%","$700","$700 per person","$1400 per group","50.00%","$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-04.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550046","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS021","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550046-05","Blue Preferred Silver PPO? 203","87% AV Level Silver Plan",,"0.87163364587435","Yes","Yes","Yes","43%","57%","$50","$300","$2,200","$60","$50","$0","$2,000","$60","$50","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","$9,800","$9800 per person","$19600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","30.00%","$50","$50 per person","$100 per group","30.00%","$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-05.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550046","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS021","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550046-06","Blue Preferred Silver PPO? 203","94% AV Level Silver Plan",,"0.938395159820657","Yes","Yes","Yes","43%","57%","$0","$300","$700","$60","$0","$0","$1,000","$60","$0","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-06.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550047","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS031","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550047-00","Blue Preferred Silver PPO? 203","Standard Silver Off Exchange Plan",,"0.691080085175031","Yes","Yes","Yes","43%","57%","$1,000","$900","$5,200","$60","$1,000","$0","$2,200","$60","$1,000","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550047","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS031","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550047-01","Blue Preferred Silver PPO? 203","Standard Silver On Exchange Plan",,"0.691080085175031","Yes","Yes","Yes","43%","57%","$1,000","$900","$5,200","$60","$1,000","$0","$2,200","$60","$1,000","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550047","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS031","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550047-02","Blue Preferred Silver PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550047","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS031","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550047-03","Blue Preferred Silver PPO? 203","Limited Cost Sharing Plan Variation",,"0.691080085175031","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550047","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS031","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550047-04","Blue Preferred Silver PPO? 203","73% AV Level Silver Plan",,"0.72850010086413","Yes","Yes","Yes","43%","57%","$700","$900","$4,300","$60","$700","$0","$2,300","$60","$700","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","$23,400","$23400 per person","$46800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","50.00%","$700","$700 per person","$1400 per group","50.00%","$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-04.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550047","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS031","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550047-05","Blue Preferred Silver PPO? 203","87% AV Level Silver Plan",,"0.87163364587435","Yes","Yes","Yes","43%","57%","$50","$300","$2,200","$60","$50","$0","$2,000","$60","$50","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","$9,800","$9800 per person","$19600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","30.00%","$50","$50 per person","$100 per group","30.00%","$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-05.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550048","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS041","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550048-00","Blue Preferred Silver PPO? 203","Standard Silver Off Exchange Plan",,"0.691080085175031","Yes","Yes","Yes","43%","57%","$1,000","$900","$5,200","$60","$1,000","$0","$2,200","$60","$1,000","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550048","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS041","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550048-01","Blue Preferred Silver PPO? 203","Standard Silver On Exchange Plan",,"0.691080085175031","Yes","Yes","Yes","43%","57%","$1,000","$900","$5,200","$60","$1,000","$0","$2,200","$60","$1,000","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550048","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS041","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550048-02","Blue Preferred Silver PPO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550048","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS041","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550048-03","Blue Preferred Silver PPO? 203","Limited Cost Sharing Plan Variation",,"0.691080085175031","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50.00%","$1,000","$1000 per person","$2000 per group","50.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550048","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS041","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550048-04","Blue Preferred Silver PPO? 203","73% AV Level Silver Plan",,"0.72850010086413","Yes","Yes","Yes","43%","57%","$700","$900","$4,300","$60","$700","$0","$2,300","$60","$700","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","$23,400","$23400 per person","$46800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","50.00%","$700","$700 per person","$1400 per group","50.00%","$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-04.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550048","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS041","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550048-05","Blue Preferred Silver PPO? 203","87% AV Level Silver Plan",,"0.87163364587435","Yes","Yes","Yes","43%","57%","$50","$300","$2,200","$60","$50","$0","$2,000","$60","$50","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","$9,800","$9800 per person","$19600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","30.00%","$50","$50 per person","$100 per group","30.00%","$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-05.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0550048","Blue Preferred Silver PPO? 203","30751MT055",,"MTN001","MTS041","MTF010","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0550048-06","Blue Preferred Silver PPO? 203","94% AV Level Silver Plan",,"0.938395159820657","Yes","Yes","Yes","43%","57%","$0","$300","$700","$60","$0","$0","$1,000","$60","$0","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%","$0","$0 per person","$0 per group","20.00%","$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/sbc/2018/MT0550039-06.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650012","Blue Focus Silver POS? 206 - Two $25 PCP Visits","30751MT065",,"MTN002","MTS012","MTF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650012-00","Blue Focus Silver POS? 206 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.66489452256629","No","Yes","Yes","43%","57%","$3,500","$900","$3,900","$60","$2,700","$1,000","$0","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","50.00%","$3,500","$3500 per person","$7000 per group","50.00%","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0650012-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650012","Blue Focus Silver POS? 206 - Two $25 PCP Visits","30751MT065",,"MTN002","MTS012","MTF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650012-01","Blue Focus Silver POS? 206 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.66489452256629","No","Yes","Yes","43%","57%","$3,500","$900","$3,900","$60","$2,700","$1,000","$0","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","50.00%","$3,500","$3500 per person","$7000 per group","50.00%","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0650012-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650012","Blue Focus Silver POS? 206 - Two $25 PCP Visits","30751MT065",,"MTN002","MTS012","MTF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650012-02","Blue Focus Silver POS? 206","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0650012-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650012","Blue Focus Silver POS? 206 - Two $25 PCP Visits","30751MT065",,"MTN002","MTS012","MTF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650012-03","Blue Focus Silver POS? 206 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.66489452256629","No","Yes","Yes","43%","57%","$3,500","$0","$0","$60","$2,900","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","50.00%","$3,500","$3500 per person","$7000 per group","50.00%","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0650012-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650012","Blue Focus Silver POS? 206 - Two $25 PCP Visits","30751MT065",,"MTN002","MTS012","MTF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650012-04","Blue Focus Silver POS? 206 - Two $15 PCP Visits","73% AV Level Silver Plan",,"0.727537283629422","No","Yes","Yes","43%","57%","$1,500","$900","$4,300","$60","$1,500","$900","$700","$60","$1,500","$0","$200","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","$23,400","$23400 per person","$46800 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50.00%","$1,500","$1500 per person","$3000 per group","50.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0650012-04.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650012","Blue Focus Silver POS? 206 - Two $25 PCP Visits","30751MT065",,"MTN002","MTS012","MTF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650012-05","Blue Focus Silver POS? 206 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.868535086696057","No","Yes","Yes","43%","57%","$100","$300","$2,300","$60","$100","$900","$800","$60","$100","$0","$500","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","$9,800","$9800 per person","$19600 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","30.00%","$100","$100 per person","$200 per group","30.00%","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0650012-05.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650012","Blue Focus Silver POS? 206 - Two $25 PCP Visits","30751MT065",,"MTN002","MTS012","MTF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650012-06","Blue Focus Silver POS? 206 - Two $10 PCP Visits","94% AV Level Silver Plan",,"0.938607292126768","No","Yes","Yes","43%","57%","$0","$300","$1,000","$60","$0","$600","$400","$60","$0","$0","$300","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","15.00%","$0","$0 per person","$0 per group","15.00%","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0650012-06.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650017","Blue Focus Silver POS? 206 - Two $25 PCP Visits","30751MT065",,"MTN002","MTS032","MTF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650017-00","Blue Focus Silver POS? 206 - Two $25 PCP Visits","Standard Silver Off Exchange Plan",,"0.66489452256629","No","Yes","Yes","43%","57%","$3,500","$900","$3,900","$60","$2,700","$1,000","$0","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","50.00%","$3,500","$3500 per person","$7000 per group","50.00%","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0650012-00.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650017","Blue Focus Silver POS? 206 - Two $25 PCP Visits","30751MT065",,"MTN002","MTS032","MTF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650017-01","Blue Focus Silver POS? 206 - Two $25 PCP Visits","Standard Silver On Exchange Plan",,"0.66489452256629","No","Yes","Yes","43%","57%","$3,500","$900","$3,900","$60","$2,700","$1,000","$0","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","50.00%","$3,500","$3500 per person","$7000 per group","50.00%","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0650012-01.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650017","Blue Focus Silver POS? 206 - Two $25 PCP Visits","30751MT065",,"MTN002","MTS032","MTF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650017-02","Blue Focus Silver POS? 206","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0650012-02.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650017","Blue Focus Silver POS? 206 - Two $25 PCP Visits","30751MT065",,"MTN002","MTS032","MTF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650017-03","Blue Focus Silver POS? 206 - Two $25 PCP Visits","Limited Cost Sharing Plan Variation",,"0.66489452256629","No","Yes","Yes","43%","57%","$3,500","$0","$0","$60","$2,900","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","50.00%","$3,500","$3500 per person","$7000 per group","50.00%","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0650012-03.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650017","Blue Focus Silver POS? 206 - Two $25 PCP Visits","30751MT065",,"MTN002","MTS032","MTF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650017-04","Blue Focus Silver POS? 206 - Two $15 PCP Visits","73% AV Level Silver Plan",,"0.727537283629422","No","Yes","Yes","43%","57%","$1,500","$900","$4,300","$60","$1,500","$900","$700","$60","$1,500","$0","$200","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","$23,400","$23400 per person","$46800 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50.00%","$1,500","$1500 per person","$3000 per group","50.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0650012-04.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650017","Blue Focus Silver POS? 206 - Two $25 PCP Visits","30751MT065",,"MTN002","MTS032","MTF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650017-05","Blue Focus Silver POS? 206 - Two $15 PCP Visits","87% AV Level Silver Plan",,"0.868535086696057","No","Yes","Yes","43%","57%","$100","$300","$2,300","$60","$100","$900","$800","$60","$100","$0","$500","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","$9,800","$9800 per person","$19600 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","30.00%","$100","$100 per person","$200 per group","30.00%","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0650012-05.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","30751","SERFF","2017-08-16 20:15:58","Individual","No","36-1236610","30751MT0650017","Blue Focus Silver POS? 206 - Two $25 PCP Visits","30751MT065",,"MTN002","MTS032","MTF003","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/MT_6T_EX.pdf","30751MT0650017-06","Blue Focus Silver POS? 206 - Two $10 PCP Visits","94% AV Level Silver Plan",,"0.938607292126768","No","Yes","Yes","43%","57%","$0","$300","$1,000","$60","$0","$600","$400","$60","$0","$0","$300","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","15.00%","$0","$0 per person","$0 per group","15.00%","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/sbc/2018/MT0650012-06.pdf","http://www.bcbsmt.com/brochure/2018/mt-plan-overview.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0110001","Access Care Gold","32225MT011",,"MTN002","MTS003","MTF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0110001-00","Access Care Gold","Standard Gold Off Exchange Plan",,"0.798851214419172","Yes","Yes","No","100%",,"$950","$60","$3,724","$60","$950","$320","$1,522","$55","$950","$280","$425","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"$17,250","$17250 per person","$34500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","30.00%",,,,,"$2,850","$2850 per person","$5700 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Access_Care_Grp_GLD_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090001","Connected Care Gold","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090001-00","Connected Care Gold","Standard Gold Off Exchange Plan",,"0.819092416792304","Yes","Yes","No","100%",,"$750","$70","$3,724","$60","$750","$360","$1,522","$55","$750","$280","$425","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Connected_Care_Ind_GLD_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090001","Connected Care Gold","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090001-01","Connected Care Gold","Standard Gold On Exchange Plan",,"0.819092416792304","Yes","Yes","No","100%",,"$750","$70","$3,724","$60","$750","$360","$1,522","$55","$750","$280","$425","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Connected_Care_Ind_GLD_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0110003","Access Care Bronze","32225MT011",,"MTN002","MTS003","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0110003-01","Access Care Bronze","Standard Bronze On Exchange Plan",,"0.585578390902469","Yes","Yes","No","100%",,"$1,376","$0","$5,974","$60","$3,422","$2,720","$1,117","$55","$637","$525","$850","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group","60.00%",,,,,"$21,600","$21600 per person","$43200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Access_Care_Grp_BRZ_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0110004","Access Care Bronze Plus","32225MT011",,"MTN002","MTS003","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0110004-00","Access Care Bronze Plus","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Access_Care_Grp_BRZ_PLUS_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090002","Connected Care Silver","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090002-02","Connected Care Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Connected_Care_SIL_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090002","Connected Care Silver","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090002-03","Connected Care Silver","Limited Cost Sharing Plan Variation",,"0.702881228244828","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$1,731","$450","$1,708","$55","$958","$455","$566","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","40.00%",,,,,"$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Connected_Care_SIL_NALCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0110004","Access Care Bronze Plus","32225MT011",,"MTN002","MTS003","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0110004-01","Access Care Bronze Plus","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Access_Care_Grp_BRZ_PLUS_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0110005","Access Care Expanded Bronze","32225MT011",,"MTN002","MTS003","MTF001","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0110005-00","Access Care Expanded Bronze","Standard Bronze Off Exchange Plan",,"0.630801138004309","Yes","Yes","No","100%",,"$1,376","$0","$5,624","$60","$4,561","$630","$1,809","$55","$637","$525","$850","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","60.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Access_Care_Grp_Exp_BRZ_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090002","Connected Care Silver","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090002-04","Connected Care Silver","73% AV Level Silver Plan",,"0.737974943863845","Yes","Yes","No","100%",,"$2,064","$0","$3,136","$60","$1,771","$410","$1,887","$55","$958","$455","$566","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$15,600","$15600 per person","$31200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","40.00%",,,,,"$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Connected_Care_Ind_SIL73_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090002","Connected Care Silver","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090002-05","Connected Care Silver","87% AV Level Silver Plan",,"0.874577076718411","Yes","Yes","No","100%",,"$500","$0","$1,500","$60","$500","$210","$1,290","$55","$500","$315","$425","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Connected_Care_Ind_SIL87_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0110005","Access Care Expanded Bronze","32225MT011",,"MTN002","MTS003","MTF001","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0110005-01","Access Care Expanded Bronze","Standard Bronze On Exchange Plan",,"0.630801138004309","Yes","Yes","No","100%",,"$1,376","$0","$5,624","$60","$4,561","$630","$1,809","$55","$637","$525","$850","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","60.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Access_Care_Grp_Exp_BRZ_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090002","Connected Care Silver","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090002-06","Connected Care Silver","94% AV Level Silver Plan",,"0.943549156318667","Yes","Yes","No","100%",,"$0","$0","$800","$60","$0","$140","$660","$55","$0","$245","$284","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Connected_Care_Ind_SIL94_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090003","Connected Care Bronze","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090003-00","Connected Care Bronze","Standard Bronze Off Exchange Plan",,"0.585578349186792","Yes","Yes","No","100%",,"$1,376","$0","$5,974","$0","$3,923","$480","$2,781","$55","$770","$0","$1,155","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group","60.00%",,,,,"$21,600","$21600 per person","$43200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Connected_Care_Ind_BRZ_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090003","Connected Care Bronze","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090003-01","Connected Care Bronze","Standard Bronze On Exchange Plan",,"0.585578349186792","Yes","Yes","No","100%",,"$1,376","$0","$5,974","$0","$3,923","$480","$2,781","$55","$770","$0","$1,155","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group","60.00%",,,,,"$21,600","$21600 per person","$43200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Connected_Care_Ind_BRZ_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090003","Connected Care Bronze","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090003-02","Connected Care Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Connected_Care_BRZ_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090003","Connected Care Bronze","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090003-03","Connected Care Bronze","Limited Cost Sharing Plan Variation",,"0.585578349186792","Yes","Yes","No","100%",,"$1,376","$0","$5,974","$0","$3,923","$480","$2,781","$55","$770","$0","$1,155","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group","60.00%",,,,,"$21,600","$21600 per person","$43200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Connected_Care_BRZ_NALCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090004","Connected Care Bronze Plus","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090004-00","Connected Care Bronze Plus","Standard Bronze Off Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$0","$6,650","$0","$0","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Connected_Care_Ind_BRZ_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090004","Connected Care Bronze Plus","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090004-01","Connected Care Bronze Plus","Standard Bronze On Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$0","$6,650","$0","$0","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Connected_Care_Ind_BRZ_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090004","Connected Care Bronze Plus","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090004-02","Connected Care Bronze Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Connected_Care_BRZ_PLUS_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090004","Connected Care Bronze Plus","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090004-03","Connected Care Bronze Plus","Limited Cost Sharing Plan Variation",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$0","$6,650","$0","$0","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Connected_Care_BRZ_PLUS_NALCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090005","Connected Care Silver Option 2","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090005-00","Connected Care Silver Option 2","Standard Silver Off Exchange Plan",,"0.675075046953061","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$4,388","$450","$2,346","$55","$822","$1,055","$265","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","40.00%",,,,,"$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Connected_Care_Ind_SIL_OP2_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090005","Connected Care Silver Option 2","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090005-01","Connected Care Silver Option 2","Standard Silver On Exchange Plan",,"0.675075046953061","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$4,388","$450","$2,346","$55","$822","$1,055","$265","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","40.00%",,,,,"$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Connected_Care_Ind_SIL_OP2_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090005","Connected Care Silver Option 2","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090005-02","Connected Care Silver Option 2","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Connected_Care_SIL_OP2_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090005","Connected Care Silver Option 2","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090005-03","Connected Care Silver Option 2","Limited Cost Sharing Plan Variation",,"0.675075046953061","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$1,260","$450","$2,346","$55","$822","$1,055","$265","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","40.00%",,,,,"$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Connected_Care_SIL_OP2_NALCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090005","Connected Care Silver Option 2","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090005-04","Connected Care Silver Option 2","73% AV Level Silver Plan",,"0.73857210542301","Yes","Yes","No","100%",,"$2,064","$0","$3,936","$60","$1,260","$450","$187","$55","$822","$1,055","$265","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"$16,800","$16800 per person","$33600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","40.00%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Connected_Care_Ind_SIL73_OP2_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090005","Connected Care Silver Option 2","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090005-05","Connected Care Silver Option 2","87% AV Level Silver Plan",,"0.870625974684902","Yes","Yes","No","100%",,"$300","$0","$2,150","$60","$300","$320","$1,522","$55","$300","$360","$425","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","30.00%",,,,,"$900","$900 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Connected_Care_Ind_SIL87_OP2_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090005","Connected Care Silver Option 2","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090005-06","Connected Care Silver Option 2","94% AV Level Silver Plan",,"0.936090582641448","Yes","Yes","No","100%",,"$0","$0","$1,000","$60","$0","$190","$810","$55","$0","$175","$284","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Connected_Care_Ind_SIL94_OP2_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090006","Connected Care Catastrophic","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Catastrophic","Not Applicable","No","On the Exchange","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090006-01","Connected Care Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,350","$0","$0","$55","$1,925","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Connected_Care_Ind_CAT_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090007","Connected Care Expanded Bronze","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090007-00","Connected Care Expanded Bronze","Standard Bronze Off Exchange Plan",,"0.634479847278194","Yes","Yes","No","100%",,"$1,720","$0","$5,480","$60","$3,174","$2,610","$931","$55","$708","$420","$708","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"$21,600","$21600 per person","$43200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Connected_Care_Ind_BRZ_EXP_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090007","Connected Care Expanded Bronze","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090007-01","Connected Care Expanded Bronze","Standard Bronze On Exchange Plan",,"0.634479847278194","Yes","Yes","No","100%",,"$1,720","$0","$5,480","$60","$3,174","$2,610","$931","$55","$708","$420","$708","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"$21,600","$21600 per person","$43200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Connected_Care_Ind_BRZ_EXP_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090007","Connected Care Expanded Bronze","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090007-02","Connected Care Expanded Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Connected_Care_BRZ_EXP_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0090007","Connected Care Expanded Bronze","32225MT009",,"MTN001","MTS002","MTF001","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0090007-03","Connected Care Expanded Bronze","Limited Cost Sharing Plan Variation",,"0.634479847278194","Yes","Yes","No","100%",,"$1,720","$0","$5,480","$60","$3,174","$2,610","$931","$55","$708","$420","$708","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"$21,600","$21600 per person","$43200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Connected_Care_BRZ_EXP_NALCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080001","Access Care Gold","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080001-00","Access Care Gold","Standard Gold Off Exchange Plan",,"0.801762545966285","Yes","Yes","No","100%",,"$800","$60","$3,724","$60","$800","$320","$1,522","$55","$800","$280","$425","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"$17,250","$17250 per person","$34500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","30.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Access_Care_Ind_GLD_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0100001","Connected Care Gold","32225MT010",,"MTN001","MTS002","MTF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0100001-00","Connected Care Gold","Standard Gold Off Exchange Plan",,"0.811336246192291","Yes","Yes","No","100%",,"$750","$60","$3,724","$60","$750","$320","$1,522","$55","$750","$280","$425","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Connected_Care_Grp_GLD_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0100001","Connected Care Gold","32225MT010",,"MTN001","MTS002","MTF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0100001-01","Connected Care Gold","Standard Gold On Exchange Plan",,"0.811336246192291","Yes","Yes","No","100%",,"$750","$60","$3,724","$60","$750","$320","$1,522","$55","$750","$280","$425","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Connected_Care_Grp_GLD_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080001","Access Care Gold","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080001-01","Access Care Gold","Standard Gold On Exchange Plan",,"0.801762545966285","Yes","Yes","No","100%",,"$800","$60","$3,724","$60","$800","$320","$1,522","$55","$800","$280","$425","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"$17,250","$17250 per person","$34500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","30.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Access_Care_Ind_GLD_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080001","Access Care Gold","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080001-02","Access Care Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Access_Care_GLD_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0100002","Connected Care Silver","32225MT010",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0100002-00","Connected Care Silver","Standard Silver Off Exchange Plan",,"0.708729911383755","Yes","Yes","No","100%",,"$2,150","$70","$4,964","$60","$1,771","$410","$1,887","$55","$958","$455","$566","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","40.00%",,,,,"$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Connected_Care_Grp_SIL_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0100002","Connected Care Silver","32225MT010",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0100002-01","Connected Care Silver","Standard Silver On Exchange Plan",,"0.708729911383755","Yes","Yes","No","100%",,"$2,150","$70","$4,964","$60","$1,771","$410","$1,887","$55","$958","$455","$566","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","40.00%",,,,,"$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Connected_Care_Grp_SIL_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080001","Access Care Gold","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080001-03","Access Care Gold","Limited Cost Sharing Plan Variation",,"0.801762545966285","Yes","Yes","No","100%",,"$800","$60","$3,724","$60","$800","$320","$1,522","$55","$800","$280","$425","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"$17,250","$17250 per person","$34500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","30.00%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Access_Care_GLD_NALCS_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080002","Access Care Silver","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080002-00","Access Care Silver","Standard Silver Off Exchange Plan",,"0.697760906432771","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$1,731","$450","$1,954","$55","$958","$455","$566","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","40.00%",,,,,"$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Access_Care_Ind_SIL_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0100003","Connected Care Bronze","32225MT010",,"MTN001","MTS002","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0100003-00","Connected Care Bronze","Standard Bronze Off Exchange Plan",,"0.5855783725307","Yes","Yes","No","100%",,"$1,376","$0","$5,974","$60","$3,409","$2,570","$1,281","$55","$770","$0","$1,155","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group","60.00%",,,,,"$21,600","$21600 per person","$43200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Connected Care_Grp_BRZ_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0100003","Connected Care Bronze","32225MT010",,"MTN001","MTS002","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0100003-01","Connected Care Bronze","Standard Bronze On Exchange Plan",,"0.5855783725307","Yes","Yes","No","100%",,"$1,376","$0","$5,974","$60","$3,409","$2,570","$1,281","$55","$770","$0","$1,155","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group","60.00%",,,,,"$21,600","$21600 per person","$43200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Connected_Care_Grp_BRZ_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080002","Access Care Silver","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080002-01","Access Care Silver","Standard Silver On Exchange Plan",,"0.697760906432771","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$1,731","$450","$1,954","$55","$958","$455","$566","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","40.00%",,,,,"$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Access_Care_Ind_SIL_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080002","Access Care Silver","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080002-02","Access Care Silver","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Access_Care_SIL_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0100004","Connected Care Silver Plus","32225MT010",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0100004-00","Connected Care Silver Plus","Standard Silver Off Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,660","$0","$0","$60","$3,600","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Connected_Care_Grp_SIL_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0100004","Connected Care Silver Plus","32225MT010",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0100004-01","Connected Care Silver Plus","Standard Silver On Exchange Plan",,"0.718168390890787","Yes","Yes","No","100%",,"$3,660","$0","$0","$60","$3,600","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0.00%",,,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Connected_Care_Grp_SIL_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080002","Access Care Silver","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080002-03","Access Care Silver","Limited Cost Sharing Plan Variation",,"0.697760906432771","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$1,731","$450","$1,954","$55","$958","$455","$566","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","40.00%",,,,,"$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Access_Care_SIL_NALCS_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080002","Access Care Silver","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080002-04","Access Care Silver","73% AV Level Silver Plan",,"0.733133362517905","Yes","Yes","No","100%",,"$2,064","$0","$4,536","$60","$1,260","$450","$1,529","$55","$1,077","$195","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"$16,800","$16800 per person","$33600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","40.00%",,,,,"$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Access_Care_Ind_SIL73_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0100005","Connected Care Bronze Plus","32225MT010",,"MTN001","MTS002","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0100005-00","Connected Care Bronze Plus","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Connected_Care_Grp_BRZ_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0100005","Connected Care Bronze Plus","32225MT010",,"MTN001","MTS002","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0100005-01","Connected Care Bronze Plus","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Connected_Care_Grp_BRZ_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080002","Access Care Silver","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080002-05","Access Care Silver","87% AV Level Silver Plan",,"0.874113109825643","Yes","Yes","No","100%",,"$550","$0","$1,100","$60","$550","$195","$905","$55","$550","$135","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","20.00%",,,,,"$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Access_Care_Ind_SIL87_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080002","Access Care Silver","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080002-06","Access Care Silver","94% AV Level Silver Plan",,"0.933063576583376","Yes","Yes","No","100%",,"$50","$0","$100","$0","$50","$0","$100","$55","$50","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","10.00%",,,,,"$150","$150 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Access_Care_Ind_SIL94_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0100006","Connected Care Silver Option 2","32225MT010",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0100006-00","Connected Care Silver Option 2","Standard Silver Off Exchange Plan",,"0.679458994848288","Yes","Yes","No","100%",,"$2,140","$0","$4,960","$60","$1,761","$420","$1,954","$55","$1,122","$150","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"$21,300","$21300 per person","$42600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","40.00%",,,,,"$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Connected_Care_Grp_SIL_Option2_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0100006","Connected Care Silver Option 2","32225MT010",,"MTN001","MTS002","MTF001","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0100006-01","Connected Care Silver Option 2","Standard Silver On Exchange Plan",,"0.679458994848288","Yes","Yes","No","100%",,"$2,140","$0","$4,960","$60","$1,761","$420","$1,954","$55","$1,122","$150","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"$21,300","$21300 per person","$42600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","40.00%",,,,,"$17,100","$17100 per person","$34200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Connected_Care_Grp_SIL_Option2_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080003","Access Care Bronze","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080003-00","Access Care Bronze","Standard Bronze Off Exchange Plan",,"0.5855783725307","Yes","Yes","No","100%",,"$1,376","$0","$5,974","$60","$3,409","$2,570","$1,281","$55","$770","$0","$1,155","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group","60.00%",,,,,"$21,600","$21600 per person","$43200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Access_Care_Ind_BRZ_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080003","Access Care Bronze","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080003-01","Access Care Bronze","Standard Bronze On Exchange Plan",,"0.5855783725307","Yes","Yes","No","100%",,"$1,376","$0","$5,974","$60","$3,409","$2,570","$1,281","$55","$770","$0","$1,155","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group","60.00%",,,,,"$21,600","$21600 per person","$43200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Access_Care_Ind_BRZ_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0100007","Connected Care Expanded Bronze","32225MT010",,"MTN001","MTS002","MTF001","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0100007-00","Connected Care Expanded Bronze","Standard Bronze Off Exchange Plan",,"0.632617764735321","Yes","Yes","No","100%",,"$1,720","$0","$5,480","$60","$3,867","$630","$2,252","$55","$708","$525","$708","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"$21,600","$21600 per person","$43200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Connected_Care_Grp_BRZ_Expanded_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","SHOP (Small Group)","No","45-1295465","32225MT0100007","Connected Care Expanded Bronze","32225MT010",,"MTN001","MTS002","MTF001","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0100007-01","Connected Care Expanded Bronze","Standard Bronze On Exchange Plan",,"0.632617764735321","Yes","Yes","No","100%",,"$1,720","$0","$5,480","$60","$3,867","$630","$2,252","$55","$708","$525","$708","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"$21,600","$21600 per person","$43200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2018/MT_2018_Connected_Care_Grp_BRZ_Expanded_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2018/MHC-MT-Small-Group-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080003","Access Care Bronze","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080003-02","Access Care Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Access_Care_BRZ_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080003","Access Care Bronze","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080003-03","Access Care Bronze","Limited Cost Sharing Plan Variation",,"0.5855783725307","Yes","Yes","No","100%",,"$1,376","$0","$5,974","$60","$3,409","$2,570","$1,281","$55","$770","$0","$1,155","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group","60.00%",,,,,"$21,600","$21600 per person","$43200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Access_Care_BRZ_NALCS_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080004","Access Care Bronze Plus","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080004-00","Access Care Bronze Plus","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Access_Care_Ind_BRZ_PLUS_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080004","Access Care Bronze Plus","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080004-01","Access Care Bronze Plus","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Access_Care_Ind_BRZ_PLUS_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080004","Access Care Bronze Plus","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080004-02","Access Care Bronze Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Access_Care_BRZ_PLUS_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080004","Access Care Bronze Plus","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080004-03","Access Care Bronze Plus","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Access_Care_BRZ_PLUS_NALCS_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080005","Access Care Expanded Bronze","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080005-00","Access Care Expanded Bronze","Standard Bronze Off Exchange Plan",,"0.636911099193105","Yes","Yes","No","100%",,"$1,376","$0","$5,424","$60","$3,860","$550","$2,259","$55","$566","$525","$850","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$20,400","$20400 per person","$40800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","60.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Access_Care_Ind_BRZ_EXP_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080005","Access Care Expanded Bronze","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080005-01","Access Care Expanded Bronze","Standard Bronze On Exchange Plan",,"0.636911099193105","Yes","Yes","No","100%",,"$1,376","$0","$5,424","$60","$3,860","$550","$2,259","$55","$566","$525","$850","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$20,400","$20400 per person","$40800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","60.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Access_Care_Ind_BRZ_EXP_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080005","Access Care Expanded Bronze","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080005-02","Access Care Expanded Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Access_Care_BRZ_EXP_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","32225","SERFF","2017-11-01 20:15:29","Individual","No","45-1295465","32225MT0080005","Access Care Expanded Bronze","32225MT008",,"MTN002","MTS001","MTF001","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,"0","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://client.formularynavigator.com/Search.aspx?siteCode=0915542158","32225MT0080005-03","Access Care Expanded Bronze","Limited Cost Sharing Plan Variation",,"0.636911099193105","Yes","Yes","No","100%",,"$1,376","$0","$5,424","$60","$3,860","$550","$2,259","$55","$566","$525","$850","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$20,400","$20400 per person","$40800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","60.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2018/2018_MT_Native_American_Access_Care_BRZ_EXP_NALCS_SBC.pdf","http://www.mhc.coop/wp-content/uploads/2018/MHC-MT-Ind-Plan-Comparison.pdf"
"2018","MT","59110","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","57-0523959","59110MT0020001","Group Dental Policy","59110MT002",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","59110MT0020001-00","Group Dental Policy","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MT","62818","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","13-5123390","62818MT0010002","Guardian Pediatric Advantage","62818MT001",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is allowed outside of the Service Area.","Yes",,"","62818MT0010002-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","86.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MT","62818","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","13-5123390","62818MT0020003","Guardian Pediatric Essentials","62818MT002",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is allowed outside of the Service Area.","Yes",,"","62818MT0020003-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","MT","70415","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","47-0098400","70415MT0030002","EHB High Passive","70415MT003",,"MTN001","MTS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","70415MT0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020003","Medica with CHI Health Silver Copay","20305NE002",,"NEN002","NES003","NEF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020003-03","Medica with CHI Health Silver Copay","Limited Cost Sharing Plan Variation",,"0.68768656753985","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHSCNEL&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020003","Medica with CHI Health Silver Copay","20305NE002",,"NEN002","NES003","NEF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020003-04","Medica with CHI Health Silver Copay","73% AV Level Silver Plan",,"0.728378078020517","Yes","Yes","No","100%",,"$2,500","$10","$2,600","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHSCNE73&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020003","Medica with CHI Health Silver Copay","20305NE002",,"NEN002","NES003","NEF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020003-05","Medica with CHI Health Silver Copay","87% AV Level Silver Plan",,"0.867990381647021","Yes","Yes","No","100%",,"$500","$0","$1,500","$60","$500","$500","$400","$0","$500","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1500 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHSCNE87&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020003","Medica with CHI Health Silver Copay","20305NE002",,"NEN002","NES003","NEF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020003-06","Medica with CHI Health Silver Copay","94% AV Level Silver Plan",,"0.930441983785859","Yes","Yes","No","100%",,"$100","$10","$600","$60","$100","$500","$100","$0","$100","$100","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","5.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHSCNE94&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010005","Medica Insure Bronze Copay","20305NE001",,"NEN001","NES001","NEF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out 0f Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010005-00","Medica Insure Bronze Copay","Standard Bronze Off Exchange Plan",,"0.605824547797741","Yes","Yes","Yes","75%","25%","$6,850","$0","$500","$60","$2,300","$1,000","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%","$6,850","per person not applicable","$13700 per group","50.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IBCNE&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010005","Medica Insure Bronze Copay","20305NE001",,"NEN001","NES001","NEF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out 0f Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010005-01","Medica Insure Bronze Copay","Standard Bronze On Exchange Plan",,"0.605824547797741","Yes","Yes","Yes","75%","25%","$6,850","$0","$500","$60","$2,300","$1,000","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%","$6,850","per person not applicable","$13700 per group","50.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IBCNE&uid=FFM","https://www.medica.com/2018insureNE"
"2018","MT","70415","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","47-0098400","70415MT0030001","EHB Low Passive","70415MT003",,"MTN001","MTS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01","2018-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","70415MT0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","MT","71788","SERFF","2017-08-16 20:15:58","Individual","Yes","94-2761537","71788MT0010001","Delta Dental PPO Pediatric Basic Plan","71788MT001",,"MTN001","MTS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","71788MT0010001-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$85","$85 per person","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/mt/71788mt0010001-18"
"2018","MT","71788","SERFF","2017-08-16 20:15:58","Individual","Yes","94-2761537","71788MT0010002","Delta Dental PPO Pediatric Preferred Plan","71788MT001",,"MTN001","MTS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","71788MT0010002-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/mt/71788mt0010002-18"
"2018","MT","71788","SERFF","2017-08-16 20:15:58","Individual","Yes","94-2761537","71788MT0010009","Delta Dental PPO Basic Plan for Families","71788MT001",,"MTN001","MTS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","71788MT0010009-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$85","$85 per person","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/mt/71788mt0010009-18"
"2018","MT","71788","SERFF","2017-08-16 20:15:58","Individual","Yes","94-2761537","71788MT0010004","Delta Dental PPO Preferred Plan for Families","71788MT001",,"MTN001","MTS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","71788MT0010004-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/mt/71788mt0010004-18"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","93895MT0010007","BESTDental Premium","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010007-00","BESTDental Premium","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTDental_Premium_Plan.pdf"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","93895MT0020003","BESTOne Advantage Gold","93895MT002",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTOne_Dental_Advantage-High_Plan.pdf"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","93895MT0020003","BESTOne Advantage Gold","93895MT002",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTOne_Dental_Advantage-High_Plan.pdf"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","93895MT0010007","BESTDental Premium","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010007-01","BESTDental Premium","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTDental_Premium_Plan.pdf"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","93895MT0010008","BESTDental Standard - H","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTDental_Standard-H_Plan.pdf"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","93895MT0020004","BESTOne Plus Gold","93895MT002",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTOne_Dental_Plus-High_Plan.pdf"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","93895MT0020004","BESTOne Plus Gold","93895MT002",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTOne_Dental_Plus-High_Plan.pdf"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","93895MT0010008","BESTDental Standard - H","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTDental_Standard-H_Plan.pdf"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","93895MT0010010","BESTDental Choice - H","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTDental_Choice-H_Plan.pdf"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","93895MT0010010","BESTDental Choice - H","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTDental_Choice-H_Plan.pdf"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","93895MT0020005","BESTOne Plus Silver","93895MT002",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTOne_Dental_Plus-Low_Plan.pdf"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","93895MT0010009","BESTDental Standard - L","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTDental_Standard-L_Plan.pdf"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","93895MT0010009","BESTDental Standard - L","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTDental_Standard-L_Plan.pdf"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","93895MT0020005","BESTOne Plus Silver","93895MT002",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTOne_Dental_Plus-Low_Plan.pdf"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","93895MT0010011","BESTDental Choice - L","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTDental_Choice-L_Plan.pdf"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","93895MT0020006","BESTOne Basic Silver","93895MT002",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTOne_Dental_Basic-Low_Plan.pdf"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","93895MT0020006","BESTOne Basic Silver","93895MT002",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTOne_Dental_Basic-Low_Plan.pdf"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","93895MT0010011","BESTDental Choice - L","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTDental_Choice-L_Plan.pdf"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","93895MT0010012","BESTDental Value","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTDental_Value_Plan.pdf"
"2018","MT","93895","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","93895MT0010012","BESTDental Value","93895MT001",,"MTN001","MTS001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/mt/2018/MT_BESTDental_Value_Plan.pdf"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010019","Medica Insure Gold Copay Plus","20305NE001",,"NEN001","NES002","NEF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010019-00","Medica Insure Gold Copay Plus","Standard Gold Off Exchange Plan",,"0.789036171260507","Yes","Yes","Yes","75%","25%","$1,000","$300","$400","$60","$1,000","$500","$300","$0","$1,000","$300","$30","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%","$1,500","per person not applicable","$4500 per group","30.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IGPCNE&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010019","Medica Insure Gold Copay Plus","20305NE001",,"NEN001","NES002","NEF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010019-01","Medica Insure Gold Copay Plus","Standard Gold On Exchange Plan",,"0.789036171260507","Yes","Yes","Yes","75%","25%","$1,000","$300","$400","$60","$1,000","$500","$300","$0","$1,000","$300","$30","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%","$1,500","per person not applicable","$4500 per group","30.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IGPCNE&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010019","Medica Insure Gold Copay Plus","20305NE001",,"NEN001","NES002","NEF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010019-02","Medica Insure Gold Copay Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","75%","25%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IGPCNEZ&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010019","Medica Insure Gold Copay Plus","20305NE001",,"NEN001","NES002","NEF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010019-03","Medica Insure Gold Copay Plus","Limited Cost Sharing Plan Variation",,"0.789036171260507","Yes","Yes","Yes","75%","25%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%","$1,500","per person not applicable","$4500 per group","30.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IGPCNEL&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020019","Medica with CHI Health Gold Copay Plus","20305NE002",,"NEN002","NES003","NEF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020019-00","Medica with CHI Health Gold Copay Plus","Standard Gold Off Exchange Plan",,"0.804018566628916","Yes","Yes","No","100%",,"$1,000","$300","$400","$60","$1,000","$500","$300","$0","$1,000","$300","$30","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHGPCNE&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020019","Medica with CHI Health Gold Copay Plus","20305NE002",,"NEN002","NES003","NEF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020019-01","Medica with CHI Health Gold Copay Plus","Standard Gold On Exchange Plan",,"0.804018566628916","Yes","Yes","No","100%",,"$1,000","$300","$400","$60","$1,000","$500","$300","$0","$1,000","$300","$30","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHGPCNE&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020019","Medica with CHI Health Gold Copay Plus","20305NE002",,"NEN002","NES003","NEF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020019-02","Medica with CHI Health Gold Copay Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHGPCNEZ&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020019","Medica with CHI Health Gold Copay Plus","20305NE002",,"NEN002","NES003","NEF002","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020019-03","Medica with CHI Health Gold Copay Plus","Limited Cost Sharing Plan Variation",,"0.804018566628916","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","30.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHGPCNEL&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010003-00","Medica Insure Silver Copay","Standard Silver Off Exchange Plan",,"0.678807172953134","Yes","Yes","Yes","75%","25%","$3,500","$10","$3,100","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%","$4,500","per person not applicable","$13500 per group","40.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ISCNE&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010003-01","Medica Insure Silver Copay","Standard Silver On Exchange Plan",,"0.678807172953134","Yes","Yes","Yes","75%","25%","$3,500","$10","$3,100","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%","$4,500","per person not applicable","$13500 per group","40.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ISCNE&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010003-02","Medica Insure Silver Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","75%","25%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ISCNEZ&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010003-03","Medica Insure Silver Copay","Limited Cost Sharing Plan Variation",,"0.678807172953134","Yes","Yes","Yes","75%","25%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%","$4,500","per person not applicable","$13500 per group","40.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ISCNEL&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010003-04","Medica Insure Silver Copay","73% AV Level Silver Plan",,"0.728378078020517","Yes","Yes","Yes","75%","25%","$2,500","$10","$2,600","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","30.00%","$2,500","per person not applicable","$7500 per group","30.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ISCNE73&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010003-05","Medica Insure Silver Copay","87% AV Level Silver Plan",,"0.867990381647021","Yes","Yes","Yes","75%","25%","$500","$0","$1,500","$60","$500","$500","$400","$0","$500","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1500 per group","20.00%","$500","per person not applicable","$1500 per group","20.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ISCNE87&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010003-06","Medica Insure Silver Copay","94% AV Level Silver Plan",,"0.930441983785859","Yes","Yes","Yes","75%","25%","$100","$10","$600","$60","$100","$500","$100","$0","$100","$100","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","5.00%","$100","per person not applicable","$300 per group","5.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ISCNE94&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020003","Medica with CHI Health Silver Copay","20305NE002",,"NEN002","NES003","NEF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020003-00","Medica with CHI Health Silver Copay","Standard Silver Off Exchange Plan",,"0.68768656753985","Yes","Yes","No","100%",,"$3,500","$10","$3,100","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHSCNE&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020003","Medica with CHI Health Silver Copay","20305NE002",,"NEN002","NES003","NEF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020003-01","Medica with CHI Health Silver Copay","Standard Silver On Exchange Plan",,"0.68768656753985","Yes","Yes","No","100%",,"$3,500","$10","$3,100","$60","$2,300","$500","$0","$0","$1,700","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$10500 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHSCNE&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020003","Medica with CHI Health Silver Copay","20305NE002",,"NEN002","NES003","NEF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020003-02","Medica with CHI Health Silver Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHSCNEZ&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010005","Medica Insure Bronze Copay","20305NE001",,"NEN001","NES001","NEF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out 0f Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010005-02","Medica Insure Bronze Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","75%","25%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IBCNEZ&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010005","Medica Insure Bronze Copay","20305NE001",,"NEN001","NES001","NEF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out 0f Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010005-03","Medica Insure Bronze Copay","Limited Cost Sharing Plan Variation",,"0.605824547797741","Yes","Yes","Yes","75%","25%","$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%","$6,850","per person not applicable","$13700 per group","50.00%","$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IBCNEL&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020005","Medica with CHI Health Bronze Copay","20305NE002",,"NEN002","NES003","NEF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out 0f Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020005-00","Medica with CHI Health Bronze Copay","Standard Bronze Off Exchange Plan",,"0.60854298019876","Yes","Yes","No","100%",,"$6,850","$0","$500","$60","$2,300","$1,000","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBCNE&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020005","Medica with CHI Health Bronze Copay","20305NE002",,"NEN002","NES003","NEF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out 0f Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020005-01","Medica with CHI Health Bronze Copay","Standard Bronze On Exchange Plan",,"0.60854298019876","Yes","Yes","No","100%",,"$6,850","$0","$500","$60","$2,300","$1,000","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBCNE&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020005","Medica with CHI Health Bronze Copay","20305NE002",,"NEN002","NES003","NEF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out 0f Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020005-02","Medica with CHI Health Bronze Copay","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBCNEZ&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020005","Medica with CHI Health Bronze Copay","20305NE002",,"NEN002","NES003","NEF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out 0f Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020005-03","Medica with CHI Health Bronze Copay","Limited Cost Sharing Plan Variation",,"0.60854298019876","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","50.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBCNEL&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010011","Medica Insure Bronze HSA","20305NE001",,"NEN001","NES001","NEF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010011-00","Medica Insure Bronze HSA","Standard Bronze Off Exchange Plan",,"0.60472271107099","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IBHNE&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010011","Medica Insure Bronze HSA","20305NE001",,"NEN001","NES001","NEF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010011-01","Medica Insure Bronze HSA","Standard Bronze On Exchange Plan",,"0.60472271107099","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IBHNE&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010011","Medica Insure Bronze HSA","20305NE001",,"NEN001","NES001","NEF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010011-02","Medica Insure Bronze HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IBHNEZ&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010011","Medica Insure Bronze HSA","20305NE001",,"NEN001","NES001","NEF005","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010011-03","Medica Insure Bronze HSA","Limited Cost Sharing Plan Variation",,"0.60472271107099","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3IBHNEL&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010023","Medica Insure Bronze  HSA Plus","20305NE001",,"NEN001","NES001","NEF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010023-00","Medica Insure Bronze  HSA Plus","Standard Bronze Off Exchange Plan",,"0.648961269523038","Yes","Yes","No","100%",,"$2,600","$0","$3,400","$60","$2,600","$0","$1,800","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBPHNE&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010023","Medica Insure Bronze  HSA Plus","20305NE001",,"NEN001","NES001","NEF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010023-01","Medica Insure Bronze  HSA Plus","Standard Bronze On Exchange Plan",,"0.648961269523038","Yes","Yes","No","100%",,"$2,600","$0","$3,400","$60","$2,600","$0","$1,800","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBPHNE&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010023","Medica Insure Bronze  HSA Plus","20305NE001",,"NEN001","NES001","NEF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010023-02","Medica Insure Bronze  HSA Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBPHNEZ&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010023","Medica Insure Bronze  HSA Plus","20305NE001",,"NEN001","NES001","NEF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010023-03","Medica Insure Bronze  HSA Plus","Limited Cost Sharing Plan Variation",,"0.648961269523038","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBPHNEL&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020011","Medica with CHI Health Bronze HSA","20305NE002",,"NEN002","NES003","NEF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020011-00","Medica with CHI Health Bronze HSA","Standard Bronze Off Exchange Plan",,"0.60472271107099","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBHNE&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020011","Medica with CHI Health Bronze HSA","20305NE002",,"NEN002","NES003","NEF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020011-01","Medica with CHI Health Bronze HSA","Standard Bronze On Exchange Plan",,"0.60472271107099","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$200","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBHNE&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020011","Medica with CHI Health Bronze HSA","20305NE002",,"NEN002","NES003","NEF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020011-02","Medica with CHI Health Bronze HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBHNEZ&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020011","Medica with CHI Health Bronze HSA","20305NE002",,"NEN002","NES003","NEF005","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020011-03","Medica with CHI Health Bronze HSA","Limited Cost Sharing Plan Variation",,"0.60472271107099","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","20.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBHNEL&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020023","Medica with CHI Health Bronze HSA Plus","20305NE002",,"NEN002","NES003","NEF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020023-00","Medica with CHI Health Bronze HSA Plus","Standard Bronze Off Exchange Plan",,"0.648961269523038","Yes","Yes","No","100%",,"$2,600","$0","$3,400","$60","$2,600","$0","$1,800","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBPHNE&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020023","Medica with CHI Health Bronze HSA Plus","20305NE002",,"NEN002","NES003","NEF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020023-01","Medica with CHI Health Bronze HSA Plus","Standard Bronze On Exchange Plan",,"0.648961269523038","Yes","Yes","No","100%",,"$2,600","$0","$3,400","$60","$2,600","$0","$1,800","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBPHNE&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020023","Medica with CHI Health Bronze HSA Plus","20305NE002",,"NEN002","NES003","NEF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020023-02","Medica with CHI Health Bronze HSA Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBPHNEZ&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020023","Medica with CHI Health Bronze HSA Plus","20305NE002",,"NEN002","NES003","NEF006","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020023-03","Medica with CHI Health Bronze HSA Plus","Limited Cost Sharing Plan Variation",,"0.648961269523038","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$5200 per group","40.00%",,,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHBPHNEL&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010013","Medica Insure Catastrophic","20305NE001",,"NEN001","NES001","NEF007","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out 0f Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010013-00","Medica Insure Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICNE&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0010013","Medica Insure Catastrophic","20305NE001",,"NEN001","NES001","NEF007","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out 0f Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0010013-01","Medica Insure Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ICNE&uid=FFM","https://www.medica.com/2018insureNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020013","Medica with CHI Health Catastrophic","20305NE002",,"NEN002","NES003","NEF007","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out 0f Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020013-00","Medica with CHI Health Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHCNE&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NE","20305","SERFF","2017-09-05 20:16:07","Individual","No","41-1490988","20305NE0020013","Medica with CHI Health Catastrophic","20305NE002",,"NEN002","NES003","NEF007","New","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Services","Yes","Out 0f Network Benefits","Yes","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=medica.hp@instamed.net&ssoAlias=MEDICAHPSSO&id=MEDICAHP.FFM","https://www.medica.com/IFBPharmacy","20305NE0020013-01","Medica with CHI Health Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1CHCNE&uid=FFM","https://www.medica.com/2018CHIHealthNE"
"2018","NH","57601","SERFF","2017-08-10 20:15:49","SHOP (Small Group)","Yes","02-0510530","57601NH0390004","Anthem Dental Family Enhanced","57601NH039",,"NHN001","NHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.882","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0390004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215611.pdf",
"2018","NH","57601","SERFF","2017-08-10 20:15:49","Individual","Yes","02-0510530","57601NH0420003","Anthem Dental Family","57601NH042",,"NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0420003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215610.pdf",
"2018","NH","57601","SERFF","2017-08-10 20:15:49","Individual","Yes","02-0510530","57601NH0420004","Anthem Dental Family Enhanced","57601NH042",,"NHN001","NHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.882","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0420004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215611.pdf",
"2018","NH","57601","SERFF","2017-08-10 20:15:49","Individual","Yes","02-0510530","57601NH0420004","Anthem Dental Family Enhanced","57601NH042",,"NHN001","NHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.882","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0420004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215611.pdf",
"2018","NH","59025","SERFF","2017-09-22 20:15:56","Individual","No","04-2663394","59025NH0330024","ElevateHealth Gold 1000","59025NH033",,"NHN001","NHS001","NHF004","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","59025NH0330024-00","ElevateHealth Gold 1000","Standard Gold Off Exchange Plan","81.65%","0.809830934755142","No","Yes","No","100%",,"$1,000","$350","$0","$0","$130","$2,410","$0","$30","$1,000","$140","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SBC_PD0000005505.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SOB_PD0000005505.PDF"
"2018","NH","59025","SERFF","2017-09-22 20:15:56","Individual","No","04-2663394","59025NH0330024","ElevateHealth Gold 1000","59025NH033",,"NHN001","NHS001","NHF004","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","59025NH0330024-01","ElevateHealth Gold 1000","Standard Gold On Exchange Plan","81.65%","0.809830934755142","No","Yes","No","100%",,"$1,000","$350","$0","$0","$130","$2,410","$0","$30","$1,000","$140","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SBC_PD0000005506.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SOB_PD0000005506.PDF"
"2018","NH","59025","SERFF","2017-09-22 20:15:56","Individual","No","04-2663394","59025NH0330024","ElevateHealth Gold 1000","59025NH033",,"NHN001","NHS001","NHF004","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","59025NH0330024-02","ElevateHealth","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$30","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SBC_PD0000005508.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SOB_PD0000005508.PDF"
"2018","NH","59025","SERFF","2017-09-22 20:15:56","Individual","No","04-2663394","59025NH0330024","ElevateHealth Gold 1000","59025NH033",,"NHN001","NHS001","NHF004","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","59025NH0330024-03","ElevateHealth Gold 1000","Limited Cost Sharing Plan Variation","81.65%","0.809830934755142","No","Yes","No","100%",,"$1,000","$350","$0","$0","$130","$2,410","$0","$30","$1,000","$140","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SBC_PD0000005507.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SOB_PD0000005507.PDF"
"2018","NE","36768","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","47-0098400","36768NE0040002","EHB High PPO","36768NE004",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","36768NE0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","NE","36768","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","47-0098400","36768NE0040001","EHB Low PPO","36768NE004",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","36768NE0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","NH","57601","SERFF","2017-08-10 20:15:49","Individual","Yes","02-0510530","57601NH0420005","Anthem Dental Family Value","57601NH042",,"NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0420005-00","Anthem Dental Family Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215612.pdf",
"2018","NH","57601","SERFF","2017-08-10 20:15:49","SHOP (Small Group)","Yes","02-0510530","57601NH0390003","Anthem Dental Family","57601NH039",,"NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0390003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215610.pdf",
"2018","NH","57601","SERFF","2017-08-10 20:15:49","SHOP (Small Group)","Yes","02-0510530","57601NH0390003","Anthem Dental Family","57601NH039",,"NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0390003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215610.pdf",
"2018","NH","57601","SERFF","2017-08-10 20:15:49","Individual","Yes","02-0510530","57601NH0420005","Anthem Dental Family Value","57601NH042",,"NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0420005-01","Anthem Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215612.pdf",
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 3800 0","96751NH015",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9985",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-03","Anthem Silver Pathway X Enhanced HMO 3800 0","Limited Cost Sharing Plan Variation","68.02%","0.688649583170081","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","0.00%","$3,800","$3800 per person","$7600 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPU","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 3800 0","96751NH015",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9985",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-04","Anthem Silver Pathway X Enhanced HMO 3800 0 S04","73% AV Level Silver Plan","72.04%","0.724810139977438","Yes","Yes","Yes","49%","51%","$2,800","$560","$0","$60","$2,800","$565","$1,433","$55","$1,738","$300","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","0.00%","$2,800","$2800 per person","$5600 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPV","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 3800 0","96751NH015",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9985",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-05","Anthem Silver Pathway X Enhanced HMO 3800 0 S05","87% AV Level Silver Plan","86.04%","0.870144870484261","Yes","Yes","Yes","49%","51%","$700","$290","$0","$60","$700","$390","$1,433","$55","$700","$120","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","0.00%","$700","$700 per person","$1400 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPW","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 3800 0","96751NH015",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9985",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-06","Anthem Silver Pathway X Enhanced HMO 3800 0 S06","94% AV Level Silver Plan","93.05%","0.933979023996093","Yes","Yes","Yes","49%","51%","$250","$140","$0","$60","$250","$370","$1,433","$55","$250","$90","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0.00%","$250","$250 per person","$500 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPX","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150024","Anthem Catastrophic Pathway X Enhanced HMO 7350 0","96751NH015",,"NHN001","NHS001","NHF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9971",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150024-00","Anthem Catastrophic Pathway X Enhanced HMO 7350 0","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","49%","51%","$7,350","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%","$7,350","$7350 per person","$14700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JZ0","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NE","36768","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","47-0098400","36768NE0030002","EHB High Passive","36768NE003",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","36768NE0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","NE","36768","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","47-0098400","36768NE0030001","EHB Low Passive","36768NE003",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","36768NE0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","NE","45550","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","47-0685003","45550NE0170001","Delta Dental Pediatric Low","45550NE017",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","45550NE0170001-00","Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0010001","Delta Dental Pediatric Low","45550NE001",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","45550NE0010001-00","Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0010001","Delta Dental Pediatric Low","45550NE001",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","45550NE0010001-01","Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0020001","Delta Dental Bronze + Delta Dental Pediatric Low","45550NE002",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.6","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency service only","Yes","similar benefits as in service area","Yes",,"","45550NE0020001-00","Delta Dental Bronze + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","47-0685003","45550NE0180001","Delta Dental Bronze + Delta Dental Pediatric Low","45550NE018",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.6","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","45550NE0180001-00","Delta Dental Bronze + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0020001","Delta Dental Bronze + Delta Dental Pediatric Low","45550NE002",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.6","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency service only","Yes","similar benefits as in service area","Yes",,"","45550NE0020001-01","Delta Dental Bronze + Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0040001","Delta Dental Silver + Delta Dental Pediatric Low","45550NE004",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.49","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","45550NE0040001-00","Delta Dental Silver + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org?2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","47-0685003","45550NE0200001","Delta Dental Silver + Delta Dental Pediatric Low","45550NE020",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.49","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","45550NE0200001-00","Delta Dental Silver + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0040001","Delta Dental Silver + Delta Dental Pediatric Low","45550NE004",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.49","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","45550NE0040001-01","Delta Dental Silver + Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org?2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0060001","Delta Dental Gold + Delta Dental Pediatric Low","45550NE006",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.38","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","45550NE0060001-00","Delta Dental Gold + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","47-0685003","45550NE0220001","Delta Dental Gold + Delta Dental Pediatric Low","45550NE022",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.38","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","45550NE0220001-00","Delta Dental Gold + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0060001","Delta Dental Gold + Delta Dental Pediatric Low","45550NE006",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.38","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","45550NE0060001-01","Delta Dental Gold + Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0080001","Delta Dental Platinum + Delta Dental Pediatric Low","45550NE008",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.34","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","45550NE0080001-00","Delta Dental Platinum + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","47-0685003","45550NE0240001","Delta Dental Platinum + Delta Dental Pediatric Low","45550NE024",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.34","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency servics only","Yes","similar benefits as in service area","Yes",,"","45550NE0240001-00","Delta Dental Platinum + Delta Dental Pediatric Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0080001","Delta Dental Platinum + Delta Dental Pediatric Low","45550NE008",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.34","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","45550NE0080001-01","Delta Dental Platinum + Delta Dental Pediatric Low","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0090001","Delta Dental Pediatric High","45550NE009",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0090001-00","Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","47-0685003","45550NE0250001","Delta Dental Pediatric High","45550NE025",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","45550NE0250001-00","Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCRNE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0090001","Delta Dental Pediatric High","45550NE009",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0090001-01","Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0100001","Delta Dental Bronze + Delta Dental Pediatric High","45550NE010",,"NEN001","NES001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.65","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0100001-00","Delta Dental Bronze + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http:www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","47-0685003","45550NE0260001","Delta Dental Bronze + Delta Dental Pediatric High","45550NE026",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.65","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","45550NE0260001-00","Delta Dental Bronze + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0100001","Delta Dental Bronze + Delta Dental Pediatric High","45550NE010",,"NEN001","NES001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.65","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0100001-01","Delta Dental Bronze + Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http:www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0120001","Delta Dental Silver + Delta Dental Pediatric High","45550NE012",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.54","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0120001-00","Delta Dental Silver + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","47-0685003","45550NE0280001","Delta Dental Silver + Delta Dental Pediatric High","45550NE028",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.54","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","45550NE0280001-00","Delta Dental Silver + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0120001","Delta Dental Silver + Delta Dental Pediatric High","45550NE012",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.54","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0120001-01","Delta Dental Silver + Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0140001","Delta Dental Gold + Delta Dental Pediatric High","45550NE014",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.43","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0140001-00","Delta Dental Gold + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http:www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","47-0685003","45550NE0300001","Delta Dental Gold + Delta Dental Pediatric High","45550NE030",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.43","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","No",,"","45550NE0300001-00","Delta Dental Gold + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0140001","Delta Dental Gold + Delta Dental Pediatric High","45550NE014",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.43","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0140001-01","Delta Dental Gold + Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http:www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0160001","Delta Dental Platinum + Delta Dental Pediatric High","45550NE016",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.38","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0160001-00","Delta Dental Platinum + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","47-0685003","45550NE0320001","Delta Dental Platinum + Delta Dental Pediatric High","45550NE032",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.38","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes",,"","45550NE0320001-00","Delta Dental Platinum + Delta Dental Pediatric High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","45550","SERFF","2017-08-14 20:15:51","Individual","Yes","47-0685003","45550NE0160001","Delta Dental Platinum + Delta Dental Pediatric High","45550NE016",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.38","Guaranteed Rate","2018-01-01","2018-12-31","Yes","emergency services only","Yes","similar benefits as in service area","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/45550","","45550NE0160001-01","Delta Dental Platinum + Delta Dental Pediatric High","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/2018HCR-NE.pdf",
"2018","NE","48282","SERFF","2017-08-11 20:15:53","SHOP (Small Group)","Yes","36-3757528","48282NE0030001","TruAssure Dental Small Group Basic Plan","48282NE003",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","48282NE0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NE","48282","SERFF","2017-08-11 20:15:53","Individual","Yes","36-3757528","48282NE0010001","TruAssure Basic Adult or Child Dental Plan","48282NE001",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","48282NE0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","69.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$105","$105 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NE","https://www.truassure.com/brochure?state=NE"
"2018","NE","48282","SERFF","2017-08-11 20:15:53","Individual","Yes","36-3757528","48282NE0010001","TruAssure Basic Adult or Child Dental Plan","48282NE001",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","48282NE0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","69.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$105","$105 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NE","https://www.truassure.com/brochure?state=NE"
"2018","NE","48282","SERFF","2017-08-11 20:15:53","SHOP (Small Group)","Yes","36-3757528","48282NE0040001","TruAssure Dental Small Group Preferred Plan","48282NE004",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","48282NE0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NE","48282","SERFF","2017-08-11 20:15:53","Individual","Yes","36-3757528","48282NE0020001","TruAssure Preferred Adult or Child Dental Plan","48282NE002",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","48282NE0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NE","https://www.truassure.com/brochure?state=NE"
"2018","NE","48282","SERFF","2017-08-11 20:15:53","Individual","Yes","36-3757528","48282NE0020001","TruAssure Preferred Adult or Child Dental Plan","48282NE002",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","48282NE0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","83.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NE","https://www.truassure.com/brochure?state=NE"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","50022NE0020003","BESTOne Advantage Gold","50022NE002",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/current/NE_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","50022NE0010007","BESTDental Premium","50022NE001",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010007-00","BESTDental Premium","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/current/NE_BESTDental_Premium_Plan.pdf"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","50022NE0010007","BESTDental Premium","50022NE001",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010007-01","BESTDental Premium","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/current/NE_BESTDental_Premium_Plan.pdf"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","50022NE0020003","BESTOne Advantage Gold","50022NE002",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/current/NE_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","50022NE0020004","BESTOne Plus Gold","50022NE002",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/current/NE_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","50022NE0010008","BESTDental Standard - H","50022NE001",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/current/NE_BESTDental_Standard-H_Plan.pdf"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","50022NE0010008","BESTDental Standard - H","50022NE001",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/current/NE_BESTDental_Standard-H_Plan.pdf"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","50022NE0020004","BESTOne Plus Gold","50022NE002",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/current/NE_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","50022NE0010010","BESTDental Choice - H","50022NE001",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/current/NE_BESTDental_Choice-H_Plan.pdf"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","50022NE0010010","BESTDental Choice - H","50022NE001",,"NEN001","NES001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/current/NE_BESTDental_Choice-H_Plan.pdf"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","50022NE0020005","BESTOne Plus Silver","50022NE002",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/current/NE_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","50022NE0010009","BESTDental Standard - L","50022NE001",,"NEN001","NES001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/current/NE_BESTDental_Standard-L_Plan.pdf"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","50022NE0010009","BESTDental Standard - L","50022NE001",,"NEN001","NES001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/current/NE_BESTDental_Standard-L_Plan.pdf"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","50022NE0020005","BESTOne Plus Silver","50022NE002",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/current/NE_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","50022NE0020006","BESTOne Basic Silver","50022NE002",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/current/NE_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","50022NE0010011","BESTDental Choice - L","50022NE001",,"NEN001","NES001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/current/NE_BESTDental_Choice-L_Plan.pdf"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","50022NE0010011","BESTDental Choice - L","50022NE001",,"NEN001","NES001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/current/NE_BESTDental_Choice-L_Plan.pdf"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","50022NE0020006","BESTOne Basic Silver","50022NE002",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ne/current/NE_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","50022NE0010012","BESTDental Value","50022NE001",,"NEN001","NES001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NE/current/NE_BESTDental_Value_Plan.pdf"
"2018","NE","50022","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","50022NE0010012","BESTDental Value","50022NE001",,"NEN001","NES001",,"Existing","Indemnity","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No","Full","No","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NE/current/NE_BESTDental_Value_Plan.pdf"
"2018","NE","88667","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","13-5581829","88667NE0060001","EHB Basic Dental Plan (Low)","88667NE006",,"NEN001","NES001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","88667NE0060001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NH","44500","SERFF","2017-08-10 20:15:49","SHOP (Small Group)","Yes","13-5581829","44500NH0080001","EHB Basic Dental Plan (Low)","44500NH008",,"NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","44500NH0080001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","NH","57601","SERFF","2017-08-10 20:15:49","Individual","Yes","02-0510530","57601NH0420003","Anthem Dental Family","57601NH042",,"NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0420003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215610.pdf",
"2018","NH","57601","SERFF","2017-08-10 20:15:49","SHOP (Small Group)","Yes","02-0510530","57601NH0390004","Anthem Dental Family Enhanced","57601NH039",,"NHN001","NHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.882","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","57601NH0390004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e215611.pdf",
"2018","NH","59025","SERFF","2017-09-22 20:15:56","Individual","No","04-2663394","59025NH0330028","ElevateHealth Silver 3500","59025NH033",,"NHN001","NHS001","NHF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99905",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","59025NH0330028-00","ElevateHealth Silver 3500","Standard Silver Off Exchange Plan",,"0.717044157425614","No","Yes","No","100%",,"$3,500","$1,170","$0","$0","$90","$2,740","$0","$30","$1,460","$340","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SBC_PD0000005515.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SOB_PD0000005515.PDF"
"2018","NH","59025","SERFF","2017-09-22 20:15:56","Individual","No","04-2663394","59025NH0330028","ElevateHealth Silver 3500","59025NH033",,"NHN001","NHS001","NHF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99905",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","59025NH0330028-01","ElevateHealth Silver 3500","Standard Silver On Exchange Plan",,"0.717044157425614","No","Yes","No","100%",,"$3,500","$1,170","$0","$0","$90","$2,740","$0","$30","$1,460","$340","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SBC_PD0000005516.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SOB_PD0000005516.PDF"
"2018","NH","59025","SERFF","2017-09-22 20:15:56","Individual","No","04-2663394","59025NH0330028","ElevateHealth Silver 3500","59025NH033",,"NHN001","NHS001","NHF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99905",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","59025NH0330028-02","ElevateHealth","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$30","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SBC_PD0000005519.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SOB_PD0000005519.PDF"
"2018","NH","59025","SERFF","2017-09-22 20:15:56","Individual","No","04-2663394","59025NH0330028","ElevateHealth Silver 3500","59025NH033",,"NHN001","NHS001","NHF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99905",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","59025NH0330028-03","ElevateHealth Silver 3500","Limited Cost Sharing Plan Variation",,"0.717044157425614","No","Yes","No","100%",,"$3,500","$1,170","$0","$0","$90","$2,740","$0","$30","$1,460","$340","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SBC_PD0000005517.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SOB_PD0000005517.PDF"
"2018","NH","59025","SERFF","2017-09-22 20:15:56","Individual","No","04-2663394","59025NH0330028","ElevateHealth Silver 3500","59025NH033",,"NHN001","NHS001","NHF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99905",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","59025NH0330028-04","ElevateHealth Silver 3000","73% AV Level Silver Plan",,"0.738226397506645","No","Yes","No","100%",,"$3,000","$1,170","$0","$0","$0","$2,740","$0","$30","$1,460","$340","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SBC_PD0000005521.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SOB_PD0000005521.PDF"
"2018","NH","59025","SERFF","2017-09-22 20:15:56","Individual","No","04-2663394","59025NH0330028","ElevateHealth Silver 3500","59025NH033",,"NHN001","NHS001","NHF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99905",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","59025NH0330028-05","ElevateHealth Silver 1500","87% AV Level Silver Plan",,"0.861137745046776","No","Yes","No","100%",,"$1,500","$880","$0","$0","$0","$1,630","$0","$30","$1,460","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SBC_PD0000005522.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SOB_PD0000005522.PDF"
"2018","NH","59025","SERFF","2017-09-22 20:15:56","Individual","No","04-2663394","59025NH0330028","ElevateHealth Silver 3500","59025NH033",,"NHN001","NHS001","NHF006","New","HMO","Silver","Not Applicable","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99905",,,"2018-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2018Value4T","59025NH0330028-06","ElevateHealth Silver 375","94% AV Level Silver Plan",,"0.949693712519345","No","Yes","No","100%",,"$0","$50","$0","$0","$0","$390","$0","$30","$380","$40","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$975","$975 per person","$1950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$375","$375 per person","$750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SBC_PD0000005523.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2018%20PLAN%20DOCUMENTS%20-%20NH%20FILES/SOB_PD0000005523.PDF"
"2018","NH","75841","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","75841NH0090001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","75841NH009",,"NHN001","NHS001","NHF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","https://ambetter.nhhealthyfamilies.com/resources/pharmacy-resources.html","75841NH0090001-00","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/75841NH0090001-00.pdf","https://api.centene.com/Brochures/2018/75841NH0090001-00.pdf"
"2018","NH","75841","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","75841NH0090001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","75841NH009",,"NHN001","NHS001","NHF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","https://ambetter.nhhealthyfamilies.com/resources/pharmacy-resources.html","75841NH0090001-01","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/75841NH0090001-01.pdf","https://api.centene.com/Brochures/2018/75841NH0090001-01.pdf"
"2018","NH","75841","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","75841NH0090001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","75841NH009",,"NHN001","NHS001","NHF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","https://ambetter.nhhealthyfamilies.com/resources/pharmacy-resources.html","75841NH0090001-02","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/75841NH0090001-02.pdf","https://api.centene.com/Brochures/2018/75841NH0090001-02.pdf"
"2018","NH","75841","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","75841NH0090001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","75841NH009",,"NHN001","NHS001","NHF001","Existing","EPO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","https://ambetter.nhhealthyfamilies.com/resources/pharmacy-resources.html","75841NH0090001-03","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/75841NH0090001-03.pdf","https://api.centene.com/Brochures/2018/75841NH0090001-03.pdf"
"2018","NH","75841","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2018)","75841NH009",,"NHN001","NHS001","NHF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","https://ambetter.nhhealthyfamilies.com/resources/pharmacy-resources.html","75841NH0090002-00","Ambetter Balanced Care 8 (2018)","Standard Silver Off Exchange Plan",,"0.718477130289052","No","Yes","No","100%",,"$5,500","$1,600","$0","$60","$1,200","$2,600","$500","$60","$1,000","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,750","$6750 per person","$13500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/75841NH0090002-00.pdf","https://api.centene.com/Brochures/2018/75841NH0090002-00.pdf"
"2018","NH","75841","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2018)","75841NH009",,"NHN001","NHS001","NHF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","https://ambetter.nhhealthyfamilies.com/resources/pharmacy-resources.html","75841NH0090002-01","Ambetter Balanced Care 8 (2018)","Standard Silver On Exchange Plan",,"0.718477130289052","No","Yes","No","100%",,"$5,500","$1,600","$0","$60","$1,200","$2,600","$500","$60","$1,000","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,750","$6750 per person","$13500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/75841NH0090002-01.pdf","https://api.centene.com/Brochures/2018/75841NH0090002-01.pdf"
"2018","NH","75841","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2018)","75841NH009",,"NHN001","NHS001","NHF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","https://ambetter.nhhealthyfamilies.com/resources/pharmacy-resources.html","75841NH0090002-02","Ambetter Balanced Care 8 (2018)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/75841NH0090002-02.pdf","https://api.centene.com/Brochures/2018/75841NH0090002-02.pdf"
"2018","NH","75841","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2018)","75841NH009",,"NHN001","NHS001","NHF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","https://ambetter.nhhealthyfamilies.com/resources/pharmacy-resources.html","75841NH0090002-03","Ambetter Balanced Care 8 (2018)","Limited Cost Sharing Plan Variation",,"0.718477130289052","No","Yes","No","100%",,"$5,500","$1,600","$0","$60","$1,200","$2,600","$500","$60","$1,000","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,750","$6750 per person","$13500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/75841NH0090002-03.pdf","https://api.centene.com/Brochures/2018/75841NH0090002-03.pdf"
"2018","NH","75841","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2018)","75841NH009",,"NHN001","NHS001","NHF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","https://ambetter.nhhealthyfamilies.com/resources/pharmacy-resources.html","75841NH0090002-04","Ambetter Balanced Care 8 (2018)","73% AV Level Silver Plan",,"0.739519481886777","No","Yes","No","100%",,"$4,300","$1,500","$0","$60","$1,200","$2,400","$500","$60","$1,000","$300","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,750","$5750 per person","$11500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/75841NH0090002-04.pdf","https://api.centene.com/Brochures/2018/75841NH0090002-04.pdf"
"2018","NH","75841","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2018)","75841NH009",,"NHN001","NHS001","NHF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","https://ambetter.nhhealthyfamilies.com/resources/pharmacy-resources.html","75841NH0090002-05","Ambetter Balanced Care 8 (2018)","87% AV Level Silver Plan",,"0.879786244366406","No","Yes","No","100%",,"$1,150","$700","$0","$60","$1,100","$900","$250","$60","$1,100","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/75841NH0090002-05.pdf","https://api.centene.com/Brochures/2018/75841NH0090002-05.pdf"
"2018","NH","75841","SERFF","2017-09-22 20:15:56","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2018)","75841NH009",,"NHN001","NHS001","NHF002","Existing","EPO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","https://ambetter.nhhealthyfamilies.com/resources/pharmacy-resources.html","75841NH0090002-06","Ambetter Balanced Care 8 (2018)","94% AV Level Silver Plan",,"0.949693712519345","No","Yes","No","100%",,"$375","$300","$0","$60","$375","$300","$0","$60","$375","$60","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$975","$975 per person","$1950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$375","$375 per person","$750 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/75841NH0090002-06.pdf","https://api.centene.com/Brochures/2018/75841NH0090002-06.pdf"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150018","Anthem Bronze Pathway X Enhanced HMO 5750 10","96751NH015",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9981",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150018-02","Anthem Bronze Pathway X Enhanced HMO 5750 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GQ3","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150018","Anthem Bronze Pathway X Enhanced HMO 5750 10","96751NH015",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9981",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150018-03","Anthem Bronze Pathway X Enhanced HMO 5750 10","Limited Cost Sharing Plan Variation","59.68%","0.619179620921775","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","10.00%","$5,750","$5750 per person","$11500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPK","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150030","Anthem Silver Pathway X Enhanced HMO 2500 30","96751NH015",,"NHN001","NHS001","NHF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9985",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150030-00","Anthem Silver Pathway X Enhanced HMO 2500 30","Standard Silver Off Exchange Plan","68.02%","0.706741264456345","Yes","Yes","Yes","49%","51%","$2,500","$40","$3,779","$60","$2,500","$310","$2,311","$55","$1,348","$0","$578","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%","$2,500","$2500 per person","$5000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2V5Z","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150030","Anthem Silver Pathway X Enhanced HMO 2500 30","96751NH015",,"NHN001","NHS001","NHF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9985",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150030-01","Anthem Silver Pathway X Enhanced HMO 2500 30","Standard Silver On Exchange Plan","68.02%","0.706741264456345","Yes","Yes","Yes","49%","51%","$2,500","$40","$3,779","$60","$2,500","$310","$2,311","$55","$1,348","$0","$578","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%","$2,500","$2500 per person","$5000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2V60","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","87701","SERFF","2017-08-10 20:15:49","Individual","Yes","02-0273013","87701NH0070001","Delta Dental Family High","87701NH007","7992708454","NHN001","NHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.9531","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","87701NH0070001-00","Delta Dental Family High","Standard High Off Exchange Plan","83.99%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/OFFHIX/oocnh2018a.pdf"
"2018","NH","87701","SERFF","2017-08-10 20:15:49","Individual","Yes","02-0273013","87701NH0070001","Delta Dental Family High","87701NH007","7992708454","NHN001","NHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.9531","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","87701NH0070001-01","Delta Dental Family High","Standard High On Exchange Plan","83.99%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/nh/oocnh20181.pdf"
"2018","NH","87701","SERFF","2017-08-10 20:15:49","Individual","Yes","02-0273013","87701NH0080001","Delta Dental Family Low","87701NH008","7992708454","NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.9958","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","87701NH0080001-00","Delta Dental Family Low","Standard Low Off Exchange Plan","71.17%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/OFFHIX/oocnh2018b.pdf"
"2018","NH","87701","SERFF","2017-08-10 20:15:49","Individual","Yes","02-0273013","87701NH0080001","Delta Dental Family Low","87701NH008","7992708454","NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"0.9958","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","87701NH0080001-01","Delta Dental Family Low","Standard Low On Exchange Plan","71.17%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/nh/oocnh20182.pdf"
"2018","NH","87701","SERFF","2017-08-10 20:15:49","Individual","Yes","02-0273013","87701NH0090001","Delta Dental Pediatric High Plan","87701NH009","7992708454","NHN001","NHS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Child-Only",,,,,"0.9958","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","87701NH0090001-01","Delta Dental Pediatric High Plan","Standard High On Exchange Plan","83.99%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/nh/oocnh20183.pdf"
"2018","NH","87701","SERFF","2017-08-10 20:15:49","Individual","Yes","02-0273013","87701NH0100001","Delta Dental Pediatric Low Plan","87701NH010","7992708454","NHN001","NHS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Child-Only",,,,,"0.9958","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","87701NH0100001-01","Delta Dental Pediatric Low Plan","Standard Low On Exchange Plan","71.17%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/nh/oocnh20184.pdf"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150015","Anthem Bronze Pathway X Enhanced HMO 25 for HSA","96751NH015",,"NHN001","NHS001","NHF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9982",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150015-00","Anthem Bronze Pathway X Enhanced HMO 25 for HSA","Standard Bronze Off Exchange Plan","61.13%","0.612635286873756","Yes","Yes","Yes","49%","51%","$5,150","$0","$3,158","$60","$4,851","$0","$2,333","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","25.00%","$5,150","$5150 per person","$10300 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JYT","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150015","Anthem Bronze Pathway X Enhanced HMO 25 for HSA","96751NH015",,"NHN001","NHS001","NHF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9982",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150015-01","Anthem Bronze Pathway X Enhanced HMO 25 for HSA","Standard Bronze On Exchange Plan","61.13%","0.612635286873756","Yes","Yes","Yes","49%","51%","$5,150","$0","$3,158","$60","$4,851","$0","$2,333","$55","$1,444","$0","$481","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","25.00%","$5,150","$5150 per person","$10300 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GPG","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150015","Anthem Bronze Pathway X Enhanced HMO 25 for HSA","96751NH015",,"NHN001","NHS001","NHF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9982",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150015-02","Anthem Bronze Pathway X Enhanced HMO 5150 25 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GQ0","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150015","Anthem Bronze Pathway X Enhanced HMO 25 for HSA","96751NH015",,"NHN001","NHS001","NHF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9982",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150015-03","Anthem Bronze Pathway X Enhanced HMO 25 for HSA","Limited Cost Sharing Plan Variation","61.13%","0.612635286873756","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","25.00%","$5,150","$5150 per person","$10300 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GPG","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9986",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-00","Anthem Silver Pathway X Enhanced HMO 10 for HSA","Standard Silver Off Exchange Plan","68.51%","0.691286028027679","Yes","Yes","Yes","49%","51%","$3,000","$0","$1,263","$60","$3,000","$0","$1,793","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JYX","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9986",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-01","Anthem Silver Pathway X Enhanced HMO 10 for HSA","Standard Silver On Exchange Plan","68.51%","0.691286028027679","Yes","Yes","Yes","49%","51%","$3,000","$0","$1,263","$60","$3,000","$0","$1,793","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GPL","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9986",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-02","Anthem Silver Pathway X Enhanced HMO 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GQ4","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9986",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-03","Anthem Silver Pathway X Enhanced HMO 10 for HSA","Limited Cost Sharing Plan Variation","68.51%","0.691286028027679","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10.00%","$3,000","$3000 per person","$6000 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GPL","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9986",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-04","Anthem Silver Pathway X Enhanced HMO 10 for HSA S04","73% AV Level Silver Plan","72.60%","0.727300119160885","Yes","Yes","Yes","49%","51%","$2,700","$0","$1,263","$60","$2,700","$0","$1,793","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10.00%","$2,700","$2700 per person","$5400 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GPM","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9986",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-05","Anthem Silver Pathway X Enhanced HMO 10 S05","87% AV Level Silver Plan","86.30%","0.862986553804247","Yes","Yes","Yes","49%","51%","$1,250","$0","$0","$60","$1,250","$0","$0","$55","$1,250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%","$1,250","$1250 per person","$2500 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPN","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9986",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-06","Anthem Silver Pathway X Enhanced HMO 10 S06","94% AV Level Silver Plan","93.80%","0.937977340786209","Yes","Yes","Yes","49%","51%","$500","$0","$0","$60","$500","$0","$0","$55","$500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPP","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150026","Anthem Bronze Pathway X Enhanced HMO 6350 40","96751NH015",,"NHN001","NHS001","NHF005","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9981",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150026-00","Anthem Bronze Pathway X Enhanced HMO 6350 40","Standard Bronze Off Exchange Plan","58.75%","0.587490585667873","Yes","Yes","Yes","49%","51%","$6,350","$0","$5,048","$60","$4,412","$0","$2,772","$55","$1,155","$0","$770","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%","$6,350","$6350 per person","$12700 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECL","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150026","Anthem Bronze Pathway X Enhanced HMO 6350 40","96751NH015",,"NHN001","NHS001","NHF005","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9981",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150026-01","Anthem Bronze Pathway X Enhanced HMO 6350 40","Standard Bronze On Exchange Plan","58.75%","0.587490585667873","Yes","Yes","Yes","49%","51%","$6,350","$0","$5,048","$60","$4,412","$0","$2,772","$55","$1,155","$0","$770","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%","$6,350","$6350 per person","$12700 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECM","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150026","Anthem Bronze Pathway X Enhanced HMO 6350 40","96751NH015",,"NHN001","NHS001","NHF005","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9981",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150026-02","Anthem Bronze Pathway X Enhanced HMO 6350 40 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2ECN","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150026","Anthem Bronze Pathway X Enhanced HMO 6350 40","96751NH015",,"NHN001","NHS001","NHF005","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9981",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150026-03","Anthem Bronze Pathway X Enhanced HMO 6350 40","Limited Cost Sharing Plan Variation","58.75%","0.587490585667873","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","40.00%","$6,350","$6350 per person","$12700 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECM","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150018","Anthem Bronze Pathway X Enhanced HMO 5750 10","96751NH015",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9981",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150018-00","Anthem Bronze Pathway X Enhanced HMO 5750 10","Standard Bronze Off Exchange Plan","59.68%","0.619179620921775","Yes","Yes","Yes","49%","51%","$5,750","$0","$1,263","$60","$5,391","$0","$1,793","$55","$1,733","$0","$193","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","10.00%","$5,750","$5750 per person","$11500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JYW","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150018","Anthem Bronze Pathway X Enhanced HMO 5750 10","96751NH015",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9981",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150018-01","Anthem Bronze Pathway X Enhanced HMO 5750 10","Standard Bronze On Exchange Plan","59.68%","0.619179620921775","Yes","Yes","Yes","49%","51%","$5,750","$0","$1,263","$60","$5,391","$0","$1,793","$55","$1,733","$0","$193","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","10.00%","$5,750","$5750 per person","$11500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPK","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150030","Anthem Silver Pathway X Enhanced HMO 2500 30","96751NH015",,"NHN001","NHS001","NHF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9985",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150030-02","Anthem Silver Pathway X Enhanced HMO 2500 30 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2V61","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150030","Anthem Silver Pathway X Enhanced HMO 2500 30","96751NH015",,"NHN001","NHS001","NHF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9985",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150030-03","Anthem Silver Pathway X Enhanced HMO 2500 30","Limited Cost Sharing Plan Variation","68.02%","0.706741264456345","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%","$2,500","$2500 per person","$5000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2V60","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150030","Anthem Silver Pathway X Enhanced HMO 2500 30","96751NH015",,"NHN001","NHS001","NHF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9985",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150030-04","Anthem Silver Pathway X Enhanced HMO 2500 30 S04","73% AV Level Silver Plan","72.91%","0.75308993316836","Yes","Yes","Yes","49%","51%","$1,500","$40","$3,779","$60","$1,500","$310","$2,311","$55","$1,348","$0","$578","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30.00%","$1,500","$1500 per person","$3000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2V63","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150030","Anthem Silver Pathway X Enhanced HMO 2500 30","96751NH015",,"NHN001","NHS001","NHF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9985",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150030-05","Anthem Silver Pathway X Enhanced HMO 2500 30 S05","87% AV Level Silver Plan","86.37%","0.875809158323211","Yes","Yes","Yes","49%","51%","$750","$20","$3,779","$60","$750","$155","$2,311","$55","$750","$0","$578","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group","$1,450","$1450 per person","$2900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30.00%","$750","$750 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2V64","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150030","Anthem Silver Pathway X Enhanced HMO 2500 30","96751NH015",,"NHN001","NHS001","NHF006","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9985",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150030-06","Anthem Silver Pathway X Enhanced HMO 2500 30 S06","94% AV Level Silver Plan","93.70%","0.940872417033104","Yes","Yes","Yes","49%","51%","$175","$20","$3,779","$60","$175","$155","$2,311","$55","$175","$0","$578","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","30.00%","$175","$175 per person","$350 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2V65","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 3800 0","96751NH015",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9985",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-00","Anthem Silver Pathway X Enhanced HMO 3800 0","Standard Silver Off Exchange Plan","68.02%","0.688649583170081","Yes","Yes","Yes","49%","51%","$3,800","$580","$0","$60","$3,800","$740","$1,433","$55","$1,708","$430","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","0.00%","$3,800","$3800 per person","$7600 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JYY","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 3800 0","96751NH015",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9985",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-01","Anthem Silver Pathway X Enhanced HMO 3800 0","Standard Silver On Exchange Plan","68.02%","0.688649583170081","Yes","Yes","Yes","49%","51%","$3,800","$580","$0","$60","$3,800","$740","$1,433","$55","$1,708","$430","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","0.00%","$3,800","$3800 per person","$7600 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPU","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 3800 0","96751NH015",,"NHN001","NHS001","NHF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9985",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-02","Anthem Silver Pathway X Enhanced HMO 3800 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GQ6","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150024","Anthem Catastrophic Pathway X Enhanced HMO 7350 0","96751NH015",,"NHN001","NHS001","NHF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9971",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150024-01","Anthem Catastrophic Pathway X Enhanced HMO 7350 0","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","49%","51%","$7,350","$0","$0","$60","$2,926","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%","$7,350","$7350 per person","$14700 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPZ","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","02-0494919","96751NH0160005","Anthem Gold Pathway X HMO 1500 20 3000","96751NH016",,"NHN003","NHS001","NHF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except primary Care Physicians, OBGYN care, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9949",,,"2018-01-01","2018-12-31","Yes","Urgent/Emergency Coverage Only","Yes","TRAD/PAR network","No",,"https://www.anthem.com/NHSelectdrugtier4/1a1b","96751NH0160005-00","Anthem Gold Pathway X HMO 1500 20 3000","Standard Gold Off Exchange Plan","78.39%","0.805564989633247","No","Yes","No","100%",,"$1,500","$0","$1,500","$60","$1,500","$1,090","$410","$55","$1,142","$900","$245","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2SZF",
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150027","Anthem Silver Pathway X Enhanced HMO 5300 25","96751NH015",,"NHN001","NHS001","NHF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9984",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150027-00","Anthem Silver Pathway X Enhanced HMO 5300 25","Standard Silver Off Exchange Plan","68.38%","0.682548981632689","Yes","Yes","Yes","49%","51%","$5,300","$110","$3,100","$60","$3,750","$590","$1,966","$55","$1,282","$140","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECP","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","02-0494919","96751NH0160008","Anthem Bronze Pathway X HMO 6550 0 6550 w HSA","96751NH016",,"NHN003","NHS001","NHF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All except primary Care Physicians, OBGYN care, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9927",,,"2018-01-01","2018-12-31","Yes","Urgent/Emergency Coverage Only","Yes","TRAD/PAR network","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160008-00","Anthem Bronze Pathway X HMO 6550 0 6550 w HSA","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2SZY",
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 3500 0","96751NH015",,"NHN001","NHS001","NHF009","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-00","Anthem Silver Pathway X Enhanced HMO 3500 0","Standard Silver Off Exchange Plan","68.01%","0.679442696427354","Yes","Yes","Yes","49%","51%","$3,500","$1,060","$0","$60","$1,917","$4,945","$0","$55","$1,559","$310","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%","$3,500","$3500 per person","$7000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2901","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 3500 0","96751NH015",,"NHN001","NHS001","NHF009","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-01","Anthem Silver Pathway X Enhanced HMO 3500 0","Standard Silver On Exchange Plan","68.01%","0.679442696427354","Yes","Yes","Yes","49%","51%","$3,500","$1,060","$0","$60","$1,917","$4,945","$0","$55","$1,559","$310","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%","$3,500","$3500 per person","$7000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2904","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","02-0494919","96751NH0160008","Anthem Bronze Pathway X HMO 6550 0 6550 w HSA","96751NH016",,"NHN003","NHS001","NHF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All except primary Care Physicians, OBGYN care, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9927",,,"2018-01-01","2018-12-31","Yes","Urgent/Emergency Coverage Only","Yes","TRAD/PAR network","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160008-01","Anthem Bronze Pathway X HMO 6550 0 6550 w HSA","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2SZX",
"2018","NH","96751","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","02-0494919","96751NH0160010","Anthem Silver Pathway X HMO 3000 0 6550 w HSA","96751NH016",,"NHN003","NHS001","NHF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All except primary Care Physicians, OBGYN care, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9944",,,"2018-01-01","2018-12-31","Yes","Urgent/Emergency Coverage Only","Yes","TRAD/PAR network","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160010-00","Anthem Silver Pathway X HMO 3000 0 6550 w HSA","Standard Silver Off Exchange Plan",,"0.715487559368302","Yes","Yes","No","100%",,"$3,000","$0","$7","$60","$3,000","$0","$852","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2SZD",
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 3500 0","96751NH015",,"NHN001","NHS001","NHF009","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-02","Anthem Silver Pathway X Enhanced HMO 3500 0 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2902","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 3500 0","96751NH015",,"NHN001","NHS001","NHF009","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-03","Anthem Silver Pathway X Enhanced HMO 3500 0","Limited Cost Sharing Plan Variation","68.01%","0.679442696427354","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%","$3,500","$3500 per person","$7000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2904","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","02-0494919","96751NH0160010","Anthem Silver Pathway X HMO 3000 0 6550 w HSA","96751NH016",,"NHN003","NHS001","NHF003","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All except primary Care Physicians, OBGYN care, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9944",,,"2018-01-01","2018-12-31","Yes","Urgent/Emergency Coverage Only","Yes","TRAD/PAR network","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160010-01","Anthem Silver Pathway X HMO 3000 0 6550 w HSA","Standard Silver On Exchange Plan",,"0.715487559368302","Yes","Yes","No","100%",,"$3,000","$0","$7","$60","$3,000","$0","$852","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2SZC",
"2018","NH","96751","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","02-0494919","96751NH0160011","Anthem Gold Pathway X HMO 1750 10 3500 w HSA","96751NH016",,"NHN003","NHS001","NHF002","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All except primary Care Physicians, OBGYN care, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9949",,,"2018-01-01","2018-12-31","Yes","Urgent/Emergency Coverage Only","Yes","TRAD/PAR network","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160011-00","Anthem Gold Pathway X HMO 1750 10 3500 w HSA","Standard Gold Off Exchange Plan",,"0.783242435147003","Yes","Yes","No","100%",,"$1,750","$0","$1,263","$60","$1,750","$0","$718","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$7000 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$3500 per person","$3500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2SZ9",
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 3500 0","96751NH015",,"NHN001","NHS001","NHF009","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-04","Anthem Silver Pathway X Enhanced HMO 3500 0 S04","73% AV Level Silver Plan","72.69%","0.72517201822532","Yes","Yes","Yes","49%","51%","$3,500","$770","$0","$60","$3,500","$1,785","$0","$55","$1,559","$270","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%","$3,500","$3500 per person","$7000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2905","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 3500 0","96751NH015",,"NHN001","NHS001","NHF009","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-05","Anthem Silver Pathway X Enhanced HMO 3500 0 S05","87% AV Level Silver Plan","86.19%","0.861720426265793","Yes","Yes","Yes","49%","51%","$900","$500","$0","$60","$900","$1,685","$0","$55","$900","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","0.00%","$900","$900 per person","$1800 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2906","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","02-0494919","96751NH0160011","Anthem Gold Pathway X HMO 1750 10 3500 w HSA","96751NH016",,"NHN003","NHS001","NHF002","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All except primary Care Physicians, OBGYN care, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9949",,,"2018-01-01","2018-12-31","Yes","Urgent/Emergency Coverage Only","Yes","TRAD/PAR network","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160011-01","Anthem Gold Pathway X HMO 1750 10 3500 w HSA","Standard Gold On Exchange Plan",,"0.783242435147003","Yes","Yes","No","100%",,"$1,750","$0","$1,263","$60","$1,750","$0","$718","$55","$1,733","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$7000 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$3500 per person","$3500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2SZ8",
"2018","NH","96751","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","02-0494919","96751NH0160012","Anthem Bronze Pathway X HMO 5250 30 6550 w HSA","96751NH016",,"NHN003","NHS001","NHF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All except primary Care Physicians, OBGYN care, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9927",,,"2018-01-01","2018-12-31","Yes","Urgent/Emergency Coverage Only","Yes","TRAD/PAR network","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160012-00","Anthem Bronze Pathway X HMO 5250 30 6550 w HSA","Standard Bronze Off Exchange Plan",,"0.611887398352848","Yes","Yes","No","100%",,"$2,830","$0","$3,720","$60","$4,560","$0","$1,990","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2SZJ",
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 3500 0","96751NH015",,"NHN001","NHS001","NHF009","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-06","Anthem Silver Pathway X Enhanced HMO 3500 0 S06","94% AV Level Silver Plan","94.97%","0.950986352249818","Yes","Yes","Yes","49%","51%","$350","$198","$0","$60","$0","$316","$0","$55","$350","$36","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$975","$975 per person","$1950 per group","$975","$975 per person","$1950 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$375","$375 per person","$750 per group","0.00%","$375","$375 per person","$750 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2903","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","02-0494919","96751NH0160012","Anthem Bronze Pathway X HMO 5250 30 6550 w HSA","96751NH016",,"NHN003","NHS001","NHF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All except primary Care Physicians, OBGYN care, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9927",,,"2018-01-01","2018-12-31","Yes","Urgent/Emergency Coverage Only","Yes","TRAD/PAR network","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160012-01","Anthem Bronze Pathway X HMO 5250 30 6550 w HSA","Standard Bronze On Exchange Plan",,"0.611887398352848","Yes","Yes","No","100%",,"$2,830","$0","$3,720","$60","$4,560","$0","$1,990","$55","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.sbc.anthem.com/dps/ccd2SZK",
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150027","Anthem Silver Pathway X Enhanced HMO 5300 25","96751NH015",,"NHN001","NHS001","NHF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9984",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150027-01","Anthem Silver Pathway X Enhanced HMO 5300 25","Standard Silver On Exchange Plan","68.38%","0.682548981632689","Yes","Yes","Yes","49%","51%","$5,300","$110","$3,100","$60","$3,750","$590","$1,966","$55","$1,282","$140","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECQ","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","02-0494919","96751NH0160005","Anthem Gold Pathway X HMO 1500 20 3000","96751NH016",,"NHN003","NHS001","NHF005","Existing","HMO","Gold","Not Applicable","Yes","Both","No","Yes","All except primary Care Physicians, OBGYN care, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9949",,,"2018-01-01","2018-12-31","Yes","Urgent/Emergency Coverage Only","Yes","TRAD/PAR network","No",,"https://www.anthem.com/NHSelectdrugtier4/1a1b","96751NH0160005-01","Anthem Gold Pathway X HMO 1500 20 3000","Standard Gold On Exchange Plan","78.39%","0.805564989633247","No","Yes","No","100%",,"$1,500","$0","$1,500","$60","$1,500","$1,090","$410","$55","$1,142","$900","$245","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2SZE",
"2018","NH","96751","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","02-0494919","96751NH0160006","Anthem Silver Pathway X HMO 3500 10 6000","96751NH016",,"NHN003","NHS001","NHF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except primary Care Physicians, OBGYN care, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.994",,,"2018-01-01","2018-12-31","Yes","Urgent/Emergency Coverage Only","Yes","TRAD/PAR network","No",,"https://www.anthem.com/NHSelectdrugtier4/1a1b","96751NH0160006-00","Anthem Silver Pathway X HMO 3500 10 6000","Standard Silver Off Exchange Plan","68.59%","0.719699377229692","No","Yes","No","100%",,"$3,500","$100","$1,260","$60","$2,634","$1,815","$293","$55","$1,255","$900","$132","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2SZM",
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150027","Anthem Silver Pathway X Enhanced HMO 5300 25","96751NH015",,"NHN001","NHS001","NHF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9984",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150027-02","Anthem Silver Pathway X Enhanced HMO 5300 25 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2ECR","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150027","Anthem Silver Pathway X Enhanced HMO 5300 25","96751NH015",,"NHN001","NHS001","NHF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9984",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150027-03","Anthem Silver Pathway X Enhanced HMO 5300 25","Limited Cost Sharing Plan Variation","68.38%","0.682548981632689","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","25.00%","$5,300","$5300 per person","$10600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECQ","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","SHOP (Small Group)","No","02-0494919","96751NH0160006","Anthem Silver Pathway X HMO 3500 10 6000","96751NH016",,"NHN003","NHS001","NHF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","Yes","All except primary Care Physicians, OBGYN care, Emergency Care, Emergency Ambulance, Chiropractors and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.994",,,"2018-01-01","2018-12-31","Yes","Urgent/Emergency Coverage Only","Yes","TRAD/PAR network","No",,"https://www.anthem.com/NHSelectdrugtier4/1a1b","96751NH0160006-01","Anthem Silver Pathway X HMO 3500 10 6000","Standard Silver On Exchange Plan","68.59%","0.719699377229692","No","Yes","No","100%",,"$3,500","$100","$1,260","$60","$2,634","$1,815","$293","$55","$1,255","$900","$132","$0","$500","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.sbc.anthem.com/dps/ccd2SZL",
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150027","Anthem Silver Pathway X Enhanced HMO 5300 25","96751NH015",,"NHN001","NHS001","NHF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9984",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150027-04","Anthem Silver Pathway X Enhanced HMO 5300 25 S04","73% AV Level Silver Plan","72.59%","0.725786480818386","Yes","Yes","Yes","49%","51%","$3,000","$100","$3,100","$60","$3,000","$550","$1,966","$55","$1,282","$120","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","$5,700","$5700 per person","$11400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%","$3,000","$3000 per person","$6000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECS","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150027","Anthem Silver Pathway X Enhanced HMO 5300 25","96751NH015",,"NHN001","NHS001","NHF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9984",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150027-05","Anthem Silver Pathway X Enhanced HMO 5300 25 S05","87% AV Level Silver Plan","86.03%","0.860627678084563","Yes","Yes","Yes","49%","51%","$800","$80","$3,100","$60","$800","$470","$1,966","$55","$800","$80","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","25.00%","$800","$800 per person","$1600 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECT","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150027","Anthem Silver Pathway X Enhanced HMO 5300 25","96751NH015",,"NHN001","NHS001","NHF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9984",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150027-06","Anthem Silver Pathway X Enhanced HMO 5300 25 S06","94% AV Level Silver Plan","93.23%","0.932666860805355","Yes","Yes","Yes","49%","51%","$200","$70","$1,244","$60","$200","$430","$1,966","$55","$200","$60","$427","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2ECU","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150033","Anthem Silver Pathway X Enhanced HMO 6300 30","96751NH015",,"NHN001","NHS001","NHF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9984",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150033-00","Anthem Silver Pathway X Enhanced HMO 6300 30","Standard Silver Off Exchange Plan","66.02%","0.676584782272355","Yes","Yes","Yes","49%","51%","$3,630","$0","$3,720","$60","$3,643","$475","$2,073","$55","$1,197","$160","$513","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","30.00%","$6,300","$6300 per person","$12600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2V6R","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150033","Anthem Silver Pathway X Enhanced HMO 6300 30","96751NH015",,"NHN001","NHS001","NHF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9984",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150033-01","Anthem Silver Pathway X Enhanced HMO 6300 30","Standard Silver On Exchange Plan","66.02%","0.676584782272355","Yes","Yes","Yes","49%","51%","$3,630","$0","$3,720","$60","$3,643","$475","$2,073","$55","$1,197","$160","$513","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","30.00%","$6,300","$6300 per person","$12600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2V6S","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150033","Anthem Silver Pathway X Enhanced HMO 6300 30","96751NH015",,"NHN001","NHS001","NHF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9984",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150033-02","Anthem Silver Pathway X Enhanced HMO 6300 30 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2V6T","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150033","Anthem Silver Pathway X Enhanced HMO 6300 30","96751NH015",,"NHN001","NHS001","NHF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9984",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150033-03","Anthem Silver Pathway X Enhanced HMO 6300 30","Limited Cost Sharing Plan Variation","66.02%","0.676584782272355","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","30.00%","$6,300","$6300 per person","$12600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2V6S","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150033","Anthem Silver Pathway X Enhanced HMO 6300 30","96751NH015",,"NHN001","NHS001","NHF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9984",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150033-04","Anthem Silver Pathway X Enhanced HMO 6300 30 S04","73% AV Level Silver Plan","73.99%","0.750581621275806","Yes","Yes","Yes","49%","51%","$2,250","$0","$3,600","$60","$2,250","$315","$2,073","$55","$1,197","$80","$513","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30.00%","$2,250","$2250 per person","$4500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2V6V","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150033","Anthem Silver Pathway X Enhanced HMO 6300 30","96751NH015",,"NHN001","NHS001","NHF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9984",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150033-05","Anthem Silver Pathway X Enhanced HMO 6300 30 S05","87% AV Level Silver Plan","87.58%","0.880145985548664","Yes","Yes","Yes","49%","51%","$678","$0","$772","$60","$750","$70","$630","$55","$750","$40","$513","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group","$1,450","$1450 per person","$2900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30.00%","$750","$750 per person","$1500 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2V6W","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150033","Anthem Silver Pathway X Enhanced HMO 6300 30","96751NH015",,"NHN001","NHS001","NHF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9984",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150033-06","Anthem Silver Pathway X Enhanced HMO 6300 30 S06","94% AV Level Silver Plan","93.90%","0.941389222390074","Yes","Yes","Yes","49%","51%","$125","$0","$475","$60","$175","$50","$375","$55","$175","$0","$425","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","30.00%","$175","$175 per person","$350 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2V6X","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150036","Anthem Gold Pathway X Enhanced HMO 1500 10","96751NH015",,"NHN001","NHS001","NHF002","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9988",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150036-00","Anthem Gold Pathway X Enhanced HMO 1500 10","Standard Gold Off Exchange Plan","76.95%","0.778240336442819","Yes","Yes","Yes","49%","51%","$1,500","$60","$1,244","$60","$1,500","$240","$1,356","$55","$1,500","$120","$171","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","10.00%","$1,500","$1500 per person","$4500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2V67","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150036","Anthem Gold Pathway X Enhanced HMO 1500 10","96751NH015",,"NHN001","NHS001","NHF002","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9988",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150036-01","Anthem Gold Pathway X Enhanced HMO 1500 10","Standard Gold On Exchange Plan","76.95%","0.778240336442819","Yes","Yes","Yes","49%","51%","$1,500","$60","$1,244","$60","$1,500","$240","$1,356","$55","$1,500","$120","$171","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","10.00%","$1,500","$1500 per person","$4500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2V86","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150036","Anthem Gold Pathway X Enhanced HMO 1500 10","96751NH015",,"NHN001","NHS001","NHF002","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9988",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150036-02","Anthem Gold Pathway X Enhanced HMO 1500 10 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2V87","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NH","96751","SERFF","2017-10-31 20:15:29","Individual","No","02-0494919","96751NH0150036","Anthem Gold Pathway X Enhanced HMO 1500 10","96751NH015",,"NHN001","NHS001","NHF002","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9988",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150036-03","Anthem Gold Pathway X Enhanced HMO 1500 10","Limited Cost Sharing Plan Variation","76.95%","0.778240336442819","Yes","Yes","Yes","49%","51%","$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","10.00%","$1,500","$1500 per person","$4500 per group","10.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2V86","http://editiondigital.net/view/IU65/2018/ON_HIX_NH_KIT_2018"
"2018","NM","17911","SERFF","2017-09-21 20:16:21","Individual","Yes","47-0397286","17911NM0060001","Delta Dental Individual PPO, EHB Certified (Exchange)","17911NM006",,"NMN001","NMS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911","","17911NM0060001-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnm.com/NM_EHB_High_2018","http://www.deltadentalnm.com/NM_EHB_High_2018"
"2018","NM","17911","SERFF","2017-09-21 20:16:21","Individual","Yes","47-0397286","17911NM0060002","Delta Dental Individual PPO, EHB Certified (Exchange)","17911NM006",,"NMN001","NMS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911","","17911NM0060002-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnm.com/NM_EHB_Low_2018","http://www.deltadentalnm.com/NM_EHB_Low_2018"
"2018","NM","17911","SERFF","2017-09-21 20:16:21","Individual","Yes","47-0397286","17911NM0090001","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","17911NM009",,"NMN001","NMS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911","","17911NM0090001-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnm.com/NM_Ped_High_2018","http://www.deltadentalnm.com/NM_Ped_High_2018"
"2018","NM","17911","SERFF","2017-09-21 20:16:21","Individual","Yes","47-0397286","17911NM0090002","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","17911NM009",,"NMN001","NMS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911","","17911NM0090002-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnm.com/NM_Ped_Low_2018","http://www.deltadentalnm.com/NM_Ped_Low_2018"
"2018","NM","19722","SERFF","2017-09-21 20:16:21","Individual","No","85-0408506","19722NM0010001","Molina Marketplace Gold","19722NM001","7053314291","NMN001","NMS001","NMF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","EMERGENT IS COVERED","Yes","EMERGENT IS COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2018.pdf","19722NM0010001-00","Molina Marketplace Gold Off Exchange","Standard Gold Off Exchange Plan",,"0.770138560314203","No","Yes","No","100%",,"$3,800","$300","$2,300","$60","$1,400","$1,200","$300","$60","$60","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-gold-2018.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","NM","19722","SERFF","2017-09-21 20:16:21","Individual","No","85-0408506","19722NM0010001","Molina Marketplace Gold","19722NM001","7053314291","NMN001","NMS001","NMF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","EMERGENT IS COVERED","Yes","EMERGENT IS COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2018.pdf","19722NM0010001-01","Molina Marketplace Gold","Standard Gold On Exchange Plan",,"0.770138560314203","No","Yes","No","100%",,"$3,800","$300","$2,300","$60","$1,400","$1,200","$300","$60","$60","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-gold-2018.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","NM","19722","SERFF","2017-09-21 20:16:21","Individual","No","85-0408506","19722NM0010001","Molina Marketplace Gold","19722NM001","7053314291","NMN001","NMS001","NMF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","EMERGENT IS COVERED","Yes","EMERGENT IS COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2018.pdf","19722NM0010001-02","Molina Marketplace Gold Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-gold-zero-2018.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","NM","19722","SERFF","2017-09-21 20:16:21","Individual","No","85-0408506","19722NM0010001","Molina Marketplace Gold","19722NM001","7053314291","NMN001","NMS001","NMF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","EMERGENT IS COVERED","Yes","EMERGENT IS COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2018.pdf","19722NM0010001-03","Molina Marketplace Gold LCS","Limited Cost Sharing Plan Variation",,"0.770138560314203","No","Yes","No","100%",,"$3,800","$300","$2,300","$60","$1,400","$1,200","$300","$60","$60","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,025","$1025 per person","$2050 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-gold-lcs-2018.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","NM","19722","SERFF","2017-09-21 20:16:21","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver","19722NM001","7053314291","NMN001","NMS001","NMF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","EMERGENT IS COVERED","Yes","EMERGENT IS COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2018.pdf","19722NM0010002-00","Molina Marketplace Silver Off Exchange","Standard Silver Off Exchange Plan",,"0.678048193152746","No","Yes","No","100%",,"$2,100","$400","$4,500","$60","$1,000","$1,700","$700","$60","$40","$700","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,950","$4950 per person","$9900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,950","$4950 per person","$9900 per group","$400","$400 per person","$800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2018.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","NM","19722","SERFF","2017-09-21 20:16:21","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver","19722NM001","7053314291","NMN001","NMS001","NMF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","EMERGENT IS COVERED","Yes","EMERGENT IS COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2018.pdf","19722NM0010002-01","Molina Marketplace Silver 250","Standard Silver On Exchange Plan",,"0.678048193152746","No","Yes","No","100%",,"$2,100","$400","$4,500","$60","$1,000","$1,700","$700","$60","$40","$700","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,950","$4950 per person","$9900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,950","$4950 per person","$9900 per group","$400","$400 per person","$800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2018.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","NM","19722","SERFF","2017-09-21 20:16:21","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver","19722NM001","7053314291","NMN001","NMS001","NMF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","EMERGENT IS COVERED","Yes","EMERGENT IS COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2018.pdf","19722NM0010002-02","Molina Marketplace Silver Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-silver-zero-2018.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","NM","19722","SERFF","2017-09-21 20:16:21","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver","19722NM001","7053314291","NMN001","NMS001","NMF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","EMERGENT IS COVERED","Yes","EMERGENT IS COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2018.pdf","19722NM0010002-03","Molina Marketplace Silver LCS","Limited Cost Sharing Plan Variation",,"0.678048193152746","No","Yes","No","100%",,"$2,100","$400","$4,500","$60","$1,000","$1,700","$700","$60","$40","$700","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,950","$4950 per person","$9900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,950","$4950 per person","$9900 per group","$400","$400 per person","$800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-silver-lcs-2018.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","NM","19722","SERFF","2017-09-21 20:16:21","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver","19722NM001","7053314291","NMN001","NMS001","NMF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","EMERGENT IS COVERED","Yes","EMERGENT IS COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2018.pdf","19722NM0010002-04","Molina Marketplace Silver 200","73% AV Level Silver Plan",,"0.739709064127067","No","Yes","No","100%",,"$1,400","$400","$3,700","$60","$1,000","$1,500","$700","$60","$40","$600","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$2,500","$2500 per person","$5000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$400","$400 per person","$800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-silver-200-2018.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","NM","19722","SERFF","2017-09-21 20:16:21","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver","19722NM001","7053314291","NMN001","NMS001","NMF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","EMERGENT IS COVERED","Yes","EMERGENT IS COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2018.pdf","19722NM0010002-05","Molina Marketplace Silver 150","87% AV Level Silver Plan",,"0.879609893257353","No","Yes","No","100%",,"$500","$200","$1,700","$60","$500","$800","$300","$60","$60","$300","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$525","$525 per person","$1050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$525","$525 per person","$1050 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-silver-150-2018.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","NM","19722","SERFF","2017-09-21 20:16:21","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver","19722NM001","7053314291","NMN001","NMS001","NMF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","EMERGENT IS COVERED","Yes","EMERGENT IS COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2018.pdf","19722NM0010002-06","Molina Marketplace Silver 100","94% AV Level Silver Plan",,"0.949265703364465","No","Yes","No","100%",,"$0","$200","$1,100","$60","$0","$400","$200","$60","$0","$100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-silver-100-2018.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","NM","19722","SERFF","2017-09-21 20:16:21","Individual","No","85-0408506","19722NM0010003","Molina Marketplace Bronze","19722NM001","7053314291","NMN001","NMS001","NMF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","EMERGENT IS COVERED","Yes","EMERGENT IS COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2018.pdf","19722NM0010003-00","Molina Marketplace Bronze Off Exchange","Standard Bronze Off Exchange Plan",,"0.625077353580658","Yes","Yes","No","100%",,"$2,100","$400","$4,500","$60","$4,000","$2,000","$700","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-bronze-2018.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","NM","19722","SERFF","2017-09-21 20:16:21","Individual","No","85-0408506","19722NM0010003","Molina Marketplace Bronze","19722NM001","7053314291","NMN001","NMS001","NMF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","EMERGENT IS COVERED","Yes","EMERGENT IS COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2018.pdf","19722NM0010003-01","Molina Marketplace Bronze","Standard Bronze On Exchange Plan",,"0.625077353580658","Yes","Yes","No","100%",,"$2,100","$400","$4,500","$60","$4,000","$2,000","$700","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-bronze-2018.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","NM","19722","SERFF","2017-09-21 20:16:21","Individual","No","85-0408506","19722NM0010003","Molina Marketplace Bronze","19722NM001","7053314291","NMN001","NMS001","NMF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","EMERGENT IS COVERED","Yes","EMERGENT IS COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2018.pdf","19722NM0010003-02","Molina Marketplace Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-bronze-zero-2018.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","NM","19722","SERFF","2017-09-21 20:16:21","Individual","No","85-0408506","19722NM0010003","Molina Marketplace Bronze","19722NM001","7053314291","NMN001","NMS001","NMF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","EMERGENT IS COVERED","Yes","EMERGENT IS COVERED","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/formulary-2018.pdf","19722NM0010003-03","Molina Marketplace Bronze LCS","Limited Cost Sharing Plan Variation",,"0.625077353580658","Yes","Yes","No","100%",,"$2,100","$400","$4,500","$60","$4,000","$2,000","$700","$60","$1,100","$400","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/summary-of-benefits-gold-lcs-2018.pdf","http://www.molinahealthcare.com/members/nm/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","NM","26075","SERFF","2017-09-21 20:16:21","Individual","Yes","95-6042390","26075NM0020003","BESTOne Advantage Gold","26075NM002",,"NMN001","NMS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/current/NM_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","NM","26075","SERFF","2017-09-21 20:16:21","Individual","Yes","95-6042390","26075NM0020003","BESTOne Advantage Gold","26075NM002",,"NMN001","NMS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/current/NM_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","NM","26075","SERFF","2017-09-21 20:16:21","Individual","Yes","95-6042390","26075NM0020004","BESTOne Plus Gold","26075NM002",,"NMN001","NMS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/current/NM_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","NM","26075","SERFF","2017-09-21 20:16:21","Individual","Yes","95-6042390","26075NM0020004","BESTOne Plus Gold","26075NM002",,"NMN001","NMS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/current/NM_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","NM","26075","SERFF","2017-09-21 20:16:21","Individual","Yes","95-6042390","26075NM0020005","BESTOne Plus Silver","26075NM002",,"NMN001","NMS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/current/NM_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","NM","26075","SERFF","2017-09-21 20:16:21","Individual","Yes","95-6042390","26075NM0020005","BESTOne Plus Silver","26075NM002",,"NMN001","NMS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/current/NM_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","NM","26075","SERFF","2017-09-21 20:16:21","Individual","Yes","95-6042390","26075NM0020006","BESTOne Basic Silver","26075NM002",,"NMN001","NMS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/current/NM_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","NM","26075","SERFF","2017-09-21 20:16:21","Individual","Yes","95-6042390","26075NM0020006","BESTOne Basic Silver","26075NM002",,"NMN001","NMS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/current/NM_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0060001","New Mexico Catastrophic","72034NM006",,"NMN001","NMS002","NMF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0060001-00","New Mexico Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Catastrophic.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0060001","New Mexico Catastrophic","72034NM006",,"NMN001","NMS002","NMF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0060001-01","New Mexico Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Catastrophic.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0050001","New Mexico Catastrophic S","72034NM005",,"NMN001","NMS001","NMF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0050001-00","New Mexico Catastrophic S","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Catastrophic_S.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0050001","New Mexico Catastrophic S","72034NM005",,"NMN001","NMS001","NMF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0050001-01","New Mexico Catastrophic S","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Catastrophic_S.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0130001-00","New Mexico Silver HD","Standard Silver Off Exchange Plan",,"0.6652586938756","Yes","Yes","No","100%",,"$4,480","$1,520","$0","$60","$4,386","$1,278","$336","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Silver_HD.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0130001-01","New Mexico Silver HD","Standard Silver On Exchange Plan",,"0.6652586938756","Yes","Yes","No","100%",,"$4,480","$1,520","$0","$60","$4,386","$1,278","$336","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Silver_HD.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0130001-02","New Mexico Silver HD","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0130001-03","New Mexico Silver HD","Limited Cost Sharing Plan Variation",,"0.6652586938756","Yes","Yes","No","100%",,"$4,480","$1,520","$0","$60","$4,386","$1,278","$336","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Silver_HD_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0130001-04","New Mexico Silver HD","73% AV Level Silver Plan",,"0.721669471067968","Yes","Yes","No","100%",,"$2,980","$1,520","$0","$60","$3,000","$1,194","$306","$55","$1,204","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Silver_HD_73%.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0130001-05","New Mexico Silver HD","87% AV Level Silver Plan",,"0.868312301179787","Yes","Yes","No","100%",,"$0","$1,500","$0","$60","$550","$763","$187","$55","$550","$255","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","20.00%",,,,,"$550","$550 per person","$1100 per group","$550","$550 per person","$1100 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Silver_HD_87%.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0130001-06","New Mexico Silver HD","94% AV Level Silver Plan",,"0.943477430850966","Yes","Yes","No","100%",,"$0","$500","$0","$60","$125","$292","$83","$55","$125","$98","$277","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","20.00%",,,,,"$125","$125 per person","$250 per group","$125","$125 per person","$250 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Silver_HD_94%o.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0170001-00","New Mexico Silver LD","Standard Silver Off Exchange Plan",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Silver_LD.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0170001-01","New Mexico Silver LD","Standard Silver On Exchange Plan",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Silver_LD.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0170001-02","New Mexico Silver LD","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0170001-03","New Mexico Silver LD","Limited Cost Sharing Plan Variation",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Silver_LD_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0170001-04","New Mexico Silver LD","73% AV Level Silver Plan",,"0.739160290286648","Yes","Yes","No","100%",,"$2,480","$1,520","$0","$60","$2,500","$1,008","$492","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Silver_LD_73%.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0170001-05","New Mexico Silver LD","87% AV Level Silver Plan",,"0.866884420915489","Yes","Yes","No","100%",,"$0","$1,500","$0","$60","$550","$640","$310","$55","$550","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","35.00%",,,,,"$550","$550 per person","$1100 per group","$550","$550 per person","$1100 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Silver_LD_87%.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0170001-06","New Mexico Silver LD","94% AV Level Silver Plan",,"0.942934961244145","Yes","Yes","No","100%",,"$0","$500","$0","$60","$125","$270","$105","$55","$125","$0","$375","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","35.00%",,,,,"$125","$125 per person","$250 per group","$125","$125 per person","$250 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Silver_LD_94%.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0180001-00","New Mexico Silver SLD","Standard Silver Off Exchange Plan",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Silver_LD.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0180001-01","New Mexico Silver SLD","Standard Silver On Exchange Plan",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Silver_LD.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0180001-02","New Mexico Silver SLD","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0180001-03","New Mexico Silver SLD","Limited Cost Sharing Plan Variation",,"0.711698661225783","Yes","Yes","No","100%",,"$3,000","$1,693","$0","$60","$3,000","$1,302","$605","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","35.00%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Silver_LD_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0180001-04","New Mexico Silver SLD","73% AV Level Silver Plan",,"0.739160290286648","Yes","Yes","No","100%",,"$2,480","$1,520","$0","$60","$2,500","$1,008","$492","$55","$996","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Silver_LD_73%.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0180001-05","New Mexico Silver SLD","87% AV Level Silver Plan",,"0.866884420915489","Yes","Yes","No","100%",,"$0","$1,500","$0","$60","$550","$640","$310","$55","$550","$255","$485","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","35.00%",,,,,"$550","$550 per person","$1100 per group","$550","$550 per person","$1100 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Silver_LD_87%.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0180001-06","New Mexico Silver SLD","94% AV Level Silver Plan",,"0.942934961244145","Yes","Yes","No","100%",,"$0","$500","$0","$60","$125","$270","$105","$55","$125","$0","$375","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","$250 per group","35.00%",,,,,"$125","$125 per person","$250 per group","$125","$125 per person","$250 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Silver_LD_94%.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0080001","New Mexico Gold","72034NM008",,"NMN001","NMS002","NMF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0080001-00","New Mexico Gold","Standard Gold Off Exchange Plan",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Gold.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0080001","New Mexico Gold","72034NM008",,"NMN001","NMS002","NMF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0080001-01","New Mexico Gold","Standard Gold On Exchange Plan",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Gold.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0080001","New Mexico Gold","72034NM008",,"NMN001","NMS002","NMF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0080001-02","New Mexico Gold","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0080001","New Mexico Gold","72034NM008",,"NMN001","NMS002","NMF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0080001-03","New Mexico Gold","Limited Cost Sharing Plan Variation",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Gold_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0090001","New Mexico Gold S","72034NM009",,"NMN001","NMS001","NMF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0090001-00","New Mexico Gold S","Standard Gold Off Exchange Plan",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Gold_S.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0090001","New Mexico Gold S","72034NM009",,"NMN001","NMS001","NMF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0090001-01","New Mexico Gold S","Standard Gold On Exchange Plan",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Gold_S.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0090001","New Mexico Gold S","72034NM009",,"NMN001","NMS001","NMF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0090001-02","New Mexico Gold S","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_American_Indian_Zero.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","72034","SERFF","2017-10-31 20:15:29","Individual","No","45-2106295","72034NM0090001","New Mexico Gold S","72034NM009",,"NMN001","NMS001","NMF004","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergency Sevices Only","No",,"No","https://chppayment.christushealth.org/chp","http://www.christushealthplan.org/nm2018healthexchangeformulary","72034NM0090001-03","New Mexico Gold S","Limited Cost Sharing Plan Variation",,"0.760821646550953","Yes","Yes","No","100%",,"$2,600","$536","$0","$60","$2,600","$659","$259","$55","$1,314","$160","$208","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,150","$4150 per person","$8300 per group",,,,"$4,150","$4150 per person","$8300 per group","$4,150","$4150 per person","$8300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15.00%",,,,,"$2,600","$2600 per person","$5200 per group","$2,600","$2600 per person","$5200 per group","No",,,"http://www.christushealthplan.org/documents/summaryofbenefits/72034_Gold_S_Limited_Cost_Sharing.pdf","https://www.christushealthplan.org/individual-family"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390102","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS042","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390102-01","Blue Community Bronze HMO? 202","Standard Bronze On Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390102","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS042","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390102-02","Blue Community Bronze HMO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390102","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS042","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390102-03","Blue Community Bronze HMO? 202","Limited Cost Sharing Plan Variation",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390103","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS052","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390103-00","Blue Community Bronze HMO? 202","Standard Bronze Off Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390113","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS032","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390113-03","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390114","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS042","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390114-00","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390114","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS042","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390114-01","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390114","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS042","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390114-02","Blue Community Bronze HMO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390114","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS042","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390114-03","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390115","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS052","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390115-00","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390103","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS052","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390103-01","Blue Community Bronze HMO? 202","Standard Bronze On Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390103","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS052","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390103-02","Blue Community Bronze HMO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390103","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS052","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390103-03","Blue Community Bronze HMO? 202","Limited Cost Sharing Plan Variation",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390077","Blue Community Security HMO? 200","75605NM039",,"NMN002","NMS012","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390077-00","Blue Community Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390077-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","Yes","36-1236610","75605NM0430001","BlueCare Dental? 1A","75605NM043",,"NMN004","NMS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430001-00","BlueCare Dental? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsnm.com/static/nm/pdf/dental/2018/bluecare-dental-individuals-and-families-nm2018.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","Yes","36-1236610","75605NM0430001","BlueCare Dental? 1A","75605NM043",,"NMN004","NMS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430001-01","BlueCare Dental? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsnm.com/static/nm/pdf/dental/2018/bluecare-dental-individuals-and-families-nm2018.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390077","Blue Community Security HMO? 200","75605NM039",,"NMN002","NMS012","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390077-01","Blue Community Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390077-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390104","Blue Community Security HMO? 200","75605NM039",,"NMN002","NMS022","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390104-00","Blue Community Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390077-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390104","Blue Community Security HMO? 200","75605NM039",,"NMN002","NMS022","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390104-01","Blue Community Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390077-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390105","Blue Community Security HMO? 200","75605NM039",,"NMN002","NMS032","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390105-00","Blue Community Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390077-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390105","Blue Community Security HMO? 200","75605NM039",,"NMN002","NMS032","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390105-01","Blue Community Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390077-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390106","Blue Community Security HMO? 200","75605NM039",,"NMN002","NMS042","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390106-00","Blue Community Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390077-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390106","Blue Community Security HMO? 200","75605NM039",,"NMN002","NMS042","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390106-01","Blue Community Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390077-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390107","Blue Community Security HMO? 200","75605NM039",,"NMN002","NMS052","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390107-00","Blue Community Security HMO? 200","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390077-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390107","Blue Community Security HMO? 200","75605NM039",,"NMN002","NMS052","NMF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390107-01","Blue Community Security HMO? 200","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,330","$20","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390077-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390079","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS012","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390079-00","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","Yes","36-1236610","75605NM0430003","BlueCare Dental 4 Kids? 1A","75605NM043",,"NMN004","NMS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430003-00","BlueCare Dental 4 Kids? 1A","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsnm.com/static/nm/pdf/dental/2018/bluecare-dental-individuals-and-families-nm2018.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","Yes","36-1236610","75605NM0430003","BlueCare Dental 4 Kids? 1A","75605NM043",,"NMN004","NMS004",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430003-01","BlueCare Dental 4 Kids? 1A","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsnm.com/static/nm/pdf/dental/2018/bluecare-dental-individuals-and-families-nm2018.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390079","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS012","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390079-01","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390079","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS012","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390079-02","Blue Community Bronze HMO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390079","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS012","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390079-03","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390112","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS022","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390112-00","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390112","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS022","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390112-01","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390112","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS022","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390112-02","Blue Community Bronze HMO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390112","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS022","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390112-03","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390113","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS032","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390113-00","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","Standard Bronze Off Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390113","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS032","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390113-01","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390113","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS032","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390113-02","Blue Community Bronze HMO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390115","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS052","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390115-01","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","Standard Bronze On Exchange Plan",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$5,500","$900","$1,000","$60","$5,500","$600","$100","$60","$1,900","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390115","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS052","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390115-02","Blue Community Bronze HMO? 201","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390084","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS022","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390084-00","Blue Community Gold HMO? 205 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390084","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS022","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390084-01","Blue Community Gold HMO? 205 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390084","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS022","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390084-02","Blue Community Gold HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390084","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS022","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390084-03","Blue Community Gold HMO? 205 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390085","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS032","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390085-00","Blue Community Gold HMO? 205 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390085","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS032","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390085-01","Blue Community Gold HMO? 205 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390115","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","75605NM039",,"NMN002","NMS052","NMF004","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390115-03","Blue Community Bronze HMO? 201 - Two $40 PCP Visits","Limited Cost Sharing Plan Variation",,"0.564969444566474","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$14700 per group","50.00%","$5,500","$5500 per person","$14700 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390079-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390076","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS012","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390076-00","Blue Community Bronze HMO? 202","Standard Bronze Off Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","Yes","36-1236610","75605NM0430002","BlueCare Dental? 1B","75605NM043",,"NMN004","NMS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430002-00","BlueCare Dental? 1B","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsnm.com/static/nm/pdf/dental/2018/bluecare-dental-individuals-and-families-nm2018.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","Yes","36-1236610","75605NM0430002","BlueCare Dental? 1B","75605NM043",,"NMN004","NMS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430002-01","BlueCare Dental? 1B","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsnm.com/static/nm/pdf/dental/2018/bluecare-dental-individuals-and-families-nm2018.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390076","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS012","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390076-01","Blue Community Bronze HMO? 202","Standard Bronze On Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390076","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS012","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390076-02","Blue Community Bronze HMO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390076","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS012","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390076-03","Blue Community Bronze HMO? 202","Limited Cost Sharing Plan Variation",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390100","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS022","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390100-00","Blue Community Bronze HMO? 202","Standard Bronze Off Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390100","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS022","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390100-01","Blue Community Bronze HMO? 202","Standard Bronze On Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390100","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS022","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390100-02","Blue Community Bronze HMO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390100","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS022","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390100-03","Blue Community Bronze HMO? 202","Limited Cost Sharing Plan Variation",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390101","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS032","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390101-00","Blue Community Bronze HMO? 202","Standard Bronze Off Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390101","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS032","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390101-01","Blue Community Bronze HMO? 202","Standard Bronze On Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390101","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS032","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390101-02","Blue Community Bronze HMO? 202","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390101","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS032","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390101-03","Blue Community Bronze HMO? 202","Limited Cost Sharing Plan Variation",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390102","Blue Community Bronze HMO? 202","75605NM039",,"NMN002","NMS042","NMF007","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390102-00","Blue Community Bronze HMO? 202","Standard Bronze Off Exchange Plan",,"0.611807799680698","Yes","Yes","Yes","43%","57%","$2,850","$900","$2,900","$60","$2,850","$0","$1,400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$8550 per group","40.00%","$2,850","$2850 per person","$8550 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsnm.com/sbc/2018/NM0390076-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390072","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS012","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390072-00","Blue Community Gold HMO? 205 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","Yes","36-1236610","75605NM0430004","BlueCare Dental 4 Kids? 1B","75605NM043",,"NMN004","NMS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430004-00","BlueCare Dental 4 Kids? 1B","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsnm.com/static/nm/pdf/dental/2018/bluecare-dental-individuals-and-families-nm2018.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","Yes","36-1236610","75605NM0430004","BlueCare Dental 4 Kids? 1B","75605NM043",,"NMN004","NMS004",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430004-01","BlueCare Dental 4 Kids? 1B","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bcbsnm.com/static/nm/pdf/dental/2018/bluecare-dental-individuals-and-families-nm2018.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390078","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS012","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390078-01","Blue Community Silver HMO? 203","Standard Silver On Exchange Plan",,"0.666249926416911","Yes","Yes","Yes","43%","57%","$1,400","$900","$5,100","$60","$1,400","$0","$2,100","$60","$1,400","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390078","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS012","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390078-02","Blue Community Silver HMO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390078","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS012","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390078-03","Blue Community Silver HMO? 203","Limited Cost Sharing Plan Variation",,"0.666249926416911","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390078","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS012","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390078-04","Blue Community Silver HMO? 203","73% AV Level Silver Plan",,"0.72838384242766","Yes","Yes","Yes","43%","57%","$650","$900","$4,400","$60","$650","$0","$2,400","$60","$650","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1950 per group","50.00%","$650","$650 per person","$1950 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-04.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390078","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS012","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390078-05","Blue Community Silver HMO? 203","87% AV Level Silver Plan",,"0.869322194606705","Yes","Yes","Yes","43%","57%","$25","$300","$2,200","$60","$25","$0","$1,800","$60","$25","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group","40.00%","$25","$25 per person","$75 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-05.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390078","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS012","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390078-06","Blue Community Silver HMO? 203","94% AV Level Silver Plan",,"0.937747805138614","Yes","Yes","Yes","43%","57%","$0","$0","$900","$60","$0","$0","$900","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$2700 per group","$900","$900 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-06.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390072","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS012","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390072-01","Blue Community Gold HMO? 205 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390072","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS012","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390072-02","Blue Community Gold HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390072","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS012","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390072-03","Blue Community Gold HMO? 205 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390085","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS032","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390085-02","Blue Community Gold HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390085","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS032","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390085-03","Blue Community Gold HMO? 205 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390093","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS032","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390093-03","Blue Community Silver HMO? 204","Limited Cost Sharing Plan Variation",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390093","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS032","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390093-04","Blue Community Silver HMO? 204","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-04.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390093","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS032","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390093-05","Blue Community Silver HMO? 204","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-05.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390093","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS032","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390093-06","Blue Community Silver HMO? 204","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-06.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390094","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS042","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390094-00","Blue Community Silver HMO? 204","Standard Silver Off Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390094","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS042","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390094-01","Blue Community Silver HMO? 204","Standard Silver On Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390086","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS042","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390086-00","Blue Community Gold HMO? 205 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390086","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS042","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390086-01","Blue Community Gold HMO? 205 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390086","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS042","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390086-02","Blue Community Gold HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390086","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS042","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390086-03","Blue Community Gold HMO? 205 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390087","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS052","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390087-00","Blue Community Gold HMO? 205 - Three $30 PCP Visits","Standard Gold Off Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390087","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS052","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390087-01","Blue Community Gold HMO? 205 - Three $30 PCP Visits","Standard Gold On Exchange Plan",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$350","$900","$4,300","$60","$350","$200","$1,400","$60","$350","$0","$600","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390087","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS052","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390087-02","Blue Community Gold HMO? 205","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390087","Blue Community Gold HMO? 205 - Three $30 PCP Visits","75605NM039",,"NMN002","NMS052","NMF002","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390087-03","Blue Community Gold HMO? 205 - Three $30 PCP Visits","Limited Cost Sharing Plan Variation",,"0.78719536981354","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$1050 per group","40.00%","$350","$350 per person","$1050 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390072-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390078","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS012","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390078-00","Blue Community Silver HMO? 203","Standard Silver Off Exchange Plan",,"0.666249926416911","Yes","Yes","Yes","43%","57%","$1,400","$900","$5,100","$60","$1,400","$0","$2,100","$60","$1,400","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390108","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS022","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390108-00","Blue Community Silver HMO? 203","Standard Silver Off Exchange Plan",,"0.666249926416911","Yes","Yes","Yes","43%","57%","$1,400","$900","$5,100","$60","$1,400","$0","$2,100","$60","$1,400","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390108","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS022","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390108-01","Blue Community Silver HMO? 203","Standard Silver On Exchange Plan",,"0.666249926416911","Yes","Yes","Yes","43%","57%","$1,400","$900","$5,100","$60","$1,400","$0","$2,100","$60","$1,400","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390108","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS022","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390108-02","Blue Community Silver HMO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390108","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS022","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390108-03","Blue Community Silver HMO? 203","Limited Cost Sharing Plan Variation",,"0.666249926416911","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390108","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS022","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390108-04","Blue Community Silver HMO? 203","73% AV Level Silver Plan",,"0.72838384242766","Yes","Yes","Yes","43%","57%","$650","$900","$4,400","$60","$650","$0","$2,400","$60","$650","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1950 per group","50.00%","$650","$650 per person","$1950 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-04.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390108","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS022","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390108-05","Blue Community Silver HMO? 203","87% AV Level Silver Plan",,"0.869322194606705","Yes","Yes","Yes","43%","57%","$25","$300","$2,200","$60","$25","$0","$1,800","$60","$25","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group","40.00%","$25","$25 per person","$75 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-05.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390108","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS022","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390108-06","Blue Community Silver HMO? 203","94% AV Level Silver Plan",,"0.937747805138614","Yes","Yes","Yes","43%","57%","$0","$0","$900","$60","$0","$0","$900","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$2700 per group","$900","$900 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-06.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390109","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS032","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390109-00","Blue Community Silver HMO? 203","Standard Silver Off Exchange Plan",,"0.666249926416911","Yes","Yes","Yes","43%","57%","$1,400","$900","$5,100","$60","$1,400","$0","$2,100","$60","$1,400","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390109","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS032","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390109-01","Blue Community Silver HMO? 203","Standard Silver On Exchange Plan",,"0.666249926416911","Yes","Yes","Yes","43%","57%","$1,400","$900","$5,100","$60","$1,400","$0","$2,100","$60","$1,400","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390109","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS032","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390109-02","Blue Community Silver HMO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390109","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS032","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390109-03","Blue Community Silver HMO? 203","Limited Cost Sharing Plan Variation",,"0.666249926416911","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390109","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS032","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390109-04","Blue Community Silver HMO? 203","73% AV Level Silver Plan",,"0.72838384242766","Yes","Yes","Yes","43%","57%","$650","$900","$4,400","$60","$650","$0","$2,400","$60","$650","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1950 per group","50.00%","$650","$650 per person","$1950 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-04.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390109","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS032","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390109-05","Blue Community Silver HMO? 203","87% AV Level Silver Plan",,"0.869322194606705","Yes","Yes","Yes","43%","57%","$25","$300","$2,200","$60","$25","$0","$1,800","$60","$25","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group","40.00%","$25","$25 per person","$75 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-05.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390109","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS032","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390109-06","Blue Community Silver HMO? 203","94% AV Level Silver Plan",,"0.937747805138614","Yes","Yes","Yes","43%","57%","$0","$0","$900","$60","$0","$0","$900","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$2700 per group","$900","$900 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-06.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390110","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS042","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390110-00","Blue Community Silver HMO? 203","Standard Silver Off Exchange Plan",,"0.666249926416911","Yes","Yes","Yes","43%","57%","$1,400","$900","$5,100","$60","$1,400","$0","$2,100","$60","$1,400","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390110","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS042","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390110-01","Blue Community Silver HMO? 203","Standard Silver On Exchange Plan",,"0.666249926416911","Yes","Yes","Yes","43%","57%","$1,400","$900","$5,100","$60","$1,400","$0","$2,100","$60","$1,400","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390110","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS042","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390110-02","Blue Community Silver HMO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390110","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS042","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390110-03","Blue Community Silver HMO? 203","Limited Cost Sharing Plan Variation",,"0.666249926416911","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390110","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS042","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390110-04","Blue Community Silver HMO? 203","73% AV Level Silver Plan",,"0.72838384242766","Yes","Yes","Yes","43%","57%","$650","$900","$4,400","$60","$650","$0","$2,400","$60","$650","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1950 per group","50.00%","$650","$650 per person","$1950 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-04.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390110","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS042","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390110-05","Blue Community Silver HMO? 203","87% AV Level Silver Plan",,"0.869322194606705","Yes","Yes","Yes","43%","57%","$25","$300","$2,200","$60","$25","$0","$1,800","$60","$25","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group","40.00%","$25","$25 per person","$75 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-05.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390110","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS042","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390110-06","Blue Community Silver HMO? 203","94% AV Level Silver Plan",,"0.937747805138614","Yes","Yes","Yes","43%","57%","$0","$0","$900","$60","$0","$0","$900","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$2700 per group","$900","$900 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-06.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390111","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS052","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390111-00","Blue Community Silver HMO? 203","Standard Silver Off Exchange Plan",,"0.666249926416911","Yes","Yes","Yes","43%","57%","$1,400","$900","$5,100","$60","$1,400","$0","$2,100","$60","$1,400","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390111","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS052","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390111-01","Blue Community Silver HMO? 203","Standard Silver On Exchange Plan",,"0.666249926416911","Yes","Yes","Yes","43%","57%","$1,400","$900","$5,100","$60","$1,400","$0","$2,100","$60","$1,400","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390111","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS052","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390111-02","Blue Community Silver HMO? 203","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390111","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS052","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390111-03","Blue Community Silver HMO? 203","Limited Cost Sharing Plan Variation",,"0.666249926416911","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$4200 per group","50.00%","$1,400","$1400 per person","$4200 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390111","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS052","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390111-04","Blue Community Silver HMO? 203","73% AV Level Silver Plan",,"0.72838384242766","Yes","Yes","Yes","43%","57%","$650","$900","$4,400","$60","$650","$0","$2,400","$60","$650","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1950 per group","50.00%","$650","$650 per person","$1950 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-04.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390111","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS052","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390111-05","Blue Community Silver HMO? 203","87% AV Level Silver Plan",,"0.869322194606705","Yes","Yes","Yes","43%","57%","$25","$300","$2,200","$60","$25","$0","$1,800","$60","$25","$0","$800","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group","40.00%","$25","$25 per person","$75 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-05.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390111","Blue Community Silver HMO? 203","75605NM039",,"NMN002","NMS052","NMF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390111-06","Blue Community Silver HMO? 203","94% AV Level Silver Plan",,"0.937747805138614","Yes","Yes","Yes","43%","57%","$0","$0","$900","$60","$0","$0","$900","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$2700 per group","$900","$900 per person","$2700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390078-06.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390074","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS012","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390074-00","Blue Community Silver HMO? 204","Standard Silver Off Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390074","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS012","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390074-01","Blue Community Silver HMO? 204","Standard Silver On Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390074","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS012","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390074-02","Blue Community Silver HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390074","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS012","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390074-03","Blue Community Silver HMO? 204","Limited Cost Sharing Plan Variation",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390074","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS012","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390074-04","Blue Community Silver HMO? 204","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-04.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390074","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS012","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390074-05","Blue Community Silver HMO? 204","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-05.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390074","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS012","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390074-06","Blue Community Silver HMO? 204","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-06.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390092","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS022","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390092-00","Blue Community Silver HMO? 204","Standard Silver Off Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390092","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS022","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390092-01","Blue Community Silver HMO? 204","Standard Silver On Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390092","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS022","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390092-02","Blue Community Silver HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390092","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS022","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390092-03","Blue Community Silver HMO? 204","Limited Cost Sharing Plan Variation",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390092","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS022","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390092-04","Blue Community Silver HMO? 204","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-04.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390092","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS022","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390092-05","Blue Community Silver HMO? 204","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-05.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390092","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS022","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390092-06","Blue Community Silver HMO? 204","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-06.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390093","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS032","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390093-00","Blue Community Silver HMO? 204","Standard Silver Off Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390093","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS032","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390093-01","Blue Community Silver HMO? 204","Standard Silver On Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390093","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS032","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390093-02","Blue Community Silver HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390094","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS042","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390094-02","Blue Community Silver HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390094","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS042","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390094-03","Blue Community Silver HMO? 204","Limited Cost Sharing Plan Variation",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390094","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS042","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390094-04","Blue Community Silver HMO? 204","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-04.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NV","34962","SERFF","2017-08-08 20:16:00","Individual","Yes","88-0244893","34962NV0010006","DeltaCare USA Basic Plan for Families","34962NV001",,"NVN001","NVS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","34962NV0010006-00","DeltaCare USA Basic Plan for Families","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/34962nv0010006-18","https://deltadentalins.com/hcx/nv/34962nv0010006-18"
"2018","NV","34962","SERFF","2017-08-08 20:16:00","Individual","Yes","88-0244893","34962NV0010006","DeltaCare USA Basic Plan for Families","34962NV001",,"NVN001","NVS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","34962NV0010006-01","DeltaCare USA Basic Plan for Families","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/34962nv0010006-18","https://deltadentalins.com/hcx/nv/34962nv0010006-18"
"2018","NV","33670","SERFF","2017-08-08 20:16:00","Individual","Yes","84-0747736","33670NV0980005","Anthem Dental Family Value","33670NV098",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","33670NV0980005-00","Anthem Dental Family Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nv/f0/s0/t0/pw_e215624.pdf"
"2018","NV","33670","SERFF","2017-08-08 20:16:00","Individual","Yes","84-0747736","33670NV0980005","Anthem Dental Family Value","33670NV098",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","33670NV0980005-01","Anthem Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nv/f0/s0/t0/pw_e215624.pdf"
"2018","NV","33670","SERFF","2017-08-08 20:16:00","Individual","Yes","84-0747736","33670NV0980003","Anthem Dental Family","33670NV098",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","33670NV0980003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nv/f0/s0/t0/pw_e215622.pdf"
"2018","NV","33670","SERFF","2017-08-08 20:16:00","Individual","Yes","84-0747736","33670NV0980003","Anthem Dental Family","33670NV098",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","33670NV0980003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nv/f0/s0/t0/pw_e215622.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010003","Ambetter Balanced Care 1 (2018)","45142NV001",,"NVN001","NVS001","NVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010003-00","Ambetter Balanced Care 1 (2018)","Standard Silver Off Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/45142NV0010003-00.pdf","https://api.centene.com/Brochures/2018/45142NV0010003-00.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010003","Ambetter Balanced Care 1 (2018)","45142NV001",,"NVN001","NVS001","NVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010003-01","Ambetter Balanced Care 1 (2018)","Standard Silver On Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/45142NV0010003-01.pdf","https://api.centene.com/Brochures/2018/45142NV0010003-01.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390094","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS042","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390094-05","Blue Community Silver HMO? 204","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-05.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390094","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS042","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390094-06","Blue Community Silver HMO? 204","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-06.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390095","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS052","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390095-00","Blue Community Silver HMO? 204","Standard Silver Off Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-00.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390095","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS052","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390095-01","Blue Community Silver HMO? 204","Standard Silver On Exchange Plan",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$1,450","$900","$4,900","$60","$1,450","$200","$1,500","$60","$1,450","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-01.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390095","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS052","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390095-02","Blue Community Silver HMO? 204","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-02.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390095","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS052","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390095-03","Blue Community Silver HMO? 204","Limited Cost Sharing Plan Variation",,"0.687191105803106","Yes","Yes","Yes","43%","57%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$4350 per group","50.00%","$1,450","$1450 per person","$4350 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-03.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390095","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS052","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390095-04","Blue Community Silver HMO? 204","73% AV Level Silver Plan",,"0.729088926487762","Yes","Yes","Yes","43%","57%","$1,000","$900","$4,000","$60","$1,000","$200","$1,700","$60","$1,000","$0","$500","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","50.00%","$1,000","$1000 per person","$3000 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-04.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390095","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS052","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390095-05","Blue Community Silver HMO? 204","87% AV Level Silver Plan",,"0.867963078203452","Yes","Yes","Yes","43%","57%","$50","$300","$2,100","$60","$50","$200","$1,900","$60","$50","$0","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group","40.00%","$50","$50 per person","$150 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-05.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","75605","SERFF","2017-09-21 20:16:21","Individual","No","36-1236610","75605NM0390095","Blue Community Silver HMO? 204","75605NM039",,"NMN002","NMS052","NMF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/NM_6T_EX.pdf","75605NM0390095-06","Blue Community Silver HMO? 204","94% AV Level Silver Plan",,"0.937454905682245","Yes","Yes","Yes","43%","57%","$0","$30","$800","$60","$0","$90","$800","$60","$0","$0","$600","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","$850","$850 per person","$2550 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%","$0","$0 per person","$0 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsnm.com/sbc/2018/NM0390074-06.pdf","http://www.bcbsnm.com/brochure/2018/nm-plan-overview.pdf"
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010012","Care Connect Gold Plus","93091NM001",,"NMN001","NMS006","NMF001","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010012-00","Care Connect Gold Plus","Standard Gold Off Exchange Plan","82.00%","0.813142112988736","Yes","Yes","No","100%",,"$500","$95","$3,671","$60","$0","$2,560","$40","$1,783","$500","$355","$237","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-goldplus-off-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010012","Care Connect Gold Plus","93091NM001",,"NMN001","NMS006","NMF001","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010012-01","Care Connect Gold Plus","Standard Gold On Exchange Plan","82.00%","0.813142112988736","Yes","Yes","No","100%",,"$500","$95","$3,671","$60","$0","$2,560","$40","$1,783","$500","$355","$237","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-goldplus-on-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010012","Care Connect Gold Plus","93091NM001",,"NMN001","NMS006","NMF001","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010012-02","Care Connect Gold Plus","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$1,783","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://mynmhc.org/care-connect-goldplus-0-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010012","Care Connect Gold Plus","93091NM001",,"NMN001","NMS006","NMF001","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010012-03","Care Connect Gold Plus","Limited Cost Sharing Plan Variation","82.00%","0.813142112988736","Yes","Yes","No","100%",,"$500","$95","$3,671","$60","$0","$2,560","$40","$1,783","$500","$355","$237","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-goldplus-lim-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010009","Care Connect Silver","93091NM001",,"NMN001","NMS006","NMF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9973",,,"2018-01-01","2018-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010009-00","Care Connect Silver","Standard Silver Off Exchange Plan","68.21%","0.670790172425585","Yes","Yes","No","100%",,"$2,396","$60","$4,894","$60","$2,229","$1,335","$1,486","$1,783","$475","$620","$316","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-off-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010009","Care Connect Silver","93091NM001",,"NMN001","NMS006","NMF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9973",,,"2018-01-01","2018-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010009-01","Care Connect Silver","Standard Silver On Exchange Plan","68.21%","0.670790172425585","Yes","Yes","No","100%",,"$2,396","$60","$4,894","$60","$2,229","$1,335","$1,486","$1,783","$475","$620","$316","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-on-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010009","Care Connect Silver","93091NM001",,"NMN001","NMS006","NMF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9973",,,"2018-01-01","2018-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010009-02","Care Connect Silver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$1,783","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://mynmhc.org/care-connect-silver-0-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010009","Care Connect Silver","93091NM001",,"NMN001","NMS006","NMF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9973",,,"2018-01-01","2018-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010009-03","Care Connect Silver","Limited Cost Sharing Plan Variation","68.21%","0.670790172425585","Yes","Yes","No","100%",,"$2,396","$60","$4,894","$60","$2,229","$1,335","$1,486","$1,783","$475","$620","$316","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-lim-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010009","Care Connect Silver","93091NM001",,"NMN001","NMS006","NMF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9973",,,"2018-01-01","2018-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010009-04","Care Connect Silver","73% AV Level Silver Plan","72.36%","0.71179393136001","Yes","Yes","No","100%",,"$966","$60","$3,824","$60","$2,229","$1,245","$1,486","$1,783","$475","$585","$316","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-73-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010009","Care Connect Silver","93091NM001",,"NMN001","NMS006","NMF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9973",,,"2018-01-01","2018-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010009-05","Care Connect Silver","87% AV Level Silver Plan","86.21%","0.85216797741858","Yes","Yes","No","100%",,"$500","$60","$1,890","$60","$500","$880","$1,070","$1,783","$500","$310","$237","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-87-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010009","Care Connect Silver","93091NM001",,"NMN001","NMS006","NMF002","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9973",,,"2018-01-01","2018-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010009-06","Care Connect Silver","94% AV Level Silver Plan","93.79%","0.934704086351255","Yes","Yes","No","100%",,"$100","$60","$840","$60","$100","$330","$570","$1,783","$100","$160","$158","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-94-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010011","Care Connect HDHP Bronze","93091NM001",,"NMN001","NMS006","NMF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9968",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010011-00","Care Connect HDHP Bronze","Standard Bronze Off Exchange Plan","60.22%","0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,456","$0","$0","$1,783","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://mynmhc.org/care-connect-bronzehdhp-off-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010011","Care Connect HDHP Bronze","93091NM001",,"NMN001","NMS006","NMF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9968",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010011-01","Care Connect HDHP Bronze","Standard Bronze On Exchange Plan","60.22%","0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,456","$0","$0","$1,783","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://mynmhc.org/care-connect-bronzehdhp-on-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010011","Care Connect HDHP Bronze","93091NM001",,"NMN001","NMS006","NMF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9968",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010011-02","Care Connect HDHP Bronze","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$1,783","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://mynmhc.org/care-connect-bronzehdhp-0-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010011","Care Connect HDHP Bronze","93091NM001",,"NMN001","NMS006","NMF008","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9968",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010011-03","Care Connect HDHP Bronze","Limited Cost Sharing Plan Variation","60.22%","0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$5,456","$0","$0","$1,783","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://mynmhc.org/care-connect-bronzehdhp-lim-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010013","Care Connect Bronze Plus","93091NM001",,"NMN001","NMS006","NMF009","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9967",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010013-00","Care Connect Bronze Plus","Standard Bronze Off Exchange Plan","64.98%","0.638076468229159","Yes","Yes","No","100%",,"$1,720","$0","$5,630","$60","$1,994","$1,175","$1,994","$1,783","$665","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-bronzeplus-off-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010013","Care Connect Bronze Plus","93091NM001",,"NMN001","NMS006","NMF009","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9967",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010013-01","Care Connect Bronze Plus","Standard Bronze On Exchange Plan","64.98%","0.638076468229159","Yes","Yes","No","100%",,"$1,720","$0","$5,630","$60","$1,994","$1,175","$1,994","$1,783","$665","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-bronzeplus-on-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010013","Care Connect Bronze Plus","93091NM001",,"NMN001","NMS006","NMF009","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9967",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010013-02","Care Connect Bronze Plus","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$1,783","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://mynmhc.org/care-connect-bronzeplus-0-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010013","Care Connect Bronze Plus","93091NM001",,"NMN001","NMS006","NMF009","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9967",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010013-03","Care Connect Bronze Plus","Limited Cost Sharing Plan Variation","64.98%","0.638076468229159","Yes","Yes","No","100%",,"$1,720","$0","$5,630","$60","$1,994","$1,175","$1,994","$1,783","$665","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-bronzeplus-lim-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010007","Care Connect Catastrophic","93091NM001",,"NMN001","NMS006","NMF008","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9967",,,"2018-01-01","2018-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010007-00","Care Connect Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$5,456","$0","$0","$1,783","$1,330","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-catastrophic-off-hmo-ind-2018.pdf",
"2018","NM","93091","SERFF","2017-10-31 20:15:29","Individual","No","45-1294709","93091NM0010007","Care Connect Catastrophic","93091NM001",,"NMN001","NMS006","NMF008","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy, Weight Loss Programs","0.9967",,,"2018-01-01","2018-12-31","Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://mynmhc.org/Formulary.aspx","93091NM0010007-01","Care Connect Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$5,456","$0","$0","$1,783","$1,330","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-catastrophic-on-hmo-ind-2018.pdf",
"2018","NV","12553","SERFF","2017-08-08 20:16:00","Individual","Yes","94-2761537","12553NV0010009","Delta Dental PPO Basic Plan for Families","12553NV001",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","12553NV0010009-00","Delta Dental PPO Basic Plan for Families","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/12553nv0010009-18","https://deltadentalins.com/hcx/nv/12553nv0010009-18"
"2018","NV","12553","SERFF","2017-08-08 20:16:00","Individual","Yes","94-2761537","12553NV0010009","Delta Dental PPO Basic Plan for Families","12553NV001",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","12553NV0010009-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/12553nv0010009-18","https://deltadentalins.com/hcx/nv/12553nv0010009-18"
"2018","NV","12553","SERFF","2017-08-08 20:16:00","Individual","Yes","94-2761537","12553NV0010010","Delta Dental PPO Preferred Plan for Families","12553NV001",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","12553NV0010010-00","Delta Dental PPO Preferred Plan for Families","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$40","$40 per person","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/12553nv0010010-18","https://deltadentalins.com/hcx/nv/12553nv0010010-18"
"2018","NV","12553","SERFF","2017-08-08 20:16:00","Individual","Yes","94-2761537","12553NV0010010","Delta Dental PPO Preferred Plan for Families","12553NV001",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","12553NV0010010-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$40","$40 per person","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/12553nv0010010-18","https://deltadentalins.com/hcx/nv/12553nv0010010-18"
"2018","NV","33670","SERFF","2017-08-08 20:16:00","Individual","Yes","84-0747736","33670NV0980004","Anthem Dental Family Enhanced","33670NV098",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.869","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","33670NV0980004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nv/f0/s0/t0/pw_e215623.pdf"
"2018","NV","33670","SERFF","2017-08-08 20:16:00","Individual","Yes","84-0747736","33670NV0980004","Anthem Dental Family Enhanced","33670NV098",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.869","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","33670NV0980004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nv/f0/s0/t0/pw_e215623.pdf"
"2018","NV","34962","SERFF","2017-08-08 20:16:00","Individual","Yes","88-0244893","34962NV0010004","DeltaCare USA Preferred Plan for Families","34962NV001",,"NVN001","NVS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","34962NV0010004-00","DeltaCare USA Preferred Plan for Families","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/34962nv0010004-18","https://deltadentalins.com/hcx/nv/34962nv0010004-18"
"2018","NV","34962","SERFF","2017-08-08 20:16:00","Individual","Yes","88-0244893","34962NV0010004","DeltaCare USA Preferred Plan for Families","34962NV001",,"NVN001","NVS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","34962NV0010004-01","DeltaCare USA Preferred Plan for Families","Standard High On Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/34962nv0010004-18","https://deltadentalins.com/hcx/nv/34962nv0010004-18"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010003","Ambetter Balanced Care 1 (2018)","45142NV001",,"NVN001","NVS001","NVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010003-02","Ambetter Balanced Care 1 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/45142NV0010003-02.pdf","https://api.centene.com/Brochures/2018/45142NV0010003-02.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010003","Ambetter Balanced Care 1 (2018)","45142NV001",,"NVN001","NVS001","NVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010003-03","Ambetter Balanced Care 1 (2018)","Limited Cost Sharing Plan Variation",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/45142NV0010003-03.pdf","https://api.centene.com/Brochures/2018/45142NV0010003-03.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010003","Ambetter Balanced Care 1 (2018)","45142NV001",,"NVN001","NVS001","NVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010003-04","Ambetter Balanced Care 1 (2018)","73% AV Level Silver Plan",,"0.739812128349422","Yes","Yes","No","100%",,"$3,000","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/45142NV0010003-04.pdf","https://api.centene.com/Brochures/2018/45142NV0010003-04.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010003","Ambetter Balanced Care 1 (2018)","45142NV001",,"NVN001","NVS001","NVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010003-05","Ambetter Balanced Care 1 (2018)","87% AV Level Silver Plan",,"0.87931537568396","Yes","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$300","$400","$60","$750","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/45142NV0010003-05.pdf","https://api.centene.com/Brochures/2018/45142NV0010003-05.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010003","Ambetter Balanced Care 1 (2018)","45142NV001",,"NVN001","NVS001","NVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010003-06","Ambetter Balanced Care 1 (2018)","94% AV Level Silver Plan",,"0.949528260595198","Yes","Yes","No","100%",,"$0","$0","$950","$60","$0","$300","$400","$60","$0","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/45142NV0010003-06.pdf","https://api.centene.com/Brochures/2018/45142NV0010003-06.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010002","Ambetter Balanced Care 4 (2018)","45142NV001",,"NVN001","NVS001","NVF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010002-00","Ambetter Balanced Care 4 (2018)","Standard Silver Off Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/45142NV0010002-00.pdf","https://api.centene.com/Brochures/2018/45142NV0010002-00.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010002","Ambetter Balanced Care 4 (2018)","45142NV001",,"NVN001","NVS001","NVF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010002-01","Ambetter Balanced Care 4 (2018)","Standard Silver On Exchange Plan",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/45142NV0010002-01.pdf","https://api.centene.com/Brochures/2018/45142NV0010002-01.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010002","Ambetter Balanced Care 4 (2018)","45142NV001",,"NVN001","NVS001","NVF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010002-02","Ambetter Balanced Care 4 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/45142NV0010002-02.pdf","https://api.centene.com/Brochures/2018/45142NV0010002-02.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010002","Ambetter Balanced Care 4 (2018)","45142NV001",,"NVN001","NVS001","NVF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010002-03","Ambetter Balanced Care 4 (2018)","Limited Cost Sharing Plan Variation",,"0.680910265893456","Yes","Yes","No","100%",,"$7,050","$0","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,050","$7050 per person","$14100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/45142NV0010002-03.pdf","https://api.centene.com/Brochures/2018/45142NV0010002-03.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010002","Ambetter Balanced Care 4 (2018)","45142NV001",,"NVN001","NVS001","NVF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010002-04","Ambetter Balanced Care 4 (2018)","73% AV Level Silver Plan",,"0.727430168333116","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$1,800","$1,300","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/45142NV0010002-04.pdf","https://api.centene.com/Brochures/2018/45142NV0010002-04.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010002","Ambetter Balanced Care 4 (2018)","45142NV001",,"NVN001","NVS001","NVF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010002-05","Ambetter Balanced Care 4 (2018)","87% AV Level Silver Plan",,"0.863154651499334","Yes","Yes","No","100%",,"$1,850","$0","$0","$60","$1,850","$0","$0","$60","$1,630","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/45142NV0010002-05.pdf","https://api.centene.com/Brochures/2018/45142NV0010002-05.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010002","Ambetter Balanced Care 4 (2018)","45142NV001",,"NVN001","NVS001","NVF003","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010002-06","Ambetter Balanced Care 4 (2018)","94% AV Level Silver Plan",,"0.940719200046497","Yes","Yes","No","100%",,"$600","$0","$0","$60","$600","$0","$0","$60","$600","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/45142NV0010002-06.pdf","https://api.centene.com/Brochures/2018/45142NV0010002-06.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010004","Ambetter Essential Care 1 (2018)","45142NV001",,"NVN001","NVS001","NVF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010004-00","Ambetter Essential Care 1 (2018)","Standard Bronze Off Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/45142NV0010004-00.pdf","https://api.centene.com/Brochures/2018/45142NV0010004-00.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010004","Ambetter Essential Care 1 (2018)","45142NV001",,"NVN001","NVS001","NVF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010004-01","Ambetter Essential Care 1 (2018)","Standard Bronze On Exchange Plan",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/45142NV0010004-01.pdf","https://api.centene.com/Brochures/2018/45142NV0010004-01.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010004","Ambetter Essential Care 1 (2018)","45142NV001",,"NVN001","NVS001","NVF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010004-02","Ambetter Essential Care 1 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/45142NV0010004-02.pdf","https://api.centene.com/Brochures/2018/45142NV0010004-02.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010004","Ambetter Essential Care 1 (2018)","45142NV001",,"NVN001","NVS001","NVF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010004-03","Ambetter Essential Care 1 (2018)","Limited Cost Sharing Plan Variation",,"0.60492572523738","Yes","Yes","No","100%",,"$6,800","$0","$0","$60","$6,200","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/45142NV0010004-03.pdf","https://api.centene.com/Brochures/2018/45142NV0010004-03.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","45142NV001",,"NVN001","NVS001","NVF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010001-00","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/45142NV0010001-00.pdf","https://api.centene.com/Brochures/2018/45142NV0010001-00.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","45142NV001",,"NVN001","NVS001","NVF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010001-01","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/45142NV0010001-01.pdf","https://api.centene.com/Brochures/2018/45142NV0010001-01.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","45142NV001",,"NVN001","NVS001","NVF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010001-02","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/45142NV0010001-02.pdf","https://api.centene.com/Brochures/2018/45142NV0010001-02.pdf"
"2018","NV","45142","SERFF","2017-09-12 20:16:13","Individual","No","20-4761189","45142NV0010001","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","45142NV001",,"NVN001","NVS001","NVF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.silversummithealthplan.com/payments","https://ambetter.silversummithealthplan.com/resources/pharmacy-resources.html","45142NV0010001-03","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/45142NV0010001-03.pdf","https://api.centene.com/Brochures/2018/45142NV0010001-03.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","Individual","Yes","95-6042390","75719NV0020003","BESTOne Advantage Gold","75719NV002",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","SHOP (Small Group)","Yes","95-6042390","75719NV0010007","BESTDental Premium","75719NV001",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010007-00","BESTDental Premium","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTDental_Premium_Plan.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","SHOP (Small Group)","Yes","95-6042390","75719NV0010007","BESTDental Premium","75719NV001",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010007-01","BESTDental Premium","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTDental_Premium_Plan.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","Individual","Yes","95-6042390","75719NV0020003","BESTOne Advantage Gold","75719NV002",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","Individual","Yes","95-6042390","75719NV0020004","BESTOne Plus Gold","75719NV002",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","SHOP (Small Group)","Yes","95-6042390","75719NV0010008","BESTDental Standard - H","75719NV001",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTDental_Standard-H_Plan.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","SHOP (Small Group)","Yes","95-6042390","75719NV0010008","BESTDental Standard - H","75719NV001",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTDental_Standard-H_Plan.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","Individual","Yes","95-6042390","75719NV0020004","BESTOne Plus Gold","75719NV002",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","SHOP (Small Group)","Yes","95-6042390","75719NV0010010","BESTDental Choice - H","75719NV001",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTDental_Choice-H_Plan.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","SHOP (Small Group)","Yes","95-6042390","75719NV0010010","BESTDental Choice - H","75719NV001",,"NVN001","NVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTDental_Choice-H_Plan.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","Individual","Yes","95-6042390","75719NV0020005","BESTOne Plus Silver","75719NV002",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","SHOP (Small Group)","Yes","95-6042390","75719NV0010009","BESTDental Standard - L","75719NV001",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTDental_Standard-L_Plan.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","SHOP (Small Group)","Yes","95-6042390","75719NV0010009","BESTDental Standard - L","75719NV001",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTDental_Standard-L_Plan.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","Individual","Yes","95-6042390","75719NV0020005","BESTOne Plus Silver","75719NV002",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","Individual","Yes","95-6042390","75719NV0020006","BESTOne Basic Silver","75719NV002",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","SHOP (Small Group)","Yes","95-6042390","75719NV0010011","BESTDental Choice - L","75719NV001",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTDental_Choice-L_Plan.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","SHOP (Small Group)","Yes","95-6042390","75719NV0010011","BESTDental Choice - L","75719NV001",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTDental_Choice-L_Plan.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","Individual","Yes","95-6042390","75719NV0020006","BESTOne Basic Silver","75719NV002",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","SHOP (Small Group)","Yes","95-6042390","75719NV0010012","BESTDental Value","75719NV001",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010012-00","BESTDental Value","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTDental_Value_Plan.pdf"
"2018","NV","75719","SERFF","2017-08-08 20:16:00","SHOP (Small Group)","Yes","95-6042390","75719NV0010012","BESTDental Value","75719NV001",,"NVN001","NVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010012-01","BESTDental Value","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/current/NV_BESTDental_Value_Plan.pdf"
"2018","NV","86438","SERFF","2017-10-31 20:15:29","Individual","Yes","26-0424586","86438NV0010001","LIBERTY NV Family Plus Plan","86438NV001",,"NVN001","NVS001",,"New","EPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"No",,"No","https://www.libertydentalplan.com/ExchangePayment","","86438NV0010001-01","LIBERTY NV Family Plus Plan","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.libertydentalplan.com/Resources/Documents/2018-LDP-NV-Family-Plus.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030052","MyHPN Bronze 7","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030052-00","MyHPN Bronze 7","Standard Bronze Off Exchange Plan",,"0.646488539193397","No","Yes","No","100%",,"$6,500","$400","$0","$0","$0","$2,300","$0","$0","$700","$700","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnbronze7.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030052","MyHPN Bronze 7","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030052-01","MyHPN Bronze 7","Standard Bronze On Exchange Plan",,"0.646488539193397","No","Yes","No","100%",,"$6,500","$400","$0","$0","$0","$2,300","$0","$0","$700","$700","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnbronze7.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030052","MyHPN Bronze 7","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030052-02","MyHPN Bronze 7","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnbronze7.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030052","MyHPN Bronze 7","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030052-03","MyHPN Bronze 7","Limited Cost Sharing Plan Variation",,"0.646488539193397","No","Yes","No","100%",,"$6,500","$400","$0","$0","$0","$2,300","$0","$0","$700","$700","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnbronze7.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030053","MyHPN Bronze 8","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030053-00","MyHPN Bronze 8","Standard Bronze Off Exchange Plan",,"0.627172818493857","No","Yes","No","100%",,"$6,600","$100","$0","$0","$100","$2,200","$0","$0","$1,300","$400","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$6,600","$6600 per person","$13200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnbronze8.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030053","MyHPN Bronze 8","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030053-01","MyHPN Bronze 8","Standard Bronze On Exchange Plan",,"0.627172818493857","No","Yes","No","100%",,"$6,600","$100","$0","$0","$100","$2,200","$0","$0","$1,300","$400","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$6,600","$6600 per person","$13200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnbronze8.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030053","MyHPN Bronze 8","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030053-02","MyHPN Bronze 8","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnbronze8.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030053","MyHPN Bronze 8","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030053-03","MyHPN Bronze 8","Limited Cost Sharing Plan Variation",,"0.627172818493857","No","Yes","No","100%",,"$6,600","$100","$0","$0","$100","$2,200","$0","$0","$1,300","$400","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$6,600","$6600 per person","$13200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnbronze8.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030055","MyHPN Bronze 10","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030055-00","MyHPN Bronze 10","Standard Bronze Off Exchange Plan",,"0.607760371132357","No","Yes","No","100%",,"$6,000","$100","$200","$0","$100","$2,200","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnbronze10.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030055","MyHPN Bronze 10","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030055-01","MyHPN Bronze 10","Standard Bronze On Exchange Plan",,"0.607760371132357","No","Yes","No","100%",,"$6,000","$100","$200","$0","$100","$2,200","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnbronze10.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030055","MyHPN Bronze 10","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030055-02","MyHPN Bronze 10","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnbronze10.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030055","MyHPN Bronze 10","95865NV003",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030055-03","MyHPN Bronze 10","Limited Cost Sharing Plan Variation",,"0.607760371132357","No","Yes","No","100%",,"$6,000","$100","$200","$0","$100","$2,200","$0","$0","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$6,000","$6000 per person","$12000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnbronze10.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030045","MyHPN Gold 5","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030045-00","MyHPN Gold 5","Standard Gold Off Exchange Plan",,"0.794004847704282","No","Yes","No","100%",,"$3,000","$200","$1,700","$0","$0","$1,900","$0","$0","$900","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpngold5.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030045","MyHPN Gold 5","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030045-01","MyHPN Gold 5","Standard Gold On Exchange Plan",,"0.794004847704282","No","Yes","No","100%",,"$3,000","$200","$1,700","$0","$0","$1,900","$0","$0","$900","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpngold5.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030045","MyHPN Gold 5","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030045-02","MyHPN Gold 5","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpngold5.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030045","MyHPN Gold 5","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Gold","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030045-03","MyHPN Gold 5","Limited Cost Sharing Plan Variation",,"0.794004847704282","No","Yes","No","100%",,"$3,000","$200","$1,700","$0","$0","$1,900","$0","$0","$900","$200","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpngold5.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030018-00","MyHPN Silver 1.1","Standard Silver Off Exchange Plan",,"0.718374152405874","No","Yes","No","100%",,"$3,000","$300","$2,500","$0","$0","$2,000","$0","$0","$700","$500","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver1 1.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030018-01","MyHPN Silver 1.1","Standard Silver On Exchange Plan",,"0.718374152405874","No","Yes","No","100%",,"$3,000","$300","$2,500","$0","$0","$2,000","$0","$0","$700","$500","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver1 1.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030018-02","MyHPN Silver 1.1","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver1 1.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030018-03","MyHPN Silver 1.1","Limited Cost Sharing Plan Variation",,"0.718374152405874","No","Yes","No","100%",,"$3,000","$300","$2,500","$0","$0","$2,000","$0","$0","$700","$500","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver1 1.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030018-04","MyHPN Silver 1.1","73% AV Level Silver Plan",,"0.739402350874491","No","Yes","No","100%",,"$3,000","$300","$2,400","$0","$0","$2,000","$0","$0","$700","$500","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,600","$5600 per person","$11200 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver1 1 73.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030018-05","MyHPN Silver 1.1","87% AV Level Silver Plan",,"0.86427411686258","No","Yes","No","100%",,"$0","$300","$1,800","$0","$0","$2,000","$0","$0","$0","$500","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver1 1 87.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030018-06","MyHPN Silver 1.1","94% AV Level Silver Plan",,"0.930444136442155","No","Yes","No","100%",,"$0","$100","$700","$0","$0","$1,000","$0","$0","$0","$500","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver1 1 94.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030014-00","MyHPN Silver 3.1","Standard Silver Off Exchange Plan",,"0.702586850308906","No","Yes","No","100%",,"$4,000","$400","$2,200","$0","$0","$2,200","$0","$0","$700","$600","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver3 1.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030014-01","MyHPN Silver 3.1","Standard Silver On Exchange Plan",,"0.702586850308906","No","Yes","No","100%",,"$4,000","$400","$2,200","$0","$0","$2,200","$0","$0","$700","$600","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver3 1.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030014-02","MyHPN Silver 3.1","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver1 1.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030014-03","MyHPN Silver 3.1","Limited Cost Sharing Plan Variation",,"0.702586850308906","No","Yes","No","100%",,"$4,000","$400","$2,200","$0","$0","$2,200","$0","$0","$700","$600","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver1 1.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030014-04","MyHPN Silver 3.1","73% AV Level Silver Plan",,"0.730765842541553","No","Yes","No","100%",,"$4,000","$300","$1,100","$0","$0","$2,200","$0","$0","$700","$600","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,350","$5350 per person","$10700 per group","$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver3 1 73.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030014-05","MyHPN Silver 3.1","87% AV Level Silver Plan",,"0.862424835027729","No","Yes","No","100%",,"$0","$300","$1,600","$0","$0","$2,200","$0","$0","$0","$600","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver3 1 87.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030014-06","MyHPN Silver 3.1","94% AV Level Silver Plan",,"0.932077594506992","No","Yes","No","100%",,"$0","$100","$600","$0","$0","$900","$0","$0","$0","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver3 1 94.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030019-00","MyHPN Silver 4.1","Standard Silver Off Exchange Plan",,"0.706229659900321","No","Yes","No","100%",,"$3,000","$400","$2,500","$0","$0","$2,200","$0","$0","$700","$700","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver4 1.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030019-01","MyHPN Silver 4.1","Standard Silver On Exchange Plan",,"0.706229659900321","No","Yes","No","100%",,"$3,000","$400","$2,500","$0","$0","$2,200","$0","$0","$700","$700","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver4 1.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030019-02","MyHPN Silver 4.1","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver4 1.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030019-03","MyHPN Silver 4.1","Limited Cost Sharing Plan Variation",,"0.706229659900321","No","Yes","No","100%",,"$3,000","$400","$2,500","$0","$0","$2,200","$0","$0","$700","$700","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2017/myhpnsilver4 1.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030019-04","MyHPN Silver 4.1","73% AV Level Silver Plan",,"0.73092307700796","No","Yes","No","100%",,"$3,000","$300","$2,200","$0","$0","$2,200","$0","$0","$700","$700","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver4 1 73.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030019-05","MyHPN Silver 4.1","87% AV Level Silver Plan",,"0.861897236559763","No","Yes","No","100%",,"$0","$300","$1,600","$0","$0","$2,100","$0","$0","$0","$700","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,850","$1850 per person","$3700 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver4 1 87.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030019-06","MyHPN Silver 4.1","94% AV Level Silver Plan",,"0.931414862337038","No","Yes","No","100%",,"$0","$100","$600","$0","$0","$900","$0","$0","$0","$400","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver4 1 94.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030047-00","MyHPN Silver 5","Standard Silver Off Exchange Plan",,"0.697708467421507","No","Yes","No","100%",,"$5,000","$400","$1,900","$0","$0","$2,200","$0","$0","$700","$600","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver5.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030047-01","MyHPN Silver 5","Standard Silver On Exchange Plan",,"0.697708467421507","No","Yes","No","100%",,"$5,000","$400","$1,900","$0","$0","$2,200","$0","$0","$700","$600","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver5.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030047-02","MyHPN Silver 5","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver5.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030047-03","MyHPN Silver 5","Limited Cost Sharing Plan Variation",,"0.697708467421507","No","Yes","No","100%",,"$5,000","$400","$1,900","$0","$0","$2,200","$0","$0","$700","$600","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver5.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030047-04","MyHPN Silver 5","73% AV Level Silver Plan",,"0.733677366333513","No","Yes","No","100%",,"$2,500","$400","$2,700","$0","$0","$2,200","$0","$0","$700","$600","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,800","$5800 per person","$11600 per group","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver5 73.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030047-05","MyHPN Silver 5","87% AV Level Silver Plan",,"0.862219081785725","No","Yes","No","100%",,"$0","$400","$1,700","$0","$0","$2,200","$0","$0","$0","$600","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,950","$1950 per person","$3900 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver5 87.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030047-06","MyHPN Silver 5","94% AV Level Silver Plan",,"0.932840217370085","No","Yes","No","100%",,"$0","$100","$500","$0","$0","$900","$0","$0","$0","$300","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver5 94.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030048-00","MyHPN Silver 6/Medicaid Transition Plan","Standard Silver Off Exchange Plan",,"0.71578870880264","No","Yes","No","100%",,"$4,500","$300","$2,100","$0","$0","$2,000","$0","$0","$700","$500","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,500","$4500 per person","$9000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver6medicaidtransitionplan.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030048-01","MyHPN Silver 6/Medicaid Transition Plan","Standard Silver On Exchange Plan",,"0.71578870880264","No","Yes","No","100%",,"$4,500","$300","$2,100","$0","$0","$2,000","$0","$0","$700","$500","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,500","$4500 per person","$9000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver6medicaidtransitionplan.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030048-02","MyHPN Silver 6/Medicaid Transition Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver6medicaidtransitionplan.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030048-03","MyHPN Silver 6/Medicaid Transition Plan","Limited Cost Sharing Plan Variation",,"0.71578870880264","No","Yes","No","100%",,"$4,500","$300","$2,100","$0","$0","$2,000","$0","$0","$700","$500","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,500","$4500 per person","$9000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver6medicaidtransitionplan.pdf","http://www.myhpnonline.com/media/other/2017/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030048-04","MyHPN Silver 6/Medicaid Transition Plan","73% AV Level Silver Plan",,"0.739637069257191","No","Yes","No","100%",,"$4,500","$300","$900","$0","$0","$2,000","$0","$0","$700","$500","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,600","$5600 per person","$11200 per group","$4,500","$4500 per person","$9000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver6medicaidtransitionplan73.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030048-05","MyHPN Silver 6/Medicaid Transition Plan","87% AV Level Silver Plan",,"0.862298609110013","No","Yes","No","100%",,"$0","$300","$2,100","$0","$0","$2,000","$0","$0","$0","$500","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver6medicaidtransitionplan87.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF002","Existing","HMO","Silver","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030048-06","MyHPN Silver 6/Medicaid Transition Plan","94% AV Level Silver Plan",,"0.932132273152329","No","Yes","No","100%",,"$0","$100","$700","$0","$0","$1,000","$0","$0","$0","$500","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpnsilver6medicaidtransitionplan94.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030023","MyHPN Catastrophic Plan","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030023-00","MyHPN Catastrophic Plan","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$60","$0","$0","$6,800","$300","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpncatastrophicplan.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","NV","95865","SERFF","2017-09-22 20:15:56","Individual","No","88-0201035","95865NV0030023","MyHPN Catastrophic Plan","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","No",,"Yes","Urgent and Emergent","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/2018/IndPDL.pdf","95865NV0030023-01","MyHPN Catastrophic Plan","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$60","$0","$0","$6,800","$300","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","No",,,"http://www.myhpnonline.com/media/SBC/2018/myhpncatastrophicplan.pdf","http://www.myhpnonline.com/media/other/2018/PlanBrochure1.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090037","AultCare Silver 1350","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090037-00","AultCare Silver 1350","Standard Silver Off Exchange Plan",,"0.719779093197617","Yes","Yes","No","100%",,"$1,350","$0","$3,730","$260","$1,350","$0","$2,160","$60","$1,350","$0","$550","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","30.00%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9372018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9372018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS003","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060070-01","AultCare Silver 6850 Select","Standard Silver On Exchange Plan","67.03%","0.682085844995871","Yes","Yes","No","100%",,"$6,850","$0","$0","$260","$2,220","$400","$1,070","$60","$1,742","$50","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6702018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6702018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS003","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060070-02","AultCare Silver 6850 Select","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090043","AultCare Gold 500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090043-01","AultCare Gold 500","Standard Gold On Exchange Plan",,"0.81563094545187","No","Yes","No","100%",,"$500","$40","$3,720","$260","$500","$460","$1,790","$60","$500","$90","$520","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9432018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9432018.pdf"
"2018","NV","99298","SERFF","2017-08-08 20:16:00","Individual","Yes","20-4023720","99298NV0010001","EMI Health Choice PPO (High)","99298NV001",,"NVN001","NVS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9651","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","99298NV0010001-01","EMI Health Choice PPO (High)","Standard High On Exchange Plan","86.34%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,"$100","$100 per person","$300 per group",,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/nv-federal-marketplace-dental.aspx"
"2018","NV","99298","SERFF","2017-08-08 20:16:00","Individual","Yes","20-4023720","99298NV0010002","EMI Health Choice PPO (Low)","99298NV001",,"NVN001","NVS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","99298NV0010002-01","EMI Health Choice PPO (Low)","Standard Low On Exchange Plan","70.71%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,"$100","$100 per person","$300 per group",,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/nv-federal-marketplace-dental.aspx"
"2018","NV","99298","SERFF","2017-08-08 20:16:00","Individual","Yes","20-4023720","99298NV0010003","EMI Health Advantage Co-Pay","99298NV001",,"NVN002","NVS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","99298NV0010003-01","EMI Health Advantage Co-Pay","Standard Low On Exchange Plan","68.83%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/nv-federal-marketplace-dental.aspx"
"2018","OH","23340","SERFF","2017-06-12 20:15:35","Individual","Yes","21-0706531","23340OH0030001","MedMutual Pediatric Dental","23340OH003",,"OHN003","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","23340OH0030001-00","MedMutual Pediatric Dental","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","23340","SERFF","2017-06-12 20:15:35","Individual","Yes","21-0706531","23340OH0030002","MedMutual Dental 1","23340OH003",,"OHN003","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","23340OH0030002-00","MedMutual Dental 1","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","23340","SERFF","2017-06-12 20:15:35","Individual","Yes","21-0706531","23340OH0030003","MedMutual Dental 2","23340OH003",,"OHN003","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","23340OH0030003-00","MedMutual Dental 2","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","23340","SERFF","2017-06-12 20:15:35","Individual","Yes","21-0706531","23340OH0030004","MedMutual Dental 3","23340OH003",,"OHN003","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","23340OH0030004-00","MedMutual Dental 3","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090050","AultCare Platinum 200","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090050-00","AultCare Platinum 200","Standard Platinum Off Exchange Plan",,"0.911941555078528","No","Yes","No","100%",,"$200","$0","$1,200","$260","$200","$300","$900","$60","$200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9502018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9502018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060049","AultCare Gold 350","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060049-00","AultCare Gold 350","Standard Gold Off Exchange Plan",,"0.809902260043543","No","Yes","No","100%",,"$350","$40","$3,100","$260","$350","$460","$1,670","$60","$350","$90","$440","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6492018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6492018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060049","AultCare Gold 350","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060049-01","AultCare Gold 350","Standard Gold On Exchange Plan",,"0.809902260043543","No","Yes","No","100%",,"$350","$40","$3,100","$260","$350","$460","$1,670","$60","$350","$90","$440","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6492018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6492018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090050","AultCare Platinum 200","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090050-01","AultCare Platinum 200","Standard Platinum On Exchange Plan",,"0.911941555078528","No","Yes","No","100%",,"$200","$0","$1,200","$260","$200","$300","$900","$60","$200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9502018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9502018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090048","AultCare Platinum 500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090048-00","AultCare Platinum 500","Standard Platinum Off Exchange Plan",,"0.900129079204471","No","Yes","No","100%",,"$500","$0","$800","$260","$500","$190","$610","$60","$500","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9482018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9482018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060049","AultCare Gold 350","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060049-02","AultCare Gold 350","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060049","AultCare Gold 350","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060049-03","AultCare Gold 350","Limited Cost Sharing Plan Variation",,"0.809902260043543","No","Yes","No","100%",,"$350","$40","$3,100","$260","$350","$460","$1,670","$60","$350","$90","$440","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6492018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6492018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090048","AultCare Platinum 500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090048-01","AultCare Platinum 500","Standard Platinum On Exchange Plan",,"0.900129079204471","No","Yes","No","100%",,"$500","$0","$800","$260","$500","$190","$610","$60","$500","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9482018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9482018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060048","AultCare Gold 750","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060048-00","AultCare Gold 750","Standard Gold Off Exchange Plan",,"0.808848915605081","No","Yes","No","100%",,"$750","$40","$2,480","$260","$750","$430","$1,550","$60","$750","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6492018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6492018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090047","AultCare Platinum 1000","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090047-00","AultCare Platinum 1000","Standard Platinum Off Exchange Plan",,"0.907608250141723","No","Yes","No","100%",,"$100","$0","$0","$260","$720","$110","$170","$60","$1,000","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9472018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9472018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090047","AultCare Platinum 1000","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090047-01","AultCare Platinum 1000","Standard Platinum On Exchange Plan",,"0.907608250141723","No","Yes","No","100%",,"$100","$0","$0","$260","$720","$110","$170","$60","$1,000","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9472018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9472018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060048","AultCare Gold 750","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060048-01","AultCare Gold 750","Standard Gold On Exchange Plan",,"0.808848915605081","No","Yes","No","100%",,"$750","$40","$2,480","$260","$750","$430","$1,550","$60","$750","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6492018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6492018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060048","AultCare Gold 750","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060048-02","AultCare Gold 750","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090043","AultCare Gold 500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090043-00","AultCare Gold 500","Standard Gold Off Exchange Plan",,"0.81563094545187","No","Yes","No","100%",,"$500","$40","$3,720","$260","$500","$460","$1,790","$60","$500","$90","$520","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9432018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9432018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060034","AultCare Gold 350 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060034-03","AultCare Gold 350 Select","Limited Cost Sharing Plan Variation",,"0.809902260043543","No","Yes","No","100%",,"$350","$40","$3,100","$260","$350","$460","$1,670","$60","$350","$90","$440","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6342018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6342018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090057","AultCare Gold 2000","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090057-01","AultCare Gold 2000","Standard Gold On Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$260","$2,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$22,050","$44100 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9572018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9572018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060042-05","AultCare Silver 3000","87% AV Level Silver Plan",,"0.86567911986988","No","Yes","No","100%",,"$990","$0","$510","$260","$770","$210","$520","$60","$1,000","$90","$350","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642872018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642872018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060042-06","AultCare Silver 3000","94% AV Level Silver Plan",,"0.945148529245251","No","Yes","No","100%",,"$140","$0","$360","$260","$200","$80","$220","$60","$200","$30","$270","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642942018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642942018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060048","AultCare Gold 750","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060048-03","AultCare Gold 750","Limited Cost Sharing Plan Variation",,"0.808848915605081","No","Yes","No","100%",,"$750","$40","$2,480","$260","$750","$430","$1,550","$60","$750","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6492018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6492018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060046","AultCare Gold 1200","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060046-00","AultCare Gold 1200","Standard Gold Off Exchange Plan",,"0.813235939148152","No","Yes","No","100%",,"$1,200","$40","$1,240","$260","$1,200","$430","$1,310","$60","$1,200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6482018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6482018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090042","AultCare Gold 750","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090042-00","AultCare Gold 750","Standard Gold Off Exchange Plan",,"0.808848915605081","No","Yes","No","100%",,"$750","$40","$2,480","$260","$750","$730","$1,550","$60","$750","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9422018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9422018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090042","AultCare Gold 750","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090042-01","AultCare Gold 750","Standard Gold On Exchange Plan",,"0.808848915605081","No","Yes","No","100%",,"$750","$40","$2,480","$260","$750","$730","$1,550","$60","$750","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9422018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9422018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060046","AultCare Gold 1200","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060046-01","AultCare Gold 1200","Standard Gold On Exchange Plan",,"0.813235939148152","No","Yes","No","100%",,"$1,200","$40","$1,240","$260","$1,200","$430","$1,310","$60","$1,200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6482018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6482018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060046","AultCare Gold 1200","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060046-02","AultCare Gold 1200","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090041","AultCare Gold 1200","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090041-00","AultCare Gold 1200","Standard Gold Off Exchange Plan",,"0.813235939148152","No","Yes","No","100%",,"$1,200","$40","$1,240","$260","$1,200","$430","$1,310","$60","$1,200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9412018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9412018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090041","AultCare Gold 1200","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090041-01","AultCare Gold 1200","Standard Gold On Exchange Plan",,"0.813235939148152","No","Yes","No","100%",,"$1,200","$40","$1,240","$260","$1,200","$430","$1,310","$60","$1,200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9412018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9412018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060046","AultCare Gold 1200","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060046-03","AultCare Gold 1200","Limited Cost Sharing Plan Variation",,"0.813235939148152","No","Yes","No","100%",,"$1,200","$40","$1,240","$260","$1,200","$430","$1,310","$60","$1,200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6482018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6482018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060034","AultCare Gold 350 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060034-00","AultCare Gold 350 Select","Standard Gold Off Exchange Plan",,"0.809902260043543","No","Yes","No","100%",,"$350","$40","$3,100","$260","$350","$460","$1,670","$60","$350","$90","$440","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6342018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6342018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090058","AultCare Gold 2500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090058-00","AultCare Gold 2500","Standard Gold Off Exchange Plan",,"0.80916568590112","No","Yes","No","100%",,"$2,500","$0","$700","$260","$1,870","$290","$1,040","$60","$1,570","$60","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9582018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9582018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090058","AultCare Gold 2500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090058-01","AultCare Gold 2500","Standard Gold On Exchange Plan",,"0.80916568590112","No","Yes","No","100%",,"$2,500","$0","$700","$260","$1,870","$290","$1,040","$60","$1,570","$60","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9582018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9582018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060034","AultCare Gold 350 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060034-01","AultCare Gold 350 Select","Standard Gold On Exchange Plan",,"0.809902260043543","No","Yes","No","100%",,"$350","$40","$3,100","$260","$350","$460","$1,670","$60","$350","$90","$440","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6342018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6342018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060034","AultCare Gold 350 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060034-02","AultCare Gold 350 Select","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090038","AultCare Silver 1400","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090038-00","AultCare Silver 1400","Standard Silver Off Exchange Plan",,"0.717720384468051","No","Yes","No","100%",,"$1,400","$0","$5,950","$260","$1,190","$560","$2,270","$60","$870","$130","$870","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50.00%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9382018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9382018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090038","AultCare Silver 1400","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090038-01","AultCare Silver 1400","Standard Silver On Exchange Plan",,"0.717720384468051","No","Yes","No","100%",,"$1,400","$0","$5,950","$260","$1,190","$560","$2,270","$60","$870","$130","$870","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50.00%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9382018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9382018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090036","AultCare Silver 3000","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090036-00","AultCare Silver 3000","Standard Silver Off Exchange Plan",,"0.714127348378482","No","Yes","No","100%",,"$3,000","$40","$3,720","$260","$1,670","$530","$1,790","$60","$1,220","$120","$520","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9362018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9362018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060033","AultCare Gold 750 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060033-00","AultCare Gold 750 Select","Standard Gold Off Exchange Plan",,"0.808848915605081","No","Yes","No","100%",,"$750","$40","$2,480","$260","$750","$430","$1,550","$60","$750","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6332018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6332018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060033","AultCare Gold 750 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060033-01","AultCare Gold 750 Select","Standard Gold On Exchange Plan",,"0.808848915605081","No","Yes","No","100%",,"$750","$40","$2,480","$260","$750","$430","$1,550","$60","$750","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6332018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6332018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090036","AultCare Silver 3000","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090036-01","AultCare Silver 3000","Standard Silver On Exchange Plan",,"0.714127348378482","No","Yes","No","100%",,"$3,000","$40","$3,720","$260","$1,670","$530","$1,790","$60","$1,220","$120","$520","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9362018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9362018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090060","AultCare Silver 4500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090060-00","AultCare Silver 4500","Standard Silver Off Exchange Plan",,"0.717637502387078","No","Yes","No","100%",,"$4,500","$40","$1,860","$260","$2,030","$460","$1,430","$60","$1,480","$90","$260","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","15.00%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9602018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9602018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060033","AultCare Gold 750 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060033-02","AultCare Gold 750 Select","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060033","AultCare Gold 750 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060033-03","AultCare Gold 750 Select","Limited Cost Sharing Plan Variation",,"0.808848915605081","No","Yes","No","100%",,"$750","$40","$2,480","$260","$750","$430","$1,550","$60","$750","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6332018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6332018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090060","AultCare Silver 4500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090060-01","AultCare Silver 4500","Standard Silver On Exchange Plan",,"0.717637502387078","No","Yes","No","100%",,"$4,500","$40","$1,860","$260","$2,030","$460","$1,430","$60","$1,480","$90","$260","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","15.00%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9602018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9602018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060031","AultCare Gold 1200 Select","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060031-00","AultCare Gold 1200 Select","Standard Gold Off Exchange Plan",,"0.813235939148152","No","Yes","No","100%",,"$1,200","$40","$1,240","$260","$1,200","$430","$1,310","$60","$1,200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6312018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6312018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060031","AultCare Gold 1200 Select","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060031-01","AultCare Gold 1200 Select","Standard Gold On Exchange Plan",,"0.813235939148152","No","Yes","No","100%",,"$1,200","$40","$1,240","$260","$1,200","$430","$1,310","$60","$1,200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6312018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6312018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060031","AultCare Gold 1200 Select","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060031-02","AultCare Gold 1200 Select","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060031","AultCare Gold 1200 Select","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060031-03","AultCare Gold 1200 Select","Limited Cost Sharing Plan Variation",,"0.813235939148152","No","Yes","No","100%",,"$1,200","$40","$1,240","$260","$1,200","$430","$1,310","$60","$1,200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6312018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6312018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060042-00","AultCare Silver 3000","Standard Silver Off Exchange Plan",,"0.708746958779191","No","Yes","No","100%",,"$3,000","$40","$3,720","$260","$1,670","$530","$1,790","$60","$1,220","$120","$520","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6422018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6422018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090046","AultCare Platinum 1500 Health Savings 500","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090046-00","AultCare Platinum 1500 Health Savings 500","Standard Platinum Off Exchange Plan",,"0.912565464171811","Yes","Yes","No","100%",,"$1,500","$0","$0","$260","$1,500","$0","$0","$60","$1,500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group",,,,"$22,050","$44100 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","0.00%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$500.00","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9462018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9462018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090046","AultCare Platinum 1500 Health Savings 500","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090046-01","AultCare Platinum 1500 Health Savings 500","Standard Platinum On Exchange Plan",,"0.912565464171811","Yes","Yes","No","100%",,"$1,500","$0","$0","$260","$1,500","$0","$0","$60","$1,500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group",,,,"$22,050","$44100 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","0.00%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$500.00","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9462018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9462018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060042-01","AultCare Silver 3000","Standard Silver On Exchange Plan",,"0.708746958779191","No","Yes","No","100%",,"$3,000","$40","$3,720","$260","$1,670","$530","$1,790","$60","$1,220","$120","$520","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6422018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6422018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060042-02","AultCare Silver 3000","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090040","AultCare Gold 1350","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090040-00","AultCare Gold 1350","Standard Gold Off Exchange Plan",,"0.811595988349369","Yes","Yes","No","100%",,"$1,350","$0","$1,240","$260","$1,350","$0","$720","$60","$1,350","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10.00%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9402018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9402018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090040","AultCare Gold 1350","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090040-01","AultCare Gold 1350","Standard Gold On Exchange Plan",,"0.811595988349369","Yes","Yes","No","100%",,"$1,350","$0","$1,240","$260","$1,350","$0","$720","$60","$1,350","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10.00%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9402018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9402018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060042-03","AultCare Silver 3000","Limited Cost Sharing Plan Variation",,"0.708746958779191","No","Yes","No","100%",,"$3,000","$40","$3,720","$260","$1,670","$530","$1,790","$60","$1,220","$120","$520","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6422018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6422018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060042-04","AultCare Silver 3000","73% AV Level Silver Plan",,"0.738565131780028","No","Yes","No","100%",,"$2,410","$0","$2,090","$260","$1,670","$460","$1,790","$60","$1,220","$90","$520","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642732018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642732018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090057","AultCare Gold 2000","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090057-00","AultCare Gold 2000","Standard Gold Off Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$260","$2,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$22,050","$44100 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9572018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9572018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090037","AultCare Silver 1350","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090037-01","AultCare Silver 1350","Standard Silver On Exchange Plan",,"0.719779093197617","Yes","Yes","No","100%",,"$1,350","$0","$3,730","$260","$1,350","$0","$2,160","$60","$1,350","$0","$550","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","30.00%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9372018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9372018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060041-00","AultCare Silver 5000","Standard Silver Off Exchange Plan",,"0.680014091986168","No","Yes","No","100%",,"$2,060","$0","$3,940","$260","$1,430","$500","$2,030","$60","$1,050","$100","$700","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6412018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6412018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060041-01","AultCare Silver 5000","Standard Silver On Exchange Plan",,"0.680014091986168","No","Yes","No","100%",,"$2,060","$0","$3,940","$260","$1,430","$500","$2,030","$60","$1,050","$100","$700","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6412018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6412018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090035","AultCare Silver 2000 80","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090035-00","AultCare Silver 2000 80","Standard Silver Off Exchange Plan",,"0.716958106629698","Yes","Yes","No","100%",,"$2,000","$0","$2,490","$260","$2,000","$0","$1,440","$60","$1,540","$0","$360","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9352018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9352018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090035","AultCare Silver 2000 80","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090035-01","AultCare Silver 2000 80","Standard Silver On Exchange Plan",,"0.716958106629698","Yes","Yes","No","100%",,"$2,000","$0","$2,490","$260","$2,000","$0","$1,440","$60","$1,540","$0","$360","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9352018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9352018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060041-02","AultCare Silver 5000","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642942018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642942018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060041-03","AultCare Silver 5000","Limited Cost Sharing Plan Variation",,"0.680014091986168","No","Yes","No","100%",,"$2,060","$0","$3,940","$260","$1,430","$500","$2,030","$60","$1,050","$100","$700","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6412018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6412018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090059","AultCare Silver 4000","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090059-00","AultCare Silver 4000","Standard Silver Off Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$260","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9592018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9592018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090059","AultCare Silver 4000","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090059-01","AultCare Silver 4000","Standard Silver On Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$260","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9592018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9592018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060041-04","AultCare Silver 5000","73% AV Level Silver Plan",,"0.725613907302408","No","Yes","No","100%",,"$2,750","$0","$1,750","$260","$1,910","$890","$480","$60","$1,390","$100","$350","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641732018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641732018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060026-03","AultCare Silver 5000 Select","Limited Cost Sharing Plan Variation",,"0.680014091986168","No","Yes","No","100%",,"$2,060","$0","$3,940","$260","$1,430","$500","$2,030","$60","$1,050","$100","$700","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6262018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6262018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060044-03","AultCare Silver 2500","Limited Cost Sharing Plan Variation",,"0.696209412094001","Yes","Yes","No","100%",,"$2,500","$0","$2,490","$260","$2,500","$0","$1,440","$60","$1,520","$0","$380","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6442018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6442018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060044-04","AultCare Silver 2500","73% AV Level Silver Plan",,"0.739077174906565","Yes","Yes","No","100%",,"$2,500","$0","$1,240","$260","$2,500","$0","$720","$60","$1,730","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644732018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644732018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060075","AultCare Bronze 6550","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060075-01","AultCare Bronze 6550","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$260","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6762018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6762018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060022","AultCare Bronze 6000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060022-00","AultCare Bronze 6000 Select","Standard Bronze Off Exchange Plan",,"0.611037252923508","Yes","Yes","No","100%",,"$5,160","$0","$1,240","$260","$5,740","$0","$660","$60","$1,730","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6222018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6222018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060041-05","AultCare Silver 5000","87% AV Level Silver Plan",,"0.865993997083117","No","Yes","No","100%",,"$900","$0","$600","$260","$750","$230","$520","$60","$900","$100","$350","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641872018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641872018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090031","AultCare Bronze 4500","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090031-00","AultCare Bronze 4500","Standard Bronze Off Exchange Plan",,"0.614451518771374","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$260","$3,230","$0","$3,230","$60","$960","$0","$960","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9312018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9312018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090031","AultCare Bronze 4500","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090031-01","AultCare Bronze 4500","Standard Bronze On Exchange Plan",,"0.614451518771374","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$260","$3,230","$0","$3,230","$60","$960","$0","$960","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9312018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9312018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060041-06","AultCare Silver 5000","94% AV Level Silver Plan",,"0.946426617284207","No","Yes","No","100%",,"$140","$0","$310","$260","$250","$50","$150","$60","$250","$0","$200","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641942018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641942018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060068-00","AultCare Silver 6850","Standard Silver Off Exchange Plan","67.03%","0.682085844995871","Yes","Yes","No","100%",,"$6,850","$0","$0","$260","$2,220","$400","$1,070","$60","$1,742","$50","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6682018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6682018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090062","AultCare Bronze 6550","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090062-00","AultCare Bronze 6550","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$260","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9622017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9622018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090062","AultCare Bronze 6550","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090062-01","AultCare Bronze 6550","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$260","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9622017.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9622018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060068-01","AultCare Silver 6850","Standard Silver On Exchange Plan","67.03%","0.682085844995871","Yes","Yes","No","100%",,"$6,850","$0","$0","$260","$2,220","$400","$1,070","$60","$1,742","$50","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6682018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6682018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060068-02","AultCare Silver 6850","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060068-03","AultCare Silver 6850","Limited Cost Sharing Plan Variation","67.03%","0.682085844995871","Yes","Yes","No","100%",,"$6,850","$0","$0","$260","$2,220","$400","$1,070","$60","$1,740","$50","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6682018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6682018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060068-04","AultCare Silver 6850","73% AV Level Silver Plan","73.78%","0.745168363025515","Yes","Yes","No","100%",,"$4,200","$0","$0","$260","$2,220","$400","$1,070","$60","$1,740","$50","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","0.00%",,,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc668732018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure668732018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060068-05","AultCare Silver 6850","87% AV Level Silver Plan","87.90%","0.880010070821482","Yes","Yes","No","100%",,"$1,200","$0","$0","$260","$730","$140","$330","$60","$1,200","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","0.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc668872018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure668872018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060068-06","AultCare Silver 6850","94% AV Level Silver Plan","94.04%","0.940304770893286","Yes","Yes","No","100%",,"$500","$0","$0","$260","$370","$50","$80","$60","$500","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc668942018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure668942018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060027-00","AultCare Silver 3000 Select","Standard Silver Off Exchange Plan",,"0.708746958779191","No","Yes","No","100%",,"$3,000","$40","$3,720","$260","$1,670","$530","$1,790","$60","$1,220","$120","$520","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6272018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6272018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060027-01","AultCare Silver 3000 Select","Standard Silver On Exchange Plan",,"0.708746958779191","No","Yes","No","100%",,"$3,000","$40","$3,720","$260","$1,670","$530","$1,790","$60","$1,220","$120","$520","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6272018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6272018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060027-02","AultCare Silver 3000 Select","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060027-03","AultCare Silver 3000 Select","Limited Cost Sharing Plan Variation",,"0.708746958779191","No","Yes","No","100%",,"$3,000","$40","$3,720","$260","$1,670","$530","$1,790","$60","$1,220","$120","$520","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6272018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6272018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060027-04","AultCare Silver 3000 Select","73% AV Level Silver Plan",,"0.738565131780028","No","Yes","No","100%",,"$2,410","$0","$2,090","$260","$1,670","$460","$1,790","$60","$1,220","$90","$520","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627732018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627732018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060027-05","AultCare Silver 3000 Select","87% AV Level Silver Plan",,"0.86567911986988","No","Yes","No","100%",,"$990","$0","$510","$260","$770","$210","$520","$60","$1,000","$90","$350","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627872018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627872018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060027-06","AultCare Silver 3000 Select","94% AV Level Silver Plan",,"0.945148529245251","No","Yes","No","100%",,"$140","$0","$360","$260","$200","$80","$220","$60","$200","$30","$270","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627942018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627942018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060026-00","AultCare Silver 5000 Select","Standard Silver Off Exchange Plan",,"0.680014091986168","No","Yes","No","100%",,"$2,060","$0","$3,940","$260","$1,430","$500","$2,030","$60","$1,050","$100","$700","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6262018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6262018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060026-01","AultCare Silver 5000 Select","Standard Silver On Exchange Plan",,"0.680014091986168","No","Yes","No","100%",,"$2,060","$0","$3,940","$260","$1,430","$500","$2,030","$60","$1,050","$100","$700","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6262018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6262018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060026-02","AultCare Silver 5000 Select","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060026-04","AultCare Silver 5000 Select","73% AV Level Silver Plan",,"0.725613907302408","No","Yes","No","100%",,"$2,750","$0","$1,750","$260","$1,910","$890","$480","$60","$1,390","$100","$350","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626732018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626732018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060026-05","AultCare Silver 5000 Select","87% AV Level Silver Plan",,"0.865993997083117","No","Yes","No","100%",,"$900","$0","$600","$260","$750","$230","$520","$60","$900","$100","$350","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626872018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626872018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060026-06","AultCare Silver 5000 Select","94% AV Level Silver Plan",,"0.946426617284207","No","Yes","No","100%",,"$140","$0","$310","$260","$250","$50","$150","$60","$250","$0","$200","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626942018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626942018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS003","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060070-00","AultCare Silver 6850 Select","Standard Silver Off Exchange Plan","67.03%","0.682085844995871","Yes","Yes","No","100%",,"$6,850","$0","$0","$260","$2,220","$400","$1,070","$60","$1,742","$50","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6702018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6702018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS003","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060070-03","AultCare Silver 6850 Select","Limited Cost Sharing Plan Variation","67.03%","0.682085844995871","Yes","Yes","No","100%",,"$6,850","$0","$0","$260","$2,220","$400","$1,070","$60","$1,740","$50","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6702018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6702018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060023","AultCare Bronze 5000 Select","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060023-01","AultCare Bronze 5000 Select","Standard Bronze On Exchange Plan",,"0.613068049855074","Yes","Yes","No","100%",,"$2,240","$0","$4,310","$260","$4,230","$0","$2,320","$60","$1,250","$0","$670","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6232018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6232018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090056","AultCare Bronze 6550 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090056-00","AultCare Bronze 6550 No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$260","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9562018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9562018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090056","AultCare Bronze 6550 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090056-01","AultCare Bronze 6550 No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$260","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9562018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9562018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060053","AultCare Gold 350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060053-03","AultCare Gold 350 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.809902260043543","No","Yes","No","100%",,"$350","$40","$3,100","$260","$350","$460","$1,670","$60","$350","$90","$440","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6532018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6532018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060072-01","AultCare Silver 6850 No Pediatric Dental","Standard Silver On Exchange Plan","67.03%","0.682085844995871","Yes","Yes","No","100%",,"$6,850","$0","$0","$260","$2,220","$400","$1,070","$60","$1,742","$50","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6722018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6722018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060061-03","AultCare Silver 5000 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.680014091986168","No","Yes","No","100%",,"$2,060","$0","$3,940","$260","$1,430","$500","$2,030","$60","$1,050","$100","$700","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6612018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6612018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060061-04","AultCare Silver 5000 Select No Pediatric Dental","73% AV Level Silver Plan",,"0.725613907302408","No","Yes","No","100%",,"$2,750","$0","$1,750","$260","$1,910","$890","$480","$60","$1,390","$100","$350","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661732018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661732018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS003","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060070-04","AultCare Silver 6850 Select","73% AV Level Silver Plan","73.78%","0.745168363025515","Yes","Yes","No","100%",,"$4,200","$0","$0","$260","$2,220","$400","$1,070","$60","$1,740","$50","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","0.00%",,,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc670732018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure670732018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS003","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060070-05","AultCare Silver 6850 Select","87% AV Level Silver Plan","87.90%","0.880010070821482","Yes","Yes","No","100%",,"$1,200","$0","$0","$260","$730","$140","$330","$60","$1,200","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","0.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc670872018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure670872018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS003","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060070-06","AultCare Silver 6850 Select","94% AV Level Silver Plan","94.04%","0.940304770893286","Yes","Yes","No","100%",,"$500","$0","$0","$260","$370","$50","$80","$60","$500","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc670942018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure670942018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060044-00","AultCare Silver 2500","Standard Silver Off Exchange Plan",,"0.696209412094001","Yes","Yes","No","100%",,"$2,500","$0","$2,490","$260","$2,500","$0","$1,440","$60","$1,520","$0","$380","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6442018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6442018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090030","AultCare Platinum 200 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090030-00","AultCare Platinum 200 No Pediatric Dental","Standard Platinum Off Exchange Plan",,"0.911941555078528","No","Yes","No","100%",,"$200","$0","$1,200","$260","$200","$300","$900","$60","$200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9302018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9302018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090030","AultCare Platinum 200 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090030-01","AultCare Platinum 200 No Pediatric Dental","Standard Platinum On Exchange Plan",,"0.911941555078528","No","Yes","No","100%",,"$200","$0","$1,200","$260","$200","$300","$900","$60","$200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9302018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9302018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060044-01","AultCare Silver 2500","Standard Silver On Exchange Plan",,"0.696209412094001","Yes","Yes","No","100%",,"$2,500","$0","$2,490","$260","$2,500","$0","$1,440","$60","$1,520","$0","$380","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6442018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6442018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060044-02","AultCare Silver 2500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090028","AultCare Platinum 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090028-00","AultCare Platinum 500 No Pediatric Dental","Standard Platinum Off Exchange Plan",,"0.900129079204471","No","Yes","No","100%",,"$500","$0","$800","$260","$500","$190","$610","$60","$500","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9282018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9282018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090028","AultCare Platinum 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090028-01","AultCare Platinum 500 No Pediatric Dental","Standard Platinum On Exchange Plan",,"0.900129079204471","No","Yes","No","100%",,"$500","$0","$800","$260","$500","$190","$610","$60","$500","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9282018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9282018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090027","AultCare Platinum 1000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090027-00","AultCare Platinum 1000 No Pediatric Dental","Standard Platinum Off Exchange Plan",,"0.907608250141723","No","Yes","No","100%",,"$100","$0","$0","$260","$720","$110","$170","$60","$1,000","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9272018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9272018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090027","AultCare Platinum 1000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090027-01","AultCare Platinum 1000 No Pediatric Dental","Standard Platinum On Exchange Plan",,"0.907608250141723","No","Yes","No","100%",,"$100","$0","$0","$260","$720","$110","$170","$60","$1,000","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9272018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9272018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060044-05","AultCare Silver 2500","87% AV Level Silver Plan",,"0.867137005624073","Yes","Yes","No","100%",,"$1,200","$0","$0","$260","$1,200","$0","$0","$60","$1,200","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","per person not applicable","$2400 per group","0.00%",,,,,"$3,600","per person not applicable","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644872018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644872018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060044-06","AultCare Silver 2500","94% AV Level Silver Plan",,"0.937977329745955","Yes","Yes","No","100%",,"$500","$0","$0","$260","$500","$0","$0","$60","$500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0.00%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644942018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644942018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090023","AultCare Gold 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090023-00","AultCare Gold 500 No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.81563094545187","No","Yes","No","100%",,"$500","$40","$3,720","$260","$500","$460","$1,790","$60","$500","$90","$520","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9232018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9232018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090023","AultCare Gold 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090023-01","AultCare Gold 500 No Pediatric Dental","Standard Gold On Exchange Plan",,"0.81563094545187","No","Yes","No","100%",,"$500","$40","$3,720","$260","$500","$460","$1,790","$60","$500","$90","$520","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9232018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9232018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060038","AultCare Bronze 5000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060038-00","AultCare Bronze 5000","Standard Bronze Off Exchange Plan",,"0.613068049855074","Yes","Yes","No","100%",,"$2,240","$0","$4,310","$260","$4,230","$0","$2,320","$60","$1,250","$0","$670","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6382018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6382018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060038","AultCare Bronze 5000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060038-01","AultCare Bronze 5000","Standard Bronze On Exchange Plan",,"0.613068049855074","Yes","Yes","No","100%",,"$2,240","$0","$4,310","$260","$4,230","$0","$2,320","$60","$1,250","$0","$670","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6382018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6382018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090022","AultCare Gold 750 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090022-00","AultCare Gold 750 No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.808848915605081","No","Yes","No","100%",,"$750","$40","$2,480","$260","$750","$730","$1,550","$60","$750","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9222018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9222018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090022","AultCare Gold 750 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090022-01","AultCare Gold 750 No Pediatric Dental","Standard Gold On Exchange Plan",,"0.808848915605081","No","Yes","No","100%",,"$750","$40","$2,480","$260","$750","$730","$1,550","$60","$750","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9222018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9222018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060038","AultCare Bronze 5000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060038-02","AultCare Bronze 5000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060038","AultCare Bronze 5000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060038-03","AultCare Bronze 5000","Limited Cost Sharing Plan Variation",,"0.613068049855074","Yes","Yes","No","100%",,"$2,240","$0","$4,310","$260","$4,230","$0","$2,320","$60","$1,250","$0","$670","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6382018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6382018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090021","AultCare Gold 1200 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090021-00","AultCare Gold 1200 No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.813235939148152","No","Yes","No","100%",,"$1,200","$40","$1,240","$260","$1,200","$430","$1,310","$60","$1,200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9212018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9212018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090021","AultCare Gold 1200 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090021-01","AultCare Gold 1200 No Pediatric Dental","Standard Gold On Exchange Plan",,"0.813235939148152","No","Yes","No","100%",,"$1,200","$40","$1,240","$260","$1,200","$430","$1,310","$60","$1,200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9212018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9212018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060037","AultCare Bronze 6000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060037-00","AultCare Bronze 6000","Standard Bronze Off Exchange Plan",,"0.611037252923508","Yes","Yes","No","100%",,"$5,160","$0","$1,240","$260","$5,740","$0","$660","$60","$1,730","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6372018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6372018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060037","AultCare Bronze 6000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060037-01","AultCare Bronze 6000","Standard Bronze On Exchange Plan",,"0.611037252923508","Yes","Yes","No","100%",,"$5,160","$0","$1,240","$260","$5,740","$0","$660","$60","$1,730","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6372018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6372018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090052","AultCare Gold 2500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090052-00","AultCare Gold 2500 No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.80916568590112","No","Yes","No","100%",,"$2,500","$0","$700","$260","$1,870","$290","$1,040","$60","$1,570","$60","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9522018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9522018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090052","AultCare Gold 2500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090052-01","AultCare Gold 2500 No Pediatric Dental","Standard Gold On Exchange Plan",,"0.80916568590112","No","Yes","No","100%",,"$2,500","$0","$700","$260","$1,870","$290","$1,040","$60","$1,570","$60","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9522018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9522018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060037","AultCare Bronze 6000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060037-02","AultCare Bronze 6000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060037","AultCare Bronze 6000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060037-03","AultCare Bronze 6000","Limited Cost Sharing Plan Variation",,"0.611037252923508","Yes","Yes","No","100%",,"$5,160","$0","$1,240","$260","$5,740","$0","$660","$60","$1,730","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6372018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6372018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090018","AultCare Silver 1400 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090018-00","AultCare Silver 1400 No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.717720384468051","No","Yes","No","100%",,"$1,400","$0","$5,950","$260","$1,190","$560","$2,270","$60","$870","$130","$870","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50.00%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9182018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9182018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090018","AultCare Silver 1400 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090018-01","AultCare Silver 1400 No Pediatric Dental","Standard Silver On Exchange Plan",,"0.717720384468051","No","Yes","No","100%",,"$1,400","$0","$5,950","$260","$1,190","$560","$2,270","$60","$870","$130","$870","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50.00%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9182018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9182018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060075","AultCare Bronze 6550","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060075-00","AultCare Bronze 6550","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$260","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6762018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6762018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090016","AultCare Silver 3000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090016-00","AultCare Silver 3000 No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.714362744145706","No","Yes","No","100%",,"$3,000","$40","$3,720","$260","$1,670","$530","$1,790","$60","$1,220","$120","$520","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9162018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9162018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090016","AultCare Silver 3000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090016-01","AultCare Silver 3000 No Pediatric Dental","Standard Silver On Exchange Plan",,"0.714362744145706","No","Yes","No","100%",,"$3,000","$40","$3,720","$260","$1,670","$530","$1,790","$60","$1,220","$120","$520","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9162018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9162018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060075","AultCare Bronze 6550","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060075-02","AultCare Bronze 6550","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060075","AultCare Bronze 6550","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060075-03","AultCare Bronze 6550","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$260","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6762018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6762018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090054","AultCare Silver 4500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090054-00","AultCare Silver 4500 No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.717637502387078","No","Yes","No","100%",,"$4,500","$40","$1,860","$260","$2,030","$460","$1,430","$60","$1,480","$90","$260","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","15.00%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9542018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9542018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090054","AultCare Silver 4500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0090054-01","AultCare Silver 4500 No Pediatric Dental","Standard Silver On Exchange Plan",,"0.717637502387078","No","Yes","No","100%",,"$4,500","$40","$1,860","$260","$2,030","$460","$1,430","$60","$1,480","$90","$260","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","15.00%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9542018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9542018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060082","AultCare Bronze 7350","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060082-00","AultCare Bronze 7350","Standard Bronze Off Exchange Plan",,"0.58543686315904","Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$7,180","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6822018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6822018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060082","AultCare Bronze 7350","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060082-01","AultCare Bronze 7350","Standard Bronze On Exchange Plan",,"0.58543686315904","Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$7,180","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6822018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6822018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060082","AultCare Bronze 7350","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060082-02","AultCare Bronze 7350","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060082","AultCare Bronze 7350","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060082-03","AultCare Bronze 7350","Limited Cost Sharing Plan Variation",,"0.58543686315904","Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$7,180","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6822018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6822018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060036","AultCare Catastrophic","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060036-00","AultCare Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$6,880","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6362018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6362018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060036","AultCare Catastrophic","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060036-01","AultCare Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$6,880","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6362018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6362018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060029-00","AultCare Silver 2500 Select","Standard Silver Off Exchange Plan",,"0.696209412094001","Yes","Yes","No","100%",,"$2,500","$0","$2,490","$260","$2,500","$0","$1,440","$60","$1,520","$0","$380","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6292018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6292018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060029-01","AultCare Silver 2500 Select","Standard Silver On Exchange Plan",,"0.696209412094001","Yes","Yes","No","100%",,"$2,500","$0","$2,490","$260","$2,500","$0","$1,440","$60","$1,520","$0","$380","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6292018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6292018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060029-02","AultCare Silver 2500 Select","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060029-03","AultCare Silver 2500 Select","Limited Cost Sharing Plan Variation",,"0.696209412094001","Yes","Yes","No","100%",,"$2,500","$0","$2,490","$260","$2,500","$0","$1,440","$60","$1,520","$0","$380","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6292018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6292018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060029-04","AultCare Silver 2500 Select","73% AV Level Silver Plan",,"0.739077174906565","Yes","Yes","No","100%",,"$2,500","$0","$1,240","$260","$2,500","$0","$720","$60","$1,730","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629732018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629732018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060029-05","AultCare Silver 2500 Select","87% AV Level Silver Plan",,"0.867137005624073","Yes","Yes","No","100%",,"$1,200","$0","$0","$260","$1,200","$0","$0","$60","$1,200","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","per person not applicable","$2400 per group","0.00%",,,,,"$3,600","per person not applicable","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629872018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629872018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060029-06","AultCare Silver 2500 Select","94% AV Level Silver Plan",,"0.937977329745955","Yes","Yes","No","100%",,"$500","$0","$0","$260","$500","$0","$0","$60","$500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0.00%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629942018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629942018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060023","AultCare Bronze 5000 Select","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060023-00","AultCare Bronze 5000 Select","Standard Bronze Off Exchange Plan",,"0.613068049855074","Yes","Yes","No","100%",,"$2,240","$0","$4,310","$260","$4,230","$0","$2,320","$60","$1,250","$0","$670","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6232018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6232018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060023","AultCare Bronze 5000 Select","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060023-02","AultCare Bronze 5000 Select","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060023","AultCare Bronze 5000 Select","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060023-03","AultCare Bronze 5000 Select","Limited Cost Sharing Plan Variation",,"0.613068049855074","Yes","Yes","No","100%",,"$2,240","$0","$4,310","$260","$4,230","$0","$2,320","$60","$1,250","$0","$670","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6232018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6232018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060022","AultCare Bronze 6000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060022-01","AultCare Bronze 6000 Select","Standard Bronze On Exchange Plan",,"0.611037252923508","Yes","Yes","No","100%",,"$5,160","$0","$1,240","$260","$5,740","$0","$660","$60","$1,730","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6222018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6222018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060018","AultCare Gold 750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060018-01","AultCare Gold 750 No Pediatric Dental","Standard Gold On Exchange Plan",,"0.808848915605081","No","Yes","No","100%",,"$750","$40","$2,480","$260","$750","$430","$1,550","$60","$750","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6182018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6182018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060060-00","AultCare Silver 3000 Select No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.708746958779191","No","Yes","No","100%",,"$3,000","$40","$3,720","$260","$1,670","$530","$1,790","$60","$1,220","$120","$520","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6602018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6602018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060060-01","AultCare Silver 3000 Select No Pediatric Dental","Standard Silver On Exchange Plan",,"0.708746958779191","No","Yes","No","100%",,"$3,000","$40","$3,720","$260","$1,670","$530","$1,790","$60","$1,220","$120","$520","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6122018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6122018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060060-02","AultCare Silver 3000 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060008","AultCare Bronze 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060008-00","AultCare Bronze 5000 No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.613068049855074","Yes","Yes","No","100%",,"$2,240","$0","$4,310","$260","$4,230","$0","$2,320","$60","$1,250","$0","$670","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6082018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6082018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060058-03","AultCare Silver 2500 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.696209412094001","Yes","Yes","No","100%",,"$2,500","$0","$2,490","$260","$2,500","$0","$1,440","$60","$1,520","$0","$380","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6582018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6582018.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010051","Ambetter Balanced Care 5 (2018)","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010051-03","Ambetter Balanced Care 5 (2018)","Limited Cost Sharing Plan Variation","66.25%","0.661631852049009","Yes","Yes","No","100%",,"$6,800","$550","$0","$60","$1,900","$1,900","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010051-03.pdf","https://api.centene.com/Brochures/2018/41047OH0010051-03.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060022","AultCare Bronze 6000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060022-02","AultCare Bronze 6000 Select","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060022","AultCare Bronze 6000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060022-03","AultCare Bronze 6000 Select","Limited Cost Sharing Plan Variation",,"0.611037252923508","Yes","Yes","No","100%",,"$5,160","$0","$1,240","$260","$5,740","$0","$660","$60","$1,730","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6222018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6222018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060076","AultCare Bronze 6550 Select","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060076-00","AultCare Bronze 6550 Select","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$260","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6762018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6762018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060076","AultCare Bronze 6550 Select","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060076-01","AultCare Bronze 6550 Select","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$260","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6762018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6762018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060076","AultCare Bronze 6550 Select","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060076-02","AultCare Bronze 6550 Select","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060076","AultCare Bronze 6550 Select","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060076-03","AultCare Bronze 6550 Select","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$260","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6762018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6762018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060084","AultCare Bronze 7350 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060084-00","AultCare Bronze 7350 Select","Standard Bronze Off Exchange Plan",,"0.58543686315904","Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$7,180","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6842018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6842018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060084","AultCare Bronze 7350 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060084-01","AultCare Bronze 7350 Select","Standard Bronze On Exchange Plan",,"0.58543686315904","Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$7,180","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6842018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6842018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060084","AultCare Bronze 7350 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060084-02","AultCare Bronze 7350 Select","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060084","AultCare Bronze 7350 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060084-03","AultCare Bronze 7350 Select","Limited Cost Sharing Plan Variation",,"0.58543686315904","Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$7,180","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6842018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6842018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060021","AultCare Catastrophic Select","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060021-00","AultCare Catastrophic Select","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$6,880","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6212018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6212018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060021","AultCare Catastrophic Select","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060021-01","AultCare Catastrophic Select","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$6,880","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6212018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6212018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060019","AultCare Gold 350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060019-00","AultCare Gold 350 No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.809902260043543","No","Yes","No","100%",,"$350","$40","$3,100","$260","$350","$460","$1,670","$60","$350","$90","$440","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6192018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6192018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090026","AultCare Platinum 1500 Health Savings 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090026-00","AultCare Platinum 1500 Health Savings 500 No Pediatric Dental","Standard Platinum Off Exchange Plan",,"0.912565464171811","Yes","Yes","No","100%",,"$1,500","$0","$0","$260","$1,500","$0","$0","$60","$1,500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group",,,,"$22,050","$44100 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","0.00%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$500.00","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9262018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9262018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090026","AultCare Platinum 1500 Health Savings 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090026-01","AultCare Platinum 1500 Health Savings 500 No Pediatric Dental","Standard Platinum On Exchange Plan",,"0.912565464171811","Yes","Yes","No","100%",,"$1,500","$0","$0","$260","$1,500","$0","$0","$60","$1,500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group",,,,"$22,050","$44100 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","0.00%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$500.00","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9262018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9262018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060019","AultCare Gold 350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060019-01","AultCare Gold 350 No Pediatric Dental","Standard Gold On Exchange Plan",,"0.809902260043543","No","Yes","No","100%",,"$350","$40","$3,100","$260","$350","$460","$1,670","$60","$350","$90","$440","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6192018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6192018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060019","AultCare Gold 350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060019-02","AultCare Gold 350 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090020","AultCare Gold 1350 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090020-00","AultCare Gold 1350 No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.811595988349369","Yes","Yes","No","100%",,"$1,350","$0","$1,240","$260","$1,350","$0","$720","$60","$1,350","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10.00%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9202018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9202018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090020","AultCare Gold 1350 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090020-01","AultCare Gold 1350 No Pediatric Dental","Standard Gold On Exchange Plan",,"0.811595988349369","Yes","Yes","No","100%",,"$1,350","$0","$1,240","$260","$1,350","$0","$720","$60","$1,350","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10.00%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9202018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9202018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060019","AultCare Gold 350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060019-03","AultCare Gold 350 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.809902260043543","No","Yes","No","100%",,"$350","$40","$3,100","$260","$350","$460","$1,670","$60","$350","$90","$440","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6192018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6192018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060018","AultCare Gold 750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060018-00","AultCare Gold 750 No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.808848915605081","No","Yes","No","100%",,"$750","$40","$2,480","$260","$750","$430","$1,550","$60","$750","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6182018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6182018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090051","AultCare Gold 2000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090051-00","AultCare Gold 2000 No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$260","$2,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$22,050","$44100 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9512018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9512018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090051","AultCare Gold 2000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090051-01","AultCare Gold 2000 No Pediatric Dental","Standard Gold On Exchange Plan",,"0.808317604026788","Yes","Yes","No","100%",,"$2,000","$0","$0","$260","$2,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$22,050","$44100 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9512018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9512018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060018","AultCare Gold 750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060018-02","AultCare Gold 750 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090017","AultCare Silver 1350 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090017-00","AultCare Silver 1350 No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.719779093197617","Yes","Yes","No","100%",,"$1,350","$0","$3,730","$260","$1,350","$0","$2,160","$60","$1,350","$0","$550","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","30.00%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9172018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9172018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090017","AultCare Silver 1350 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090017-01","AultCare Silver 1350 No Pediatric Dental","Standard Silver On Exchange Plan",,"0.719779093197617","Yes","Yes","No","100%",,"$1,350","$0","$3,730","$260","$1,350","$0","$2,160","$60","$1,350","$0","$550","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","30.00%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9172018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9172018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060018","AultCare Gold 750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060018-03","AultCare Gold 750 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.808848915605081","No","Yes","No","100%",,"$750","$40","$2,480","$260","$750","$430","$1,550","$60","$750","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6182018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6182018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060016","AultCare Gold 1200 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060016-00","AultCare Gold 1200 No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.813235939148152","No","Yes","No","100%",,"$1,200","$40","$1,240","$260","$1,200","$430","$1,310","$60","$1,200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6162018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6162018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090015","AultCare Silver 2000 80 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090015-00","AultCare Silver 2000 80 No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.716958106629698","Yes","Yes","No","100%",,"$2,000","$0","$2,490","$260","$2,000","$0","$1,440","$60","$1,540","$0","$360","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9152018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9152018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090015","AultCare Silver 2000 80 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090015-01","AultCare Silver 2000 80 No Pediatric Dental","Standard Silver On Exchange Plan",,"0.716958106629698","Yes","Yes","No","100%",,"$2,000","$0","$2,490","$260","$2,000","$0","$1,440","$60","$1,540","$0","$360","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20.00%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9152018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9152018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060016","AultCare Gold 1200 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060016-01","AultCare Gold 1200 No Pediatric Dental","Standard Gold On Exchange Plan",,"0.813235939148152","No","Yes","No","100%",,"$1,200","$40","$1,240","$260","$1,200","$430","$1,310","$60","$1,200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6162018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6162018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060016","AultCare Gold 1200 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060016-02","AultCare Gold 1200 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090053","AultCare Silver 4000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090053-00","AultCare Silver 4000 No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$260","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9532018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9532018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090053","AultCare Silver 4000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090053-01","AultCare Silver 4000 No Pediatric Dental","Standard Silver On Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$260","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9532018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9532018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060016","AultCare Gold 1200 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060016-03","AultCare Gold 1200 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.813235939148152","No","Yes","No","100%",,"$1,200","$40","$1,240","$260","$1,200","$430","$1,310","$60","$1,200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6162018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6162018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060053","AultCare Gold 350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060053-00","AultCare Gold 350 Select No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.809902260043543","No","Yes","No","100%",,"$350","$40","$3,100","$260","$350","$460","$1,670","$60","$350","$90","$440","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6532018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6532018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090011","AultCare Bronze 4500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090011-00","AultCare Bronze 4500 No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.614451518771374","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$260","$3,230","$0","$3,230","$60","$960","$0","$960","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9112018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9112018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1624818","28162OH0090011","AultCare Bronze 4500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0090011-01","AultCare Bronze 4500 No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.614451518771374","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$260","$3,230","$0","$3,230","$60","$960","$0","$960","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9112018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9112018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060053","AultCare Gold 350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060053-01","AultCare Gold 350 Select No Pediatric Dental","Standard Gold On Exchange Plan",,"0.809902260043543","No","Yes","No","100%",,"$350","$40","$3,100","$260","$350","$460","$1,670","$60","$350","$90","$440","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25.00%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6532018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6532018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060053","AultCare Gold 350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060053-02","AultCare Gold 350 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060054","AultCare Gold 750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060054-00","AultCare Gold 750 Select No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.808848915605081","No","Yes","No","100%",,"$750","$40","$2,480","$260","$750","$430","$1,550","$60","$750","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6542018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6542018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060054","AultCare Gold 750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060054-01","AultCare Gold 750 Select No Pediatric Dental","Standard Gold On Exchange Plan",,"0.808848915605081","No","Yes","No","100%",,"$750","$40","$2,480","$260","$750","$430","$1,550","$60","$750","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6542018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6542018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060054","AultCare Gold 750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060054-02","AultCare Gold 750 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060054","AultCare Gold 750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060054-03","AultCare Gold 750 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.808848915605081","No","Yes","No","100%",,"$750","$40","$2,480","$260","$750","$430","$1,550","$60","$750","$80","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20.00%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6542018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6542018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060056","AultCare Gold 1200 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060056-00","AultCare Gold 1200 Select No Pediatric Dental","Standard Gold Off Exchange Plan",,"0.813235939148152","No","Yes","No","100%",,"$1,200","$40","$1,240","$260","$1,200","$430","$1,310","$60","$1,200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6562018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6562018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060056","AultCare Gold 1200 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060056-01","AultCare Gold 1200 Select No Pediatric Dental","Standard Gold On Exchange Plan",,"0.813235939148152","No","Yes","No","100%",,"$1,200","$40","$1,240","$260","$1,200","$430","$1,310","$60","$1,200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6562018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6562018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060056","AultCare Gold 1200 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060056-02","AultCare Gold 1200 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060056","AultCare Gold 1200 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060056-03","AultCare Gold 1200 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.813235939148152","No","Yes","No","100%",,"$1,200","$40","$1,240","$260","$1,200","$430","$1,310","$60","$1,200","$80","$170","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6562018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6562018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060012-00","AultCare Silver 3000 No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.708746958779191","No","Yes","No","100%",,"$3,000","$40","$3,720","$260","$1,670","$530","$1,790","$60","$1,220","$120","$520","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6122018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6122018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060012-01","AultCare Silver 3000 No Pediatric Dental","Standard Silver On Exchange Plan",,"0.708746958779191","No","Yes","No","100%",,"$3,000","$40","$3,720","$260","$1,670","$530","$1,790","$60","$1,220","$120","$520","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6122018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6122018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060012-02","AultCare Silver 3000 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060012-03","AultCare Silver 3000 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.708746958779191","No","Yes","No","100%",,"$3,000","$40","$3,720","$260","$1,670","$530","$1,790","$60","$1,220","$120","$520","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6122018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6122018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060012-04","AultCare Silver 3000 No Pediatric Dental","73% AV Level Silver Plan",,"0.738565131780028","No","Yes","No","100%",,"$2,410","$0","$2,090","$260","$1,670","$460","$1,790","$60","$1,220","$90","$520","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612732018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612732018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060012-05","AultCare Silver 3000 No Pediatric Dental","87% AV Level Silver Plan",,"0.86567911986988","No","Yes","No","100%",,"$990","$0","$510","$260","$770","$210","$520","$60","$1,000","$90","$350","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612872018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612872018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060012-06","AultCare Silver 3000 No Pediatric Dental","94% AV Level Silver Plan",,"0.945148529245251","No","Yes","No","100%",,"$140","$0","$360","$260","$200","$80","$220","$60","$200","$30","$270","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612942018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612942018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060011-00","AultCare Silver 5000 No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.680014091986168","No","Yes","No","100%",,"$2,060","$0","$3,940","$260","$1,430","$500","$2,030","$60","$1,050","$100","$700","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6112018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6112018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060011-01","AultCare Silver 5000 No Pediatric Dental","Standard Silver On Exchange Plan",,"0.680014091986168","No","Yes","No","100%",,"$2,060","$0","$3,940","$260","$1,430","$500","$2,030","$60","$1,050","$100","$700","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6112018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6112018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060011-02","AultCare Silver 5000 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060011-03","AultCare Silver 5000 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.680014091986168","No","Yes","No","100%",,"$2,060","$0","$3,940","$260","$1,430","$500","$2,030","$60","$1,050","$100","$700","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6112018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6112018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060011-04","AultCare Silver 5000 No Pediatric Dental","73% AV Level Silver Plan",,"0.725613907302408","No","Yes","No","100%",,"$2,750","$0","$1,750","$260","$1,910","$890","$480","$60","$1,390","$100","$350","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611732018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611732018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060011-05","AultCare Silver 5000 No Pediatric Dental","87% AV Level Silver Plan",,"0.865993997083117","No","Yes","No","100%",,"$900","$0","$600","$260","$750","$230","$520","$60","$900","$100","$350","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611872018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611872018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060011-06","AultCare Silver 5000 No Pediatric Dental","94% AV Level Silver Plan",,"0.946426617284207","No","Yes","No","100%",,"$140","$0","$310","$260","$250","$50","$150","$60","$250","$0","$200","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611942018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611942018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060072-00","AultCare Silver 6850 No Pediatric Dental","Standard Silver Off Exchange Plan","67.03%","0.682085844995871","Yes","Yes","No","100%",,"$6,850","$0","$0","$260","$2,220","$400","$1,070","$60","$1,742","$50","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6722018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6722018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060072-02","AultCare Silver 6850 No Pediatric Dental","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060072-03","AultCare Silver 6850 No Pediatric Dental","Limited Cost Sharing Plan Variation","67.03%","0.682085844995871","Yes","Yes","No","100%",,"$6,850","$0","$0","$260","$2,220","$400","$1,070","$60","$1,740","$50","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6722018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6722018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060072-04","AultCare Silver 6850 No Pediatric Dental","73% AV Level Silver Plan","73.78%","0.745168363025515","Yes","Yes","No","100%",,"$4,200","$0","$0","$260","$2,220","$400","$1,070","$60","$1,740","$50","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","0.00%",,,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc672732018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure672732018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060072-05","AultCare Silver 6850 No Pediatric Dental","87% AV Level Silver Plan","87.90%","0.880010070821482","Yes","Yes","No","100%",,"$1,200","$0","$0","$260","$730","$140","$330","$60","$1,200","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","0.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc672872018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure672872018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060072-06","AultCare Silver 6850 No Pediatric Dental","94% AV Level Silver Plan","94.04%","0.940304770893286","Yes","Yes","No","100%",,"$500","$0","$0","$260","$370","$50","$80","$60","$500","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc672942018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure672942018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060060-03","AultCare Silver 3000 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.708746958779191","No","Yes","No","100%",,"$3,000","$40","$3,720","$260","$1,670","$530","$1,790","$60","$1,220","$120","$520","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6602018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6602018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060060-04","AultCare Silver 3000 Select No Pediatric Dental","73% AV Level Silver Plan",,"0.738565131780028","No","Yes","No","100%",,"$2,410","$0","$2,090","$260","$1,670","$460","$1,790","$60","$1,220","$90","$520","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612732018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612732018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060060-05","AultCare Silver 3000 Select No Pediatric Dental","87% AV Level Silver Plan",,"0.86567911986988","No","Yes","No","100%",,"$990","$0","$510","$260","$770","$210","$520","$60","$1,000","$90","$350","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612872018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612872018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060060-06","AultCare Silver 3000 Select No Pediatric Dental","94% AV Level Silver Plan",,"0.945148529245251","No","Yes","No","100%",,"$140","$0","$360","$260","$200","$80","$220","$60","$200","$30","$270","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20.00%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612942018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612942018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060061-00","AultCare Silver 5000 Select No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.680014091986168","No","Yes","No","100%",,"$2,060","$0","$3,940","$260","$1,430","$500","$2,030","$60","$1,050","$100","$700","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6612018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6612018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060061-01","AultCare Silver 5000 Select No Pediatric Dental","Standard Silver On Exchange Plan",,"0.680014091986168","No","Yes","No","100%",,"$2,060","$0","$3,940","$260","$1,430","$500","$2,030","$60","$1,050","$100","$700","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6612018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6612018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060061-02","AultCare Silver 5000 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060061-05","AultCare Silver 5000 Select No Pediatric Dental","87% AV Level Silver Plan",,"0.865993997083117","No","Yes","No","100%",,"$900","$0","$600","$260","$750","$230","$520","$60","$900","$100","$350","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661872018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661872018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF001","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2018.aspx","28162OH0060061-06","AultCare Silver 5000 Select No Pediatric Dental","94% AV Level Silver Plan",,"0.946426617284207","No","Yes","No","100%",,"$140","$0","$310","$260","$250","$50","$150","$60","$250","$0","$200","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20.00%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661942018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661942018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060074-00","AultCare Silver 6850 Select No Pediatric Dental","Standard Silver Off Exchange Plan","67.03%","0.682085844995871","Yes","Yes","No","100%",,"$6,850","$0","$0","$260","$2,220","$400","$1,070","$60","$1,742","$50","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6742018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6742018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060074-01","AultCare Silver 6850 Select No Pediatric Dental","Standard Silver On Exchange Plan","67.03%","0.682085844995871","Yes","Yes","No","100%",,"$6,850","$0","$0","$260","$2,220","$400","$1,070","$60","$1,742","$50","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6742018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6742018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060074-02","AultCare Silver 6850 Select No Pediatric Dental","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060074-03","AultCare Silver 6850 Select No Pediatric Dental","Limited Cost Sharing Plan Variation","67.03%","0.682085844995871","Yes","Yes","No","100%",,"$6,850","$0","$0","$260","$2,220","$400","$1,070","$60","$1,740","$50","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6742018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6742018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060074-04","AultCare Silver 6850 Select No Pediatric Dental","73% AV Level Silver Plan","73.78%","0.745168363025515","Yes","Yes","No","100%",,"$4,200","$0","$0","$260","$2,220","$400","$1,070","$60","$1,740","$50","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","0.00%",,,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc674732018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure674732018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060074-05","AultCare Silver 6850 Select No Pediatric Dental","87% AV Level Silver Plan","87.90%","0.880010070821482","Yes","Yes","No","100%",,"$1,200","$0","$0","$260","$730","$140","$330","$60","$1,200","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","0.00%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc674872018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure674872018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF003","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2018.aspx","28162OH0060074-06","AultCare Silver 6850 Select No Pediatric Dental","94% AV Level Silver Plan","94.04%","0.940304770893286","Yes","Yes","No","100%",,"$500","$0","$0","$260","$370","$50","$80","$60","$500","$0","$0","$0",,"0","0","4",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc674942018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure674942018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060014-00","AultCare Silver 2500 No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.696209412094001","Yes","Yes","No","100%",,"$2,500","$0","$2,490","$260","$2,500","$0","$1,440","$60","$1,520","$0","$380","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6142018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6142018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060014-01","AultCare Silver 2500 No Pediatric Dental","Standard Silver On Exchange Plan",,"0.696209412094001","Yes","Yes","No","100%",,"$2,500","$0","$2,490","$260","$2,500","$0","$1,440","$60","$1,520","$0","$380","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6142018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6142018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060014-02","AultCare Silver 2500 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060014-03","AultCare Silver 2500 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.696209412094001","Yes","Yes","No","100%",,"$2,500","$0","$2,490","$260","$2,500","$0","$1,440","$60","$1,520","$0","$380","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6142018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6142018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060014-04","AultCare Silver 2500 No Pediatric Dental","73% AV Level Silver Plan",,"0.739077174906565","Yes","Yes","No","100%",,"$2,500","$0","$1,240","$260","$2,500","$0","$720","$60","$1,730","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614732018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614732018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060014-05","AultCare Silver 2500 No Pediatric Dental","87% AV Level Silver Plan",,"0.867137005624073","Yes","Yes","No","100%",,"$1,200","$0","$0","$260","$1,200","$0","$0","$60","$1,200","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","per person not applicable","$2400 per group","0.00%",,,,,"$3,600","per person not applicable","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614872018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614872018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060014-06","AultCare Silver 2500 No Pediatric Dental","94% AV Level Silver Plan",,"0.937977329745955","Yes","Yes","No","100%",,"$500","$0","$0","$260","$500","$0","$0","$60","$500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0.00%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614942018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614942018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060051","AultCare Catastrophic No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060051-01","AultCare Catastrophic No Pediatric Dental","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$6,880","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6512018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6512018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060058-00","AultCare Silver 2500 Select No Pediatric Dental","Standard Silver Off Exchange Plan",,"0.696209412094001","Yes","Yes","No","100%",,"$2,500","$0","$2,490","$260","$2,500","$0","$1,440","$60","$1,520","$0","$380","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6582018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6582018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060058-01","AultCare Silver 2500 Select No Pediatric Dental","Standard Silver On Exchange Plan",,"0.696209412094001","Yes","Yes","No","100%",,"$2,500","$0","$2,490","$260","$2,500","$0","$1,440","$60","$1,520","$0","$380","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6582018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6582018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060058-02","AultCare Silver 2500 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2018)","41047OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010019-03","Ambetter Balanced Care 2 (2018)","Limited Cost Sharing Plan Variation",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010019-03.pdf","https://api.centene.com/Brochures/2018/41047OH0010019-03.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2018)","41047OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010019-04","Ambetter Balanced Care 2 (2018)","73% AV Level Silver Plan",,"0.729896135538709","Yes","Yes","No","100%",,"$4,600","$400","$0","$60","$1,900","$1,400","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010019-04.pdf","https://api.centene.com/Brochures/2018/41047OH0010019-04.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2018)","41047OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010019-05","Ambetter Balanced Care 2 (2018)","87% AV Level Silver Plan",,"0.867181007012531","Yes","Yes","No","100%",,"$1,700","$10","$0","$60","$1,500","$250","$0","$60","$1,600","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010019-05.pdf","https://api.centene.com/Brochures/2018/41047OH0010019-05.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060008","AultCare Bronze 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060008-01","AultCare Bronze 5000 No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.613068049855074","Yes","Yes","No","100%",,"$2,240","$0","$4,310","$260","$4,230","$0","$2,320","$60","$1,250","$0","$670","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6082018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6082018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060008","AultCare Bronze 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060008-02","AultCare Bronze 5000 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060008","AultCare Bronze 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060008-03","AultCare Bronze 5000 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.613068049855074","Yes","Yes","No","100%",,"$2,240","$0","$4,310","$260","$4,230","$0","$2,320","$60","$1,250","$0","$670","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6082018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6082018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060007","AultCare Bronze 6000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060007-00","AultCare Bronze 6000 No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.611037252923508","Yes","Yes","No","100%",,"$5,160","$0","$1,240","$260","$5,740","$0","$660","$60","$1,730","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6072018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6072018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060007","AultCare Bronze 6000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060007-01","AultCare Bronze 6000 No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.611037252923508","Yes","Yes","No","100%",,"$5,160","$0","$1,240","$260","$5,740","$0","$660","$60","$1,730","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6072018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6072018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060007","AultCare Bronze 6000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060007-02","AultCare Bronze 6000 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060007","AultCare Bronze 6000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060007-03","AultCare Bronze 6000 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.611037252923508","Yes","Yes","No","100%",,"$5,160","$0","$1,240","$260","$5,740","$0","$660","$60","$1,730","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6072018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6072018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060077","AultCare Bronze 6550 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060077-00","AultCare Bronze 6550 No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$260","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6772018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6772018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060077","AultCare Bronze 6550 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060077-01","AultCare Bronze 6550 No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$260","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6772018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6772018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060077","AultCare Bronze 6550 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060077-02","AultCare Bronze 6550 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060077","AultCare Bronze 6550 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060077-03","AultCare Bronze 6550 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$260","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6772018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6772018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060086","AultCare Bronze 7350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060086-00","AultCare Bronze 7350 No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.58543686315904","Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$7,180","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6862018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6862018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060086","AultCare Bronze 7350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060086-01","AultCare Bronze 7350 No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.58543686315904","Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$7,180","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6862018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6862018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060086","AultCare Bronze 7350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060086-02","AultCare Bronze 7350 No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060086","AultCare Bronze 7350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060086-03","AultCare Bronze 7350 No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.58543686315904","Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$7,180","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6862018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6862018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060051","AultCare Catastrophic No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060051-00","AultCare Catastrophic No Pediatric Dental","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$6,880","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6512018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6512018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060058-04","AultCare Silver 2500 Select No Pediatric Dental","73% AV Level Silver Plan",,"0.739077174906565","Yes","Yes","No","100%",,"$2,500","$0","$1,240","$260","$2,500","$0","$720","$60","$1,730","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$4000 per group","10.00%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658732018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658732018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060058-05","AultCare Silver 2500 Select No Pediatric Dental","87% AV Level Silver Plan",,"0.867137005624073","Yes","Yes","No","100%",,"$1,200","$0","$0","$260","$1,200","$0","$0","$60","$1,200","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","per person not applicable","$2400 per group","0.00%",,,,,"$3,600","per person not applicable","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658872018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658872018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060058-06","AultCare Silver 2500 Select No Pediatric Dental","94% AV Level Silver Plan",,"0.937977329745955","Yes","Yes","No","100%",,"$500","$0","$0","$260","$500","$0","$0","$60","$500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0.00%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658942018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658942018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060064","AultCare Bronze 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060064-00","AultCare Bronze 5000 Select No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.613068049855074","Yes","Yes","No","100%",,"$2,240","$0","$4,310","$260","$4,230","$0","$2,320","$60","$1,250","$0","$670","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6642018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6642018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060064","AultCare Bronze 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060064-01","AultCare Bronze 5000 Select No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.613068049855074","Yes","Yes","No","100%",,"$2,240","$0","$4,310","$260","$4,230","$0","$2,320","$60","$1,250","$0","$670","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6642018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6642018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060064","AultCare Bronze 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060064-02","AultCare Bronze 5000 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060064","AultCare Bronze 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060064-03","AultCare Bronze 5000 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.613068049855074","Yes","Yes","No","100%",,"$2,240","$0","$4,310","$260","$4,230","$0","$2,320","$60","$1,250","$0","$670","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6642018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6642018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060065","AultCare Bronze 6000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060065-00","AultCare Bronze 6000 Select No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.611037252923508","Yes","Yes","No","100%",,"$5,160","$0","$1,240","$260","$5,740","$0","$660","$60","$1,730","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6652018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6652018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060065","AultCare Bronze 6000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060065-01","AultCare Bronze 6000 Select No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.611037252923508","Yes","Yes","No","100%",,"$5,160","$0","$1,240","$260","$5,740","$0","$660","$60","$1,730","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6652018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6652018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060065","AultCare Bronze 6000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060065-02","AultCare Bronze 6000 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060065","AultCare Bronze 6000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060065-03","AultCare Bronze 6000 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.611037252923508","Yes","Yes","No","100%",,"$5,160","$0","$1,240","$260","$5,740","$0","$660","$60","$1,730","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6652018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6652018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060078","AultCare Bronze 6550 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060078-00","AultCare Bronze 6550 Select No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$260","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6782018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6782018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060078","AultCare Bronze 6550 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060078-01","AultCare Bronze 6550 Select No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$260","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6782018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6782018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060078","AultCare Bronze 6550 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060078-02","AultCare Bronze 6550 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060078","AultCare Bronze 6550 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060078-03","AultCare Bronze 6550 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$260","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6782018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6782018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060088","AultCare Bronze 7350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060088-00","AultCare Bronze 7350 Select No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.58543686315904","Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$7,180","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6882018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6882018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060088","AultCare Bronze 7350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060088-01","AultCare Bronze 7350 Select No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.58543686315904","Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$7,180","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6882018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6882018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060088","AultCare Bronze 7350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060088-02","AultCare Bronze 7350 Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060088","AultCare Bronze 7350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060088-03","AultCare Bronze 7350 Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.58543686315904","Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$7,180","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6882018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6882018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060066","AultCare Catastrophic Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060066-00","AultCare Catastrophic Select No Pediatric Dental","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$6,880","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6662018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6662018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060066","AultCare Catastrophic Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF002","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2018.aspx","28162OH0060066-01","AultCare Catastrophic Select No Pediatric Dental","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$260","$6,880","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6662018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6662018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060080","AultCare Bronze Standard Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF004","Existing","PPO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyd2018.aspx","28162OH0060080-00","AultCare Bronze Standard Select No Pediatric Dental","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$260","$5,690","$220","$950","$60","$1,050","$150","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6802018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6802018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060080","AultCare Bronze Standard Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF004","Existing","PPO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyd2018.aspx","28162OH0060080-01","AultCare Bronze Standard Select No Pediatric Dental","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$260","$5,690","$220","$950","$60","$1,050","$150","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6802018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6802018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060080","AultCare Bronze Standard Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF004","Existing","PPO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyd2018.aspx","28162OH0060080-02","AultCare Bronze Standard Select No Pediatric Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2018.pdf"
"2018","OH","28162","SERFF","2017-09-06 20:16:09","Individual","No","34-1624818","28162OH0060080","AultCare Bronze Standard Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS003","OHF004","Existing","PPO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyd2018.aspx","28162OH0060080-03","AultCare Bronze Standard Select No Pediatric Dental","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$260","$5,690","$220","$950","$60","$1,050","$150","$700","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$19,950","$19950 per person","$39900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6802018.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6802018.pdf"
"2018","OH","29276","SERFF","2017-06-19 20:15:40","SHOP (Small Group)","Yes","31-1440175","29276OH0860003","Anthem Dental Family","29276OH086",,"OHN002","OHS002",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","29276OH0860003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e215625.pdf",
"2018","OH","29276","SERFF","2017-06-19 20:15:40","Individual","Yes","31-1440175","29276OH0830005","Anthem Dental Family Value","29276OH083",,"OHN002","OHS002",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","29276OH0830005-01","Anthem Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e215627.pdf",
"2018","OH","29276","SERFF","2017-06-19 20:15:40","Individual","Yes","31-1440175","29276OH0890005","Anthem Dental Family Value","29276OH089",,"OHN002","OHS002",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","29276OH0890005-00","Anthem Dental Family Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e215627.pdf",
"2018","OH","29276","SERFF","2017-06-19 20:15:40","SHOP (Small Group)","Yes","31-1440175","29276OH0860004","Anthem Dental Family Enhanced","29276OH086",,"OHN002","OHS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.824","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","29276OH0860004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e215626.pdf",
"2018","OH","29276","SERFF","2017-06-19 20:15:40","Individual","Yes","31-1440175","29276OH0830003","Anthem Dental Family","29276OH083",,"OHN002","OHS002",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","29276OH0830003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e215625.pdf",
"2018","OH","29276","SERFF","2017-06-19 20:15:40","Individual","Yes","31-1440175","29276OH0890003","Anthem Dental Family","29276OH089",,"OHN002","OHS002",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","29276OH0890003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e215625.pdf",
"2018","OH","29276","SERFF","2017-06-19 20:15:40","Individual","Yes","31-1440175","29276OH0830004","Anthem Dental Family Enhanced","29276OH083",,"OHN002","OHS002",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.824","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","29276OH0830004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e215626.pdf",
"2018","OH","29276","SERFF","2017-06-19 20:15:40","Individual","Yes","31-1440175","29276OH0890004","Anthem Dental Family Enhanced","29276OH089",,"OHN002","OHS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.824","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","29276OH0890004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e215626.pdf",
"2018","OH","30042","SERFF","2017-06-12 20:15:35","SHOP (Small Group)","Yes","31-1119867","30042OH0010001","SDC-Kids Plan High","30042OH001",,"OHN001","OHS001",,"Existing","PPO","High","Design 1",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Matches in County Coverage","Yes","Matches in County Coverage","Yes",,"","30042OH0010001-00","SDC-Kids Plan High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","30042","SERFF","2017-06-12 20:15:35","SHOP (Small Group)","Yes","31-1119867","30042OH0020001","SDC-Kids Plan Low","30042OH002",,"OHN001","OHS001",,"Existing","PPO","Low","Design 2",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Matches in County Coverage","Yes","Matches in County Coverage","Yes",,"","30042OH0020001-00","SDC-Kids Plan Low","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$150","per person not applicable","per group not applicable","$225","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","30042","SERFF","2017-06-12 20:15:35","SHOP (Small Group)","Yes","31-1119867","30042OH0030001","SDC-Preferred Kids Plan High","30042OH003",,"OHN001","OHS001",,"Existing","PPO","High","Design 1",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Matches in County Coverage","Yes","Matches in County Coverage","Yes",,"","30042OH0030001-00","SDC-Preferred Kids Plan High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","30042","SERFF","2017-06-12 20:15:35","SHOP (Small Group)","Yes","31-1119867","30042OH0040001","SDC-Preferred Kids Plan Low","30042OH004",,"OHN001","OHS001",,"Existing","PPO","Low","Design 2",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Matches in County Coverage","Yes","Matches in County Coverage","Yes",,"","30042OH0040001-00","SDC-Preferred Kids Plan Low","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$225","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","34964","SERFF","2017-06-14 20:15:39","Individual","Yes","59-0397210","34964OH0030001","DentaQuest PPO  Pediatric High","34964OH003",,"OHN002","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","34964OH0030001-00","DentaQuest PPO  Pediatric High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/"
"2018","OH","34964","SERFF","2017-06-14 20:15:39","Individual","Yes","59-0397210","34964OH0030001","DentaQuest PPO  Pediatric High","34964OH003",,"OHN002","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","34964OH0030001-01","DentaQuest PPO  Pediatric High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/"
"2018","OH","34964","SERFF","2017-06-14 20:15:39","Individual","Yes","59-0397210","34964OH0030003","DentaQuest PPO Family High","34964OH003",,"OHN002","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","34964OH0030003-00","DentaQuest PPO Family High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/"
"2018","OH","34964","SERFF","2017-06-14 20:15:39","Individual","Yes","59-0397210","34964OH0030003","DentaQuest PPO Family High","34964OH003",,"OHN002","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","34964OH0030003-01","DentaQuest PPO Family High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/"
"2018","OH","34964","SERFF","2017-06-14 20:15:39","Individual","Yes","59-0397210","34964OH0030004","DentaQuest PPO Family Low","34964OH003",,"OHN002","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","34964OH0030004-00","DentaQuest PPO Family Low","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/"
"2018","OH","34964","SERFF","2017-06-14 20:15:39","Individual","Yes","59-0397210","34964OH0030004","DentaQuest PPO Family Low","34964OH003",,"OHN002","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","34964OH0030004-01","DentaQuest PPO Family Low","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/"
"2018","OH","34968","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","13-5581829","34968OH0150002","EHB Basic Dental Plan (Low)","34968OH015",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","34968OH0150002-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010004","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","41047OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010004-00","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/41047OH0010004-00.pdf","https://api.centene.com/Brochures/2018/41047OH0010004-00.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010004","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","41047OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010004-01","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/41047OH0010004-01.pdf","https://api.centene.com/Brochures/2018/41047OH0010004-01.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010004","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","41047OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010004-02","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/41047OH0010004-02.pdf","https://api.centene.com/Brochures/2018/41047OH0010004-02.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010004","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","41047OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010004-03","Ambetter Secure Care 1 (2018) with 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.794578625553923","No","Yes","No","100%",,"$1,000","$40","$2,500","$60","$1,500","$600","$600","$60","$1,000","$0","$400","$0","$350","0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/41047OH0010004-03.pdf","https://api.centene.com/Brochures/2018/41047OH0010004-03.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2018)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010018-00","Ambetter Balanced Care 1 (2018)","Standard Silver Off Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010018-00.pdf","https://api.centene.com/Brochures/2018/41047OH0010018-00.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2018)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010018-01","Ambetter Balanced Care 1 (2018)","Standard Silver On Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010018-01.pdf","https://api.centene.com/Brochures/2018/41047OH0010018-01.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2018)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010018-02","Ambetter Balanced Care 1 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010018-02.pdf","https://api.centene.com/Brochures/2018/41047OH0010018-02.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2018)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010018-03","Ambetter Balanced Care 1 (2018)","Limited Cost Sharing Plan Variation",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010018-03.pdf","https://api.centene.com/Brochures/2018/41047OH0010018-03.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2018)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010018-04","Ambetter Balanced Care 1 (2018)","73% AV Level Silver Plan",,"0.739812128349422","Yes","Yes","No","100%",,"$3,000","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010018-04.pdf","https://api.centene.com/Brochures/2018/41047OH0010018-04.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2018)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010018-05","Ambetter Balanced Care 1 (2018)","87% AV Level Silver Plan",,"0.87931537568396","Yes","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$300","$400","$60","$750","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010018-05.pdf","https://api.centene.com/Brochures/2018/41047OH0010018-05.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2018)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010018-06","Ambetter Balanced Care 1 (2018)","94% AV Level Silver Plan",,"0.949528260595198","Yes","Yes","No","100%",,"$0","$0","$950","$60","$0","$300","$400","$60","$0","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010018-06.pdf","https://api.centene.com/Brochures/2018/41047OH0010018-06.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2018)","41047OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010019-00","Ambetter Balanced Care 2 (2018)","Standard Silver Off Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010019-00.pdf","https://api.centene.com/Brochures/2018/41047OH0010019-00.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2018)","41047OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010019-01","Ambetter Balanced Care 2 (2018)","Standard Silver On Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010019-01.pdf","https://api.centene.com/Brochures/2018/41047OH0010019-01.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2018)","41047OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010019-02","Ambetter Balanced Care 2 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010019-02.pdf","https://api.centene.com/Brochures/2018/41047OH0010019-02.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2018)","41047OH001",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010019-06","Ambetter Balanced Care 2 (2018)","94% AV Level Silver Plan",,"0.942313720589882","Yes","Yes","No","100%",,"$572","$3","$0","$60","$500","$70","$0","$60","$575","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010019-06.pdf","https://api.centene.com/Brochures/2018/41047OH0010019-06.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010051","Ambetter Balanced Care 5 (2018)","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010051-00","Ambetter Balanced Care 5 (2018)","Standard Silver Off Exchange Plan","66.25%","0.661631852049009","Yes","Yes","No","100%",,"$6,800","$550","$0","$60","$1,900","$1,900","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010051-00.pdf","https://api.centene.com/Brochures/2018/41047OH0010051-00.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010051","Ambetter Balanced Care 5 (2018)","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010051-01","Ambetter Balanced Care 5 (2018)","Standard Silver On Exchange Plan","66.25%","0.661631852049009","Yes","Yes","No","100%",,"$6,800","$550","$0","$60","$1,900","$1,900","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010051-01.pdf","https://api.centene.com/Brochures/2018/41047OH0010051-01.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010051","Ambetter Balanced Care 5 (2018)","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010051-02","Ambetter Balanced Care 5 (2018)","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010051-02.pdf","https://api.centene.com/Brochures/2018/41047OH0010051-02.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010051","Ambetter Balanced Care 5 (2018)","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010051-04","Ambetter Balanced Care 5 (2018)","73% AV Level Silver Plan","72.15%","0.718557057101132","Yes","Yes","No","100%",,"$5,000","$300","$0","$60","$1,900","$1,500","$0","$60","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010051-04.pdf","https://api.centene.com/Brochures/2018/41047OH0010051-04.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010051","Ambetter Balanced Care 5 (2018)","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010051-05","Ambetter Balanced Care 5 (2018)","87% AV Level Silver Plan","86.18%","0.858472329117886","Yes","Yes","No","100%",,"$1,950","$0","$0","$60","$1,600","$300","$0","$60","$1,600","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010051-05.pdf","https://api.centene.com/Brochures/2018/41047OH0010051-05.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010051","Ambetter Balanced Care 5 (2018)","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010051-06","Ambetter Balanced Care 5 (2018)","94% AV Level Silver Plan","93.63%","0.935092701963358","Yes","Yes","No","100%",,"$675","$0","$0","$60","$565","$100","$0","$60","$675","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010051-06.pdf","https://api.centene.com/Brochures/2018/41047OH0010051-06.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2018)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010021-00","Ambetter Balanced Care 10 (2018)","Standard Silver Off Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010021-00.pdf","https://api.centene.com/Brochures/2018/41047OH0010021-00.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2018)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010021-01","Ambetter Balanced Care 10 (2018)","Standard Silver On Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010021-01.pdf","https://api.centene.com/Brochures/2018/41047OH0010021-01.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2018)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010021-02","Ambetter Balanced Care 10 (2018)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010021-02.pdf","https://api.centene.com/Brochures/2018/41047OH0010021-02.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2018)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010021-03","Ambetter Balanced Care 10 (2018)","Limited Cost Sharing Plan Variation",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010021-03.pdf","https://api.centene.com/Brochures/2018/41047OH0010021-03.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2018)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010021-04","Ambetter Balanced Care 10 (2018)","73% AV Level Silver Plan",,"0.73985223196154","Yes","Yes","No","100%",,"$3,700","$100","$2,000","$60","$1,500","$900","$400","$60","$1,300","$90","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010021-04.pdf","https://api.centene.com/Brochures/2018/41047OH0010021-04.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2018)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010021-05","Ambetter Balanced Care 10 (2018)","87% AV Level Silver Plan",,"0.879858510990049","Yes","Yes","No","100%",,"$800","$0","$1,400","$60","$850","$300","$400","$60","$850","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010021-05.pdf","https://api.centene.com/Brochures/2018/41047OH0010021-05.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2018)","41047OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010021-06","Ambetter Balanced Care 10 (2018)","94% AV Level Silver Plan",,"0.949794807417026","Yes","Yes","No","100%",,"$250","$0","$300","$60","$250","$160","$185","$60","$250","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$595","$595 per person","$1190 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0010021-06.pdf","https://api.centene.com/Brochures/2018/41047OH0010021-06.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010024","Ambetter Balanced Care 12 (2018)","41047OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010024-00","Ambetter Balanced Care 12 (2018)","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/41047OH0010024-00.pdf","https://api.centene.com/Brochures/2018/41047OH0010024-00.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010024","Ambetter Balanced Care 12 (2018)","41047OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010024-01","Ambetter Balanced Care 12 (2018)","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/41047OH0010024-01.pdf","https://api.centene.com/Brochures/2018/41047OH0010024-01.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010024","Ambetter Balanced Care 12 (2018)","41047OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010024-02","Ambetter Balanced Care 12 (2018)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/41047OH0010024-02.pdf","https://api.centene.com/Brochures/2018/41047OH0010024-02.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010024","Ambetter Balanced Care 12 (2018)","41047OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010024-03","Ambetter Balanced Care 12 (2018)","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/41047OH0010024-03.pdf","https://api.centene.com/Brochures/2018/41047OH0010024-03.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010024","Ambetter Balanced Care 12 (2018)","41047OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010024-04","Ambetter Balanced Care 12 (2018)","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$600","$2,000","$60","$1,500","$1,500","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/41047OH0010024-04.pdf","https://api.centene.com/Brochures/2018/41047OH0010024-04.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010024","Ambetter Balanced Care 12 (2018)","41047OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010024-05","Ambetter Balanced Care 12 (2018)","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$100","$1,600","$60","$700","$600","$400","$60","$700","$80","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/41047OH0010024-05.pdf","https://api.centene.com/Brochures/2018/41047OH0010024-05.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0010024","Ambetter Balanced Care 12 (2018)","41047OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0010024-06","Ambetter Balanced Care 12 (2018)","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$100","$500","$60","$250","$200","$90","$60","$250","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2018/41047OH0010024-06.pdf","https://api.centene.com/Brochures/2018/41047OH0010024-06.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020018-00","Ambetter Balanced Care 1 (2018) + Vision","Standard Silver Off Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020018-00.pdf","https://api.centene.com/Brochures/2018/41047OH0020018-00.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020018-01","Ambetter Balanced Care 1 (2018) + Vision","Standard Silver On Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020018-01.pdf","https://api.centene.com/Brochures/2018/41047OH0020018-01.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020018-02","Ambetter Balanced Care 1 (2018) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020018-02.pdf","https://api.centene.com/Brochures/2018/41047OH0020018-02.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020018-03","Ambetter Balanced Care 1 (2018) + Vision","Limited Cost Sharing Plan Variation",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020018-03.pdf","https://api.centene.com/Brochures/2018/41047OH0020018-03.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020018-04","Ambetter Balanced Care 1 (2018) + Vision","73% AV Level Silver Plan",,"0.739812128349422","Yes","Yes","No","100%",,"$3,000","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020018-04.pdf","https://api.centene.com/Brochures/2018/41047OH0020018-04.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020018-05","Ambetter Balanced Care 1 (2018) + Vision","87% AV Level Silver Plan",,"0.87931537568396","Yes","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$300","$400","$60","$750","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020018-05.pdf","https://api.centene.com/Brochures/2018/41047OH0020018-05.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020018-06","Ambetter Balanced Care 1 (2018) + Vision","94% AV Level Silver Plan",,"0.949528260595198","Yes","Yes","No","100%",,"$0","$0","$950","$60","$0","$300","$400","$60","$0","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020018-06.pdf","https://api.centene.com/Brochures/2018/41047OH0020018-06.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020019-00","Ambetter Balanced Care 2 (2018) + Vision","Standard Silver Off Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020019-00.pdf","https://api.centene.com/Brochures/2018/41047OH0020019-00.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020019-01","Ambetter Balanced Care 2 (2018) + Vision","Standard Silver On Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020019-01.pdf","https://api.centene.com/Brochures/2018/41047OH0020019-01.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020019-02","Ambetter Balanced Care 2 (2018) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020019-02.pdf","https://api.centene.com/Brochures/2018/41047OH0020019-02.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020019-03","Ambetter Balanced Care 2 (2018) + Vision","Limited Cost Sharing Plan Variation",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020019-03.pdf","https://api.centene.com/Brochures/2018/41047OH0020019-03.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020019-04","Ambetter Balanced Care 2 (2018) + Vision","73% AV Level Silver Plan",,"0.729896135538709","Yes","Yes","No","100%",,"$4,600","$400","$0","$60","$1,900","$1,400","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020019-04.pdf","https://api.centene.com/Brochures/2018/41047OH0020019-04.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020019-05","Ambetter Balanced Care 2 (2018) + Vision","87% AV Level Silver Plan",,"0.867181007012531","Yes","Yes","No","100%",,"$1,700","$10","$0","$60","$1,500","$250","$0","$60","$1,600","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020019-05.pdf","https://api.centene.com/Brochures/2018/41047OH0020019-05.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020019-06","Ambetter Balanced Care 2 (2018) + Vision","94% AV Level Silver Plan",,"0.942313720589882","Yes","Yes","No","100%",,"$572","$3","$0","$60","$500","$70","$0","$60","$575","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020019-06.pdf","https://api.centene.com/Brochures/2018/41047OH0020019-06.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020020-00","Ambetter Balanced Care 10 (2018) + Vision","Standard Silver Off Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020020-00.pdf","https://api.centene.com/Brochures/2018/41047OH0020020-00.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020020-01","Ambetter Balanced Care 10 (2018) + Vision","Standard Silver On Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020020-01.pdf","https://api.centene.com/Brochures/2018/41047OH0020020-01.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020020-02","Ambetter Balanced Care 10 (2018) + Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020020-02.pdf","https://api.centene.com/Brochures/2018/41047OH0020020-02.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020020-03","Ambetter Balanced Care 10 (2018) + Vision","Limited Cost Sharing Plan Variation",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020020-03.pdf","https://api.centene.com/Brochures/2018/41047OH0020020-03.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020020-04","Ambetter Balanced Care 10 (2018) + Vision","73% AV Level Silver Plan",,"0.73985223196154","Yes","Yes","No","100%",,"$3,700","$100","$2,000","$60","$1,500","$900","$400","$60","$1,300","$90","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020020-04.pdf","https://api.centene.com/Brochures/2018/41047OH0020020-04.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020020-05","Ambetter Balanced Care 10 (2018) + Vision","87% AV Level Silver Plan",,"0.879858510990049","Yes","Yes","No","100%",,"$800","$0","$1,400","$60","$850","$300","$400","$60","$850","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020020-05.pdf","https://api.centene.com/Brochures/2018/41047OH0020020-05.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2018) + Vision","41047OH002",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9874",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0020020-06","Ambetter Balanced Care 10 (2018) + Vision","94% AV Level Silver Plan",,"0.949794807417026","Yes","Yes","No","100%",,"$250","$0","$300","$60","$250","$160","$185","$60","$250","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$595","$595 per person","$1190 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0020020-06.pdf","https://api.centene.com/Brochures/2018/41047OH0020020-06.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030018","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030018-00","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030018-00.pdf","https://api.centene.com/Brochures/2018/41047OH0030018-00.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030018","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030018-01","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030018-01.pdf","https://api.centene.com/Brochures/2018/41047OH0030018-01.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030018","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030018-02","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030018-02.pdf","https://api.centene.com/Brochures/2018/41047OH0030018-02.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030018","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030018-03","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.703221609667176","Yes","Yes","No","100%",,"$4,100","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030018-03.pdf","https://api.centene.com/Brochures/2018/41047OH0030018-03.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030018","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030018-04","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.739812128349422","Yes","Yes","No","100%",,"$3,000","$400","$2,000","$60","$1,500","$1,300","$400","$60","$1,300","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030018-04.pdf","https://api.centene.com/Brochures/2018/41047OH0030018-04.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030018","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030018-05","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.87931537568396","Yes","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$300","$400","$60","$750","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030018-05.pdf","https://api.centene.com/Brochures/2018/41047OH0030018-05.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030018","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030018-06","Ambetter Balanced Care 1 (2018) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949528260595198","Yes","Yes","No","100%",,"$0","$0","$950","$60","$0","$300","$400","$60","$0","$30","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030018-06.pdf","https://api.centene.com/Brochures/2018/41047OH0030018-06.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030019","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030019-00","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030019-00.pdf","https://api.centene.com/Brochures/2018/41047OH0030019-00.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030019","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030019-01","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030019-01.pdf","https://api.centene.com/Brochures/2018/41047OH0030019-01.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030019","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030019-02","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030019-02.pdf","https://api.centene.com/Brochures/2018/41047OH0030019-02.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030019","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030019-03","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.691430423189955","Yes","Yes","No","100%",,"$6,100","$400","$0","$60","$1,900","$1,500","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030019-03.pdf","https://api.centene.com/Brochures/2018/41047OH0030019-03.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030019","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030019-04","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.729896135538709","Yes","Yes","No","100%",,"$4,600","$400","$0","$60","$1,900","$1,400","$0","$60","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030019-04.pdf","https://api.centene.com/Brochures/2018/41047OH0030019-04.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030019","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030019-05","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.867181007012531","Yes","Yes","No","100%",,"$1,700","$10","$0","$60","$1,500","$250","$0","$60","$1,600","$20","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030019-05.pdf","https://api.centene.com/Brochures/2018/41047OH0030019-05.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030019","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030019-06","Ambetter Balanced Care 2 (2018) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.942313720589882","Yes","Yes","No","100%",,"$572","$3","$0","$60","$500","$70","$0","$60","$575","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$575","$575 per person","$1150 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030019-06.pdf","https://api.centene.com/Brochures/2018/41047OH0030019-06.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030020","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030020-00","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","Standard Silver Off Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030020-00.pdf","https://api.centene.com/Brochures/2018/41047OH0030020-00.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030020","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030020-01","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","Standard Silver On Exchange Plan",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030020-01.pdf","https://api.centene.com/Brochures/2018/41047OH0030020-01.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030020","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030020-02","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030020-02.pdf","https://api.centene.com/Brochures/2018/41047OH0030020-02.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030020","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030020-03","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","Limited Cost Sharing Plan Variation",,"0.712810513763331","Yes","Yes","No","100%",,"$4,400","$300","$2,000","$60","$1,500","$1,200","$400","$60","$1,300","$100","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030020-03.pdf","https://api.centene.com/Brochures/2018/41047OH0030020-03.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030020","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030020-04","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","73% AV Level Silver Plan",,"0.73985223196154","Yes","Yes","No","100%",,"$3,700","$100","$2,000","$60","$1,500","$900","$400","$60","$1,300","$90","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030020-04.pdf","https://api.centene.com/Brochures/2018/41047OH0030020-04.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030020","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030020-05","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","87% AV Level Silver Plan",,"0.879858510990049","Yes","Yes","No","100%",,"$800","$0","$1,400","$60","$850","$300","$400","$60","$850","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030020-05.pdf","https://api.centene.com/Brochures/2018/41047OH0030020-05.pdf"
"2018","OH","41047","SERFF","2017-10-31 20:15:29","Individual","No","32-0045282","41047OH0030020","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9521",,,"2018-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","https://ambetter.buckeyehealthplan.com/resources/pharmacy-resources.html","41047OH0030020-06","Ambetter Balanced Care 10 (2018) + Vision + Adult Dental","94% AV Level Silver Plan",,"0.949794807417026","Yes","Yes","No","100%",,"$250","$0","$300","$60","$250","$160","$185","$60","$250","$20","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$595","$595 per person","$1190 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2018/41047OH0030020-06.pdf","https://api.centene.com/Brochures/2018/41047OH0030020-06.pdf"
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0070001","Saver Bronze","45845OH007",,"OHN001","OHS001","OHF012","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994871",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0070001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF012","45845OH0070001-03","Saver Bronze - Free Calls with Doctors, Free Preventive Care, HSA-Compatible","Limited Cost Sharing Plan Variation",,"0.606270750044867","Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0070001-03",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0080001","Saver Silver","45845OH008",,"OHN001","OHS001","OHF013","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0080001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF013","45845OH0080001-00","Saver Silver - Free Calls with Doctors, Free Preventive Care, HSA-Compatible","Standard Silver Off Exchange Plan",,"0.662934672262727","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$5,000","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0080001-00",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0080001","Saver Silver","45845OH008",,"OHN001","OHS001","OHF013","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0080001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF013","45845OH0080001-01","Saver Silver - Free Calls with Doctors, Free Preventive Care, HSA-Compatible","Standard Silver On Exchange Plan",,"0.662934672262727","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$5,000","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0080001-01",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0080001","Saver Silver","45845OH008",,"OHN001","OHS001","OHF013","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0080001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF013","45845OH0080001-02","Saver Silver - Free Calls with Doctors, Free Preventive Care","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0080001-02",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0080001","Saver Silver","45845OH008",,"OHN001","OHS001","OHF013","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0080001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF013","45845OH0080001-03","Saver Silver - Free Calls with Doctors, Free Preventive Care, HSA-Compatible","Limited Cost Sharing Plan Variation",,"0.662934672262727","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$5,000","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0080001-03",
"2018","OH","44346","SERFF","2017-08-16 20:15:58","Individual","Yes","20-4023720","44346OH0010001","EMI Health Choice PPO (High)","44346OH001",,"OHN001","OHS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9651","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","44346OH0010001-01","EMI Health Choice PPO (High)","Standard High On Exchange Plan","86.44%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$15","$15 per person","$45 per group",,"$15","$15 per person","$45 per group",,"$15","$15 per person","$45 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/oh-federal-marketplace-dental.aspx"
"2018","OH","44346","SERFF","2017-08-16 20:15:58","Individual","Yes","20-4023720","44346OH0010002","EMI Health Choice PPO (Low)","44346OH001",,"OHN001","OHS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","44346OH0010002-01","EMI Health Choice PPO (Low)","Standard Low On Exchange Plan","70.71%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,"$100","$100 per person","$300 per group",,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/oh-federal-marketplace-dental.aspx"
"2018","OH","44346","SERFF","2017-08-16 20:15:58","Individual","Yes","20-4023720","44346OH0010003","EMI Health Advantage Co-Pay","44346OH001",,"OHN002","OHS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","44346OH0010003-01","EMI Health Advantage Co-Pay","Standard Low On Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/oh-federal-marketplace-dental.aspx"
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0020001","Classic Bronze","45845OH002",,"OHN001","OHS001","OHF001","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994871",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0020001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF001","45845OH0020001-00","Classic Bronze - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Standard Bronze Off Exchange Plan",,"0.612190384161606","Yes","Yes","No","100%",,"$3,500","$0","$1,400","$200","$3,500","$0","$800","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0020001-00",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0020001","Classic Bronze","45845OH002",,"OHN001","OHS001","OHF001","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994871",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0020001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF001","45845OH0020001-01","Classic Bronze - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Standard Bronze On Exchange Plan",,"0.612190384161606","Yes","Yes","No","100%",,"$3,500","$0","$1,400","$200","$3,500","$0","$800","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0020001-01",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0020001","Classic Bronze","45845OH002",,"OHN001","OHS001","OHF001","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994871",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0020001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF001","45845OH0020001-02","Classic Bronze - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0020001-02",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0020001","Classic Bronze","45845OH002",,"OHN001","OHS001","OHF001","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994871",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0020001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF001","45845OH0020001-03","Classic Bronze - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Limited Cost Sharing Plan Variation",,"0.612190384161606","Yes","Yes","No","100%",,"$3,500","$0","$1,400","$200","$3,500","$0","$800","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0020001-03",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0030001","Classic Silver","45845OH003",,"OHN001","OHS001","OHF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0030001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF002","45845OH0030001-00","Classic Silver - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Standard Silver Off Exchange Plan",,"0.662572941613667","Yes","Yes","No","100%",,"$5,000","$10","$900","$200","$3,100","$500","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0030001-00",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0030001","Classic Silver","45845OH003",,"OHN001","OHS001","OHF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0030001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF002","45845OH0030001-01","Classic Silver - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Standard Silver On Exchange Plan",,"0.662572941613667","Yes","Yes","No","100%",,"$5,000","$10","$900","$200","$3,100","$500","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0030001-01",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0030001","Classic Silver","45845OH003",,"OHN001","OHS001","OHF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0030001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF002","45845OH0030001-02","Classic Silver - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0030001-02",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0030001","Classic Silver","45845OH003",,"OHN001","OHS001","OHF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0030001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF002","45845OH0030001-03","Classic Silver - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Limited Cost Sharing Plan Variation",,"0.662572941613667","Yes","Yes","No","100%",,"$5,000","$10","$900","$200","$3,100","$500","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0030001-03",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0030001","Classic Silver","45845OH003",,"OHN001","OHS001","OHF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0030001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF002","45845OH0030001-04","Classic Silver - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","73% AV Level Silver Plan",,"0.739795272671222","Yes","Yes","No","100%",,"$3,000","$10","$1,000","$200","$0","$1,600","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0030001-04",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0030001","Classic Silver","45845OH003",,"OHN001","OHS001","OHF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0030001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF002","45845OH0030001-05","Classic Silver - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","87% AV Level Silver Plan",,"0.877207875721853","Yes","Yes","No","100%",,"$800","$0","$1,100","$200","$0","$700","$0","$80","$800","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0030001-05",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0030001","Classic Silver","45845OH003",,"OHN001","OHS001","OHF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0030001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF002","45845OH0030001-06","Classic Silver - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","94% AV Level Silver Plan",,"0.933657569584975","Yes","Yes","No","100%",,"$300","$0","$600","$200","$0","$700","$0","$80","$300","$100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0030001-06",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0040001","Classic Gold","45845OH004",,"OHN001","OHS001","OHF006","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.995493",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0040001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF006","45845OH0040001-00","Classic Gold - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Standard Gold Off Exchange Plan",,"0.760216081874643","Yes","Yes","No","100%",,"$1,500","$10","$1,000","$200","$0","$1,700","$0","$80","$1,500","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0040001-00",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0040001","Classic Gold","45845OH004",,"OHN001","OHS001","OHF006","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.995493",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0040001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF006","45845OH0040001-01","Classic Gold - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Standard Gold On Exchange Plan",,"0.760216081874643","Yes","Yes","No","100%",,"$1,500","$10","$1,000","$200","$0","$1,700","$0","$80","$1,500","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0040001-01",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0040001","Classic Gold","45845OH004",,"OHN001","OHS001","OHF006","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.995493",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0040001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF006","45845OH0040001-02","Classic Gold - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0040001-02",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0040001","Classic Gold","45845OH004",,"OHN001","OHS001","OHF006","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.995493",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0040001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF006","45845OH0040001-03","Classic Gold - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Limited Cost Sharing Plan Variation",,"0.760216081874643","Yes","Yes","No","100%",,"$1,500","$10","$1,000","$200","$0","$1,700","$0","$80","$1,500","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0040001-03",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0050001","Simple Bronze","45845OH005",,"OHN001","OHS001","OHF007","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994836",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0050001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF007","45845OH0050001-00","Simple Bronze - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Standard Bronze Off Exchange Plan",,"0.585436865833666","Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0050001-00",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0050001","Simple Bronze","45845OH005",,"OHN001","OHS001","OHF007","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994836",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0050001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF007","45845OH0050001-01","Simple Bronze - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Standard Bronze On Exchange Plan",,"0.585436865833666","Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0050001-01",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0050001","Simple Bronze","45845OH005",,"OHN001","OHS001","OHF007","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994836",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0050001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF007","45845OH0050001-02","Simple Bronze - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0050001-02",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0050001","Simple Bronze","45845OH005",,"OHN001","OHS001","OHF007","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994836",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0050001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF007","45845OH0050001-03","Simple Bronze - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Limited Cost Sharing Plan Variation",,"0.585436865833666","Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0050001-03",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0060001","Simple Silver","45845OH006",,"OHN001","OHS001","OHF008","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0060001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF008","45845OH0060001-00","Simple Silver - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Standard Silver Off Exchange Plan",,"0.663904198665731","Yes","Yes","No","100%",,"$6,300","$10","$0","$200","$3,000","$400","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0060001-00",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0060001","Simple Silver","45845OH006",,"OHN001","OHS001","OHF008","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0060001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF008","45845OH0060001-01","Simple Silver - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Standard Silver On Exchange Plan",,"0.663904198665731","Yes","Yes","No","100%",,"$6,300","$10","$0","$200","$3,000","$400","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0060001-01",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0060001","Simple Silver","45845OH006",,"OHN001","OHS001","OHF008","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0060001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF008","45845OH0060001-02","Simple Silver - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0060001-02",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0060001","Simple Silver","45845OH006",,"OHN001","OHS001","OHF008","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0060001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF008","45845OH0060001-03","Simple Silver - Free Calls with Doctors, Free Preventive Care, $100 Step Tracking Rewards","Limited Cost Sharing Plan Variation",,"0.663904198665731","Yes","Yes","No","100%",,"$6,300","$10","$0","$200","$3,000","$400","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0060001-03",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0060001","Simple Silver","45845OH006",,"OHN001","OHS001","OHF008","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0060001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF008","45845OH0060001-04","Simple Silver CSR 250","73% AV Level Silver Plan",,"0.73717727932139","Yes","Yes","No","100%",,"$5,000","$0","$0","$200","$0","$1,600","$0","$80","$1,500","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0060001-04",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0060001","Simple Silver","45845OH006",,"OHN001","OHS001","OHF008","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0060001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF008","45845OH0060001-05","Simple Silver CSR 200","87% AV Level Silver Plan",,"0.870456207778575","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$0","$700","$0","$80","$1,500","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0060001-05",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0060001","Simple Silver","45845OH006",,"OHN001","OHS001","OHF008","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0060001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF008","45845OH0060001-06","Simple Silver CSR 150","94% AV Level Silver Plan",,"0.931798197179833","Yes","Yes","No","100%",,"$800","$0","$0","$200","$0","$700","$0","$80","$800","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0060001-06",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0010001","Simple Secure","45845OH001",,"OHN001","OHS001","OHF017","New","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994079",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0010001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF017","45845OH0010001-00","Simple Secure","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0010001-00",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0010001","Simple Secure","45845OH001",,"OHN001","OHS001","OHF017","New","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994079",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0010001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF017","45845OH0010001-01","Simple Secure","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0010001-01",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0070001","Saver Bronze","45845OH007",,"OHN001","OHS001","OHF012","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994871",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0070001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF012","45845OH0070001-00","Saver Bronze - Free Calls with Doctors, Free Preventive Care, HSA-Compatible","Standard Bronze Off Exchange Plan",,"0.606270750044867","Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0070001-00",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0070001","Saver Bronze","45845OH007",,"OHN001","OHS001","OHF012","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994871",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0070001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF012","45845OH0070001-01","Saver Bronze - Free Calls with Doctors, Free Preventive Care, HSA-Compatible","Standard Bronze On Exchange Plan",,"0.606270750044867","Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0070001-01",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0070001","Saver Bronze","45845OH007",,"OHN001","OHS001","OHF012","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994871",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0070001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF012","45845OH0070001-02","Saver Bronze - Free Calls with Doctors, Free Preventive Care","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0070001-02",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0080001","Saver Silver","45845OH008",,"OHN001","OHS001","OHF013","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0080001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF013","45845OH0080001-04","Saver Silver - Free Calls with Doctors, Free Preventive Care","73% AV Level Silver Plan",,"0.730146679152217","Yes","Yes","No","100%",,"$2,000","$0","$900","$200","$2,000","$0","$700","$80","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0080001-04",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0080001","Saver Silver","45845OH008",,"OHN001","OHS001","OHF013","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0080001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF013","45845OH0080001-05","Saver Silver - Free Calls with Doctors, Free Preventive Care","87% AV Level Silver Plan",,"0.876025321101243","Yes","Yes","No","100%",,"$500","$0","$600","$200","$500","$0","$500","$80","$500","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0080001-05",
"2018","OH","45845","SERFF","2017-10-17 20:15:27","Individual","No","36-4859637","45845OH0080001","Saver Silver","45845OH008",,"OHN001","OHS001","OHF013","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.994925",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment/?state=oh&year=2018&hios=45845OH0080001","https://www.hioscar.com/search/OH/drugs?year=2018&formulary=OHF013","45845OH0080001-06","Saver Silver - Free Calls with Doctors, Free Preventive Care","94% AV Level Silver Plan",,"0.943518531900987","Yes","Yes","No","100%",,"$100","$0","$600","$200","$100","$0","$500","$80","$100","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.hioscar.com/hx/sbc/?state=oh&year=2018&hios=45845OH0080001-06",
"2018","OH","47509","SERFF","2017-06-14 20:15:39","Individual","Yes","95-6042390","47509OH0020003","BESTOne Advantage Gold","47509OH002",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/OH/current/OH_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","OH","47509","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","95-6042390","47509OH0010007","BESTDental Premium","47509OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010007-00","BESTDental Premium","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/CURRENT/OH_BESTDental_Premium_Plan.pdf"
"2018","OH","47509","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","95-6042390","47509OH0010007","BESTDental Premium","47509OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010007-01","BESTDental Premium","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/current/OH_BESTDental_Premium_Plan.pdf"
"2018","OH","47509","SERFF","2017-06-14 20:15:39","Individual","Yes","95-6042390","47509OH0020003","BESTOne Advantage Gold","47509OH002",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/OH/current/OH_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","OH","47509","SERFF","2017-06-14 20:15:39","Individual","Yes","95-6042390","47509OH0020004","BESTOne Plus Gold","47509OH002",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/OH/current/OH_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","OH","47509","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","95-6042390","47509OH0010008","BESTDental Standard - H","47509OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/current/OH_BESTDental_Standard-H_Plan.pdf"
"2018","OH","47509","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","95-6042390","47509OH0010008","BESTDental Standard - H","47509OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/current/OH_BESTDental_Standard-H_Plan.pdf"
"2018","OH","47509","SERFF","2017-06-14 20:15:39","Individual","Yes","95-6042390","47509OH0020004","BESTOne Plus Gold","47509OH002",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/OH/current/OH_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","OH","47509","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","95-6042390","47509OH0010010","BESTDental Choice - H","47509OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/current/OH_BESTDental_Choice-H_Plan.pdf"
"2018","OH","47509","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","95-6042390","47509OH0010010","BESTDental Choice - H","47509OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/current/OH_BESTDental_Choice-H_Plan.pdf"
"2018","OH","47509","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","95-6042390","47509OH0010009","BESTDental Standard - L","47509OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/oh/current/OH_BESTDental_Standard-L_Plan.pdf"
"2018","OH","47509","SERFF","2017-06-14 20:15:39","Individual","Yes","95-6042390","47509OH0020005","BESTOne Plus Silver","47509OH002",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/OH/current/OH_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","OH","47509","SERFF","2017-06-14 20:15:39","Individual","Yes","95-6042390","47509OH0020005","BESTOne Plus Silver","47509OH002",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/OH/current/OH_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","OH","47509","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","95-6042390","47509OH0010009","BESTDental Standard - L","47509OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/oh/current/OH_BESTDental_Standard-L_Plan.pdf"
"2018","OH","47509","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","95-6042390","47509OH0010011","BESTDental Choice - L","47509OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/oh/current/OH_BESTDental_Choice-L_Plan.pdf"
"2018","OH","47509","SERFF","2017-06-14 20:15:39","Individual","Yes","95-6042390","47509OH0020006","BESTOne Basic Silver","47509OH002",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/OH/current/OH_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","OH","47509","SERFF","2017-06-14 20:15:39","Individual","Yes","95-6042390","47509OH0020006","BESTOne Basic Silver","47509OH002",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/OH/current/OH_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","OH","47509","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","95-6042390","47509OH0010011","BESTDental Choice - L","47509OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/oh/current/OH_BESTDental_Choice-L_Plan.pdf"
"2018","OH","47509","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","95-6042390","47509OH0010012","BESTDental Value","47509OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/oh/current/OH_BESTDental_Value_Plan.pdf"
"2018","OH","47509","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","95-6042390","47509OH0010012","BESTDental Value","47509OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/oh/current/OH_BESTDental_Value_Plan.pdf"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1520042","SummaCare Bronze 5000 HSA with SCConnect Network","52664OH152",,"OHN001","OHS001","OHF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1520042-00","SummaCare Bronze 5000 HSA with SCConnect Network","Standard Bronze Off Exchange Plan",,"0.618628875540942","Yes","Yes","No","100%",,"$4,070","$0","$2,480","$60","$5,000","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$100,000","$100000 per person","$200000 per group","$106,550","$106550 per person","$213100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$25,000","$25000 per person","$50000 per group","$30,000","$30000 per person","$60000 per group","Yes",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareBronze5000HSASCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareBronze5000HSASCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1809108","52664OH1490728","SummaCare Silver 5000-18 with SCSelect Network","52664OH149",,"OHN002","OHS002","OHF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1490728-00","SummaCare Silver 5000-18 with SCSelect Network","Standard Silver Off Exchange Plan",,"0.714991772004654","No","Yes","No","100%",,"$4,520","$0","$2,480","$60","$1,489","$1,260","$372","$55","$859","$1,050","$215","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","$28,000","$28000 per person","$56000 per group","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","$200","$200 per person","per group not applicable","20.00%",,,,,"$600","$600 per person","per group not applicable","$800","$800 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-18SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-18SCSelectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1809108","52664OH1490728","SummaCare Silver 5000-18 with SCSelect Network","52664OH149",,"OHN002","OHS002","OHF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1490728-01","SummaCare Silver 5000-18 with SCSelect Network","Standard Silver On Exchange Plan",,"0.714991772004654","No","Yes","No","100%",,"$4,520","$0","$2,480","$60","$1,489","$1,260","$372","$55","$859","$1,050","$215","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","$28,000","$28000 per person","$56000 per group","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","$200","$200 per person","per group not applicable","20.00%",,,,,"$600","$600 per person","per group not applicable","$800","$800 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-18SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-18SCSelectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1520042","SummaCare Bronze 5000 HSA with SCConnect Network","52664OH152",,"OHN001","OHS001","OHF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1520042-01","SummaCare Bronze 5000 HSA with SCConnect Network","Standard Bronze On Exchange Plan",,"0.618628875540942","Yes","Yes","No","100%",,"$4,070","$0","$2,480","$60","$5,000","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$100,000","$100000 per person","$200000 per group","$106,550","$106550 per person","$213100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$25,000","$25000 per person","$50000 per group","$30,000","$30000 per person","$60000 per group","Yes",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareBronze5000HSASCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareBronze5000HSASCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1520042","SummaCare Bronze 5000 HSA with SCConnect Network","52664OH152",,"OHN001","OHS001","OHF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1520042-02","SummaCare Bronze 5000 HSA with SCConnect Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareBronze5000HSA-100SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareBronze5000HSA-100SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1809108","52664OH1490729","SummaCare Silver 5000-18 with SCSelect Network","52664OH149",,"OHN002","OHS003","OHF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1490729-00","SummaCare Silver 5000-18 with SCSelect Network","Standard Silver Off Exchange Plan",,"0.714991772004654","No","Yes","No","100%",,"$4,520","$0","$2,480","$60","$1,489","$1,260","$372","$55","$859","$1,050","$215","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","$28,000","$28000 per person","$56000 per group","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","$200","$200 per person","per group not applicable","20.00%",,,,,"$600","$600 per person","per group not applicable","$800","$800 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-18SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-18SCSelectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1809108","52664OH1490729","SummaCare Silver 5000-18 with SCSelect Network","52664OH149",,"OHN002","OHS003","OHF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1490729-01","SummaCare Silver 5000-18 with SCSelect Network","Standard Silver On Exchange Plan",,"0.714991772004654","No","Yes","No","100%",,"$4,520","$0","$2,480","$60","$1,489","$1,260","$372","$55","$859","$1,050","$215","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","$28,000","$28000 per person","$56000 per group","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","$200","$200 per person","per group not applicable","20.00%",,,,,"$600","$600 per person","per group not applicable","$800","$800 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-18SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-18SCSelectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1520042","SummaCare Bronze 5000 HSA with SCConnect Network","52664OH152",,"OHN001","OHS001","OHF004","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1520042-03","SummaCare Bronze 5000 HSA with SCConnect Network","Limited Cost Sharing Plan Variation",,"0.618628875540942","Yes","Yes","No","100%",,"$4,070","$0","$2,480","$60","$5,000","$0","$1,437","$55","$1,540","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$100,000","$100000 per person","$200000 per group","$106,550","$106550 per person","$213100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$25,000","$25000 per person","$50000 per group","$30,000","$30000 per person","$60000 per group","Yes",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareBronze5000HSA-LimitedSCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareBronze5000HSA-LimitedSCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1520029","SummaCare Value with SCConnect Network and 3 Free PCP Visits","52664OH152",,"OHN001","OHS001","OHF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1520029-00","SummaCare Individual Value with 3 Free PCP Visits and SCConnect Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$100,000","$100000 per person","$200000 per group","$107,350","$107350 per person","$214700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$25,000","$25000 per person","$50000 per group","$32,350","$32350 per person","$64700 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareValueSCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareValueSCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1809108","52664OH1490730","SummaCare Silver 5000-18 with SCConnect Network","52664OH149",,"OHN001","OHS001","OHF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1490730-00","SummaCare Silver 5000-18 with SCConnect Network","Standard Silver Off Exchange Plan",,"0.714991772004654","No","Yes","No","100%",,"$4,520","$0","$2,480","$60","$1,489","$1,260","$372","$55","$859","$1,050","$215","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","$28,000","$28000 per person","$56000 per group","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","$200","$200 per person","per group not applicable","20.00%",,,,,"$600","$600 per person","per group not applicable","$800","$800 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-18SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-18SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1809108","52664OH1490730","SummaCare Silver 5000-18 with SCConnect Network","52664OH149",,"OHN001","OHS001","OHF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1490730-01","SummaCare Silver 5000-18 with SCConnect Network","Standard Silver On Exchange Plan",,"0.714991772004654","No","Yes","No","100%",,"$4,520","$0","$2,480","$60","$1,489","$1,260","$372","$55","$859","$1,050","$215","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$21,000","$21000 per person","$42000 per group","$28,000","$28000 per person","$56000 per group","$5,000","$5000 per person","$10000 per group","20.00%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","$200","$200 per person","per group not applicable","20.00%",,,,,"$600","$600 per person","per group not applicable","$800","$800 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-18SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-18SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1520029","SummaCare Value with SCConnect Network and 3 Free PCP Visits","52664OH152",,"OHN001","OHS001","OHF003","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1520029-01","SummaCare Individual Value with 3 Free PCP Visits and SCConnect Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$100,000","$100000 per person","$200000 per group","$107,350","$107350 per person","$214700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$25,000","$25000 per person","$50000 per group","$32,350","$32350 per person","$64700 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareValueSCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareValueSCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1809108","52664OH1490746","SummaCare Silver 3150-18 with SCConnect Network","52664OH149",,"OHN001","OHS001","OHF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1490746-00","SummaCare Silver 3150-18 with SCConnect Network","Standard Silver Off Exchange Plan",,"0.718048456129935","No","Yes","No","100%",,"$3,150","$110","$2,480","$60","$1,489","$1,220","$372","$55","$859","$1,050","$215","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","$29,400","$29400 per person","$58800 per group","$3,150","$3150 per person","$6300 per group","20.00%",,,,,"$9,450","$9450 per person","$18900 per group","$12,600","$12600 per person","$25200 per group","$200","$200 per person","per group not applicable","20.00%",,,,,"$600","$600 per person","per group not applicable","$800","$800 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3150-18SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3150-18SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1809108","52664OH1490746","SummaCare Silver 3150-18 with SCConnect Network","52664OH149",,"OHN001","OHS001","OHF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1490746-01","SummaCare Silver 3150-18 with SCConnect Network","Standard Silver On Exchange Plan",,"0.718048456129935","No","Yes","No","100%",,"$3,150","$110","$2,480","$60","$1,489","$1,220","$372","$55","$859","$1,050","$215","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","$29,400","$29400 per person","$58800 per group","$3,150","$3150 per person","$6300 per group","20.00%",,,,,"$9,450","$9450 per person","$18900 per group","$12,600","$12600 per person","$25200 per group","$200","$200 per person","per group not applicable","20.00%",,,,,"$600","$600 per person","per group not applicable","$800","$800 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3150-18SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3150-18SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1809108","52664OH1490748","SummaCare Silver 3150-18 with SCSelect Network","52664OH149",,"OHN002","OHS003","OHF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1490748-00","SummaCare Silver 3150-18 with SCSelect Network","Standard Silver Off Exchange Plan",,"0.718048456129935","No","Yes","No","100%",,"$3,150","$110","$2,480","$60","$1,489","$1,220","$372","$55","$859","$1,050","$215","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","$29,400","$29400 per person","$58800 per group","$3,150","$3150 per person","$6300 per group","20.00%",,,,,"$9,450","$9450 per person","$18900 per group","$12,600","$12600 per person","$25200 per group","$200","$200 per person","per group not applicable","20.00%",,,,,"$600","$600 per person","per group not applicable","$800","$800 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3150-18SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3150-18SCSelectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1809108","52664OH1490748","SummaCare Silver 3150-18 with SCSelect Network","52664OH149",,"OHN002","OHS003","OHF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1490748-01","SummaCare Silver 3150-18 with SCSelect Network","Standard Silver On Exchange Plan",,"0.718048456129935","No","Yes","No","100%",,"$3,150","$110","$2,480","$60","$1,489","$1,220","$372","$55","$859","$1,050","$215","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","$29,400","$29400 per person","$58800 per group","$3,150","$3150 per person","$6300 per group","20.00%",,,,,"$9,450","$9450 per person","$18900 per group","$12,600","$12600 per person","$25200 per group","$200","$200 per person","per group not applicable","20.00%",,,,,"$600","$600 per person","per group not applicable","$800","$800 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3150-18SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3150-18SCSelectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1809108","52664OH1490750","SummaCare Silver 3150-18 with SCSelect Network","52664OH149",,"OHN002","OHS002","OHF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1490750-00","SummaCare Silver 3150-18 with SCSelect Network","Standard Silver Off Exchange Plan",,"0.718048456129935","No","Yes","No","100%",,"$3,150","$110","$2,480","$60","$1,489","$1,220","$372","$55","$859","$1,050","$215","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","$29,400","$29400 per person","$58800 per group","$3,150","$3150 per person","$6300 per group","20.00%",,,,,"$9,450","$9450 per person","$18900 per group","$12,600","$12600 per person","$25200 per group","$200","$200 per person","per group not applicable","20.00%",,,,,"$600","$600 per person","per group not applicable","$800","$800 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3150-18SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3150-18SCSelectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1809108","52664OH1490750","SummaCare Silver 3150-18 with SCSelect Network","52664OH149",,"OHN002","OHS002","OHF002","New","PPO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1490750-01","SummaCare Silver 3150-18 with SCSelect Network","Standard Silver On Exchange Plan",,"0.718048456129935","No","Yes","No","100%",,"$3,150","$110","$2,480","$60","$1,489","$1,220","$372","$55","$859","$1,050","$215","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$22,050","$22050 per person","$44100 per group","$29,400","$29400 per person","$58800 per group","$3,150","$3150 per person","$6300 per group","20.00%",,,,,"$9,450","$9450 per person","$18900 per group","$12,600","$12600 per person","$25200 per group","$200","$200 per person","per group not applicable","20.00%",,,,,"$600","$600 per person","per group not applicable","$800","$800 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3150-18SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3150-18SCSelectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1809108","52664OH1500194","SummaCare Bronze 5500 HSA-18 with SCSelect Network","52664OH150",,"OHN002","OHS002","OHF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1500194-00","SummaCare Bronze 5500 HSA-18 with SCSelect Network","Standard Bronze Off Exchange Plan",,"0.611976578329457","Yes","Yes","No","100%",,"$4,070","$0","$2,480","$60","$5,224","$0","$1,326","$55","$1,540","$0","$385","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$16,500","$16500 per person","$33000 per group","$22,000","$22000 per person","$44000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze5500HSA-18SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze5500HSA-18SCSelectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3500  with SCConnect Network and 3 Free PCP Visits","52664OH151",,"OHN001","OHS001","OHF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510032-00","SummaCare Silver 3500 with SCConnect Network and 3 Free PCP Visits","Standard Silver Off Exchange Plan",,"0.718962282150524","Yes","Yes","No","100%",,"$3,500","$40","$3,720","$60","$1,303","$1,005","$558","$55","$752","$1,080","$322","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$100,000","$100000 per person","$200000 per group","$107,350","$107350 per person","$214700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,500","$23500 per person","$47000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver3500SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver3500SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3500  with SCConnect Network and 3 Free PCP Visits","52664OH151",,"OHN001","OHS001","OHF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510032-01","SummaCare Silver 3500 with SCConnect Network and 3 Free PCP Visits","Standard Silver On Exchange Plan",,"0.718962282150524","Yes","Yes","No","100%",,"$3,500","$40","$3,720","$60","$1,303","$1,005","$558","$55","$752","$1,080","$322","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$100,000","$100000 per person","$200000 per group","$107,350","$107350 per person","$214700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,500","$23500 per person","$47000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver3500SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver3500SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1809108","52664OH1500194","SummaCare Bronze 5500 HSA-18 with SCSelect Network","52664OH150",,"OHN002","OHS002","OHF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1500194-01","SummaCare Bronze 5500 HSA-18 with SCSelect Network","Standard Bronze On Exchange Plan",,"0.611976578329457","Yes","Yes","No","100%",,"$4,070","$0","$2,480","$60","$5,224","$0","$1,326","$55","$1,540","$0","$385","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$16,500","$16500 per person","$33000 per group","$22,000","$22000 per person","$44000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze5500HSA-18SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze5500HSA-18SCSelectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3500  with SCConnect Network and 3 Free PCP Visits","52664OH151",,"OHN001","OHS001","OHF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510032-02","SummaCare Silver 3500 with SCConnect Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver3500-100SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver3500-100SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1809108","52664OH1500195","SummaCare Bronze 5500 HSA-18 with SCSelect Network","52664OH150",,"OHN002","OHS003","OHF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1500195-00","SummaCare Bronze 5500 HSA-18 with SCSelect Network","Standard Bronze Off Exchange Plan",,"0.611976578329457","Yes","Yes","No","100%",,"$4,070","$0","$2,480","$60","$5,224","$0","$1,326","$55","$1,540","$0","$385","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$16,500","$16500 per person","$33000 per group","$22,000","$22000 per person","$44000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze5500HSA-18SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze5500HSA-18SCSelectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1809108","52664OH1500195","SummaCare Bronze 5500 HSA-18 with SCSelect Network","52664OH150",,"OHN002","OHS003","OHF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1500195-01","SummaCare Bronze 5500 HSA-18 with SCSelect Network","Standard Bronze On Exchange Plan",,"0.611976578329457","Yes","Yes","No","100%",,"$4,070","$0","$2,480","$60","$5,224","$0","$1,326","$55","$1,540","$0","$385","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$16,500","$16500 per person","$33000 per group","$22,000","$22000 per person","$44000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze5500HSA-18SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze5500HSA-18SCSelectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3500  with SCConnect Network and 3 Free PCP Visits","52664OH151",,"OHN001","OHS001","OHF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510032-03","SummaCare Silver 3500 with SCConnect Network and 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.718962282150524","Yes","Yes","No","100%",,"$3,500","$40","$3,720","$60","$1,303","$1,005","$558","$55","$752","$1,080","$322","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$100,000","$100000 per person","$200000 per group","$107,350","$107350 per person","$214700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,500","$23500 per person","$47000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver3500-LimitedSCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver3500-LimitedSCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3500  with SCConnect Network and 3 Free PCP Visits","52664OH151",,"OHN001","OHS001","OHF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510032-04","SummaCare Silver 3500-73 with SCConnect Network and 3 Free PCP Visits","73% AV Level Silver Plan",,"0.739798059698193","Yes","Yes","No","100%",,"$2,408","$0","$3,442","$60","$1,303","$1,005","$558","$55","$752","$1,080","$322","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$100,000","$100000 per person","$200000 per group","$105,850","$105850 per person","$211700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","$13,500","$13500 per person","$27000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver3500-73SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver3500-73SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1809108","52664OH1500196","SummaCare Bronze 5500 HSA-18 with SCConnect Network","52664OH150",,"OHN001","OHS001","OHF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1500196-00","SummaCare Bronze 5500 HSA-18 with SCConnect Network","Standard Bronze Off Exchange Plan",,"0.611976578329457","Yes","Yes","No","100%",,"$4,070","$0","$2,480","$60","$5,224","$0","$1,326","$55","$1,540","$0","$385","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$16,500","$16500 per person","$33000 per group","$22,000","$22000 per person","$44000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze5500HSA-18SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze5500HSA-18SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","SHOP (Small Group)","No","34-1809108","52664OH1500196","SummaCare Bronze 5500 HSA-18 with SCConnect Network","52664OH150",,"OHN001","OHS001","OHF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1500196-01","SummaCare Bronze 5500 HSA-18 with SCConnect Network","Standard Bronze On Exchange Plan",,"0.611976578329457","Yes","Yes","No","100%",,"$4,070","$0","$2,480","$60","$5,224","$0","$1,326","$55","$1,540","$0","$385","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20.00%",,,,,"$16,500","$16500 per person","$33000 per group","$22,000","$22000 per person","$44000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze5500HSA-18SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze5500HSA-18SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3500  with SCConnect Network and 3 Free PCP Visits","52664OH151",,"OHN001","OHS001","OHF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510032-05","SummaCare Silver 3500-87 with SCConnect Network and 3 Free PCP Visits","87% AV Level Silver Plan",,"0.862793844646159","Yes","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$625","$372","$55","$750","$660","$215","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$100,000","$100000 per person","$200000 per group","$102,450","$102450 per person","$204900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver3500-87SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver3500-87SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3500  with SCConnect Network and 3 Free PCP Visits","52664OH151",,"OHN001","OHS001","OHF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510032-06","SummaCare Silver 3500-94 with SCConnect Network and 3 Free PCP Visits","94% AV Level Silver Plan",,"0.930636599746703","Yes","Yes","No","100%",,"$100","$0","$900","$60","$100","$625","$186","$55","$100","$660","$107","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$100,000","$100000 per person","$200000 per group","$101,000","$101000 per person","$202000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver3500-94SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver3500-94SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000  with SCConnect Network and 3 Free PCP Visits","52664OH151",,"OHN001","OHS001","OHF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510038-00","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","Standard Silver Off Exchange Plan",,"0.7057530646343","No","Yes","No","100%",,"$3,630","$0","$3,720","$60","$1,303","$995","$558","$55","$752","$1,065","$322","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$100,000","$100000 per person","$200000 per group","$107,350","$107350 per person","$214700 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$1,000","$1000 per person","per group not applicable","40.00%",,,,,"$3,000","$3000 per person","per group not applicable","$4,000","$4000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver5000SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver5000SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000  with SCConnect Network and 3 Free PCP Visits","52664OH151",,"OHN001","OHS001","OHF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510038-01","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","Standard Silver On Exchange Plan",,"0.7057530646343","No","Yes","No","100%",,"$3,630","$0","$3,720","$60","$1,303","$995","$558","$55","$752","$1,065","$322","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$100,000","$100000 per person","$200000 per group","$107,350","$107350 per person","$214700 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$1,000","$1000 per person","per group not applicable","40.00%",,,,,"$3,000","$3000 per person","per group not applicable","$4,000","$4000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver5000SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver5000SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000  with SCConnect Network and 3 Free PCP Visits","52664OH151",,"OHN001","OHS001","OHF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510038-02","SummaCare Silver 5000 with SCConnect Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver5000-100SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver5000-100SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000  with SCConnect Network and 3 Free PCP Visits","52664OH151",,"OHN001","OHS001","OHF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510038-03","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.7057530646343","No","Yes","No","100%",,"$3,630","$0","$3,720","$60","$1,303","$995","$558","$55","$752","$1,065","$322","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$100,000","$100000 per person","$200000 per group","$107,350","$107350 per person","$214700 per group","$5,000","$5000 per person","$10000 per group","30.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$1,000","$1000 per person","per group not applicable","40.00%",,,,,"$3,000","$3000 per person","per group not applicable","$4,000","$4000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver5000-LimitedSCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver5000-LimitedSCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000  with SCConnect Network and 3 Free PCP Visits","52664OH151",,"OHN001","OHS001","OHF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510038-04","SummaCare Silver 5000-73 with SCConnect Network and 3 Free PCP Visits","73% AV Level Silver Plan",,"0.736157796020793","No","Yes","No","100%",,"$2,408","$0","$3,442","$60","$1,303","$995","$558","$55","$752","$1,065","$322","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$100,000","$100000 per person","$200000 per group","$105,850","$105850 per person","$211700 per group","$4,000","$4000 per person","$8000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","$14,000","$14000 per person","$28000 per group","$500","$500 per person","per group not applicable","40.00%",,,,,"$1,500","$1500 per person","per group not applicable","$2,000","$2000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver5000-73SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver5000-73SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000  with SCConnect Network and 3 Free PCP Visits","52664OH151",,"OHN001","OHS001","OHF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510038-05","SummaCare Silver 5000-87 with SCConnect Network and 3 Free PCP Visits","87% AV Level Silver Plan",,"0.862520809680974","No","Yes","No","100%",,"$750","$0","$1,700","$60","$750","$625","$372","$55","$750","$660","$215","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$100,000","$100000 per person","$200000 per group","$102,450","$102450 per person","$204900 per group","$750","$750 per person","$1500 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","$200","$200 per person","per group not applicable","40.00%",,,,,"$600","$600 per person","per group not applicable","$800","$800 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver5000-87SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver5000-87SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000  with SCConnect Network and 3 Free PCP Visits","52664OH151",,"OHN001","OHS001","OHF005","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510038-06","SummaCare Silver 5000-94 with SCConnect Network and 3 Free PCP Visits","94% AV Level Silver Plan",,"0.930848247479796","No","Yes","No","100%",,"$100","$0","$850","$60","$100","$625","$186","$55","$100","$660","$107","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"$100,000","$100000 per person","$200000 per group","$100,950","$100950 per person","$201900 per group","$100","$100 per person","$200 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","$100","$100 per person","per group not applicable","40.00%",,,,,"$300","$300 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver5000-94SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver5000-94SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510050","SummaCare Gold 750  with SCConnect Network and 3 Free PCP Visits","52664OH151",,"OHN001","OHS001","OHF005","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510050-00","SummaCare Gold 750 with SCConnect Network and 3 Free PCP Visits","Standard Gold Off Exchange Plan",,"0.806685354458224","Yes","Yes","No","100%",,"$750","$40","$3,480","$60","$750","$985","$372","$55","$750","$1,050","$215","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$100,000","$100000 per person","$200000 per group","$107,350","$107350 per person","$214700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareGold750SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareGold750SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510050","SummaCare Gold 750  with SCConnect Network and 3 Free PCP Visits","52664OH151",,"OHN001","OHS001","OHF005","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510050-01","SummaCare Gold 750 with SCConnect Network and 3 Free PCP Visits","Standard Gold On Exchange Plan",,"0.806685354458224","Yes","Yes","No","100%",,"$750","$40","$3,480","$60","$750","$985","$372","$55","$750","$1,050","$215","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$100,000","$100000 per person","$200000 per group","$107,350","$107350 per person","$214700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareGold750SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareGold750SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510050","SummaCare Gold 750  with SCConnect Network and 3 Free PCP Visits","52664OH151",,"OHN001","OHS001","OHF005","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510050-02","SummaCare Gold 750 with SCConnect Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareGold750-100SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareGold750-100SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510050","SummaCare Gold 750  with SCConnect Network and 3 Free PCP Visits","52664OH151",,"OHN001","OHS001","OHF005","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510050-03","SummaCare Gold 750 with SCConnect Network and 3 Free PCP Visits","Limited Cost Sharing Plan Variation",,"0.806685354458224","Yes","Yes","No","100%",,"$750","$40","$3,480","$60","$750","$985","$372","$55","$750","$1,050","$215","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$100,000","$100000 per person","$200000 per group","$107,350","$107350 per person","$214700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareGold750-LimitedSCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareGold750-LimitedSCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510055","SummaCare Silver 5000 40 with SCConnect Network","52664OH151",,"OHN001","OHS001","OHF006","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510055-00","SummaCare Silver 5000 40 with SCConnect Network","Standard Silver Off Exchange Plan",,"0.665085219966133","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,281","$355","$2,287","$55","$1,155","$0","$770","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$100,000","$100000 per person","$200000 per group","$107,350","$107350 per person","$214700 per group","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$2,000","$2000 per person","per group not applicable","40.00%",,,,,"$6,000","$6000 per person","per group not applicable","$8,000","$8000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver500040SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver500040SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510055","SummaCare Silver 5000 40 with SCConnect Network","52664OH151",,"OHN001","OHS001","OHF006","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510055-01","SummaCare Silver 5000 40 with SCConnect Network","Standard Silver On Exchange Plan",,"0.665085219966133","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,281","$355","$2,287","$55","$1,155","$0","$770","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$100,000","$100000 per person","$200000 per group","$107,350","$107350 per person","$214700 per group","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$2,000","$2000 per person","per group not applicable","40.00%",,,,,"$6,000","$6000 per person","per group not applicable","$8,000","$8000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver500040SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver500040SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510055","SummaCare Silver 5000 40 with SCConnect Network","52664OH151",,"OHN001","OHS001","OHF006","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510055-02","SummaCare Silver 5000 40 with SCConnect Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver5000-10040SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver5000-10040SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510055","SummaCare Silver 5000 40 with SCConnect Network","52664OH151",,"OHN001","OHS001","OHF006","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510055-03","SummaCare Silver 5000 40 with SCConnect Network","Limited Cost Sharing Plan Variation",,"0.665085219966133","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,281","$355","$2,287","$55","$1,155","$0","$770","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$100,000","$100000 per person","$200000 per group","$107,350","$107350 per person","$214700 per group","$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$2,000","$2000 per person","per group not applicable","40.00%",,,,,"$6,000","$6000 per person","per group not applicable","$8,000","$8000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver5000-Limited40SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver5000-Limited40SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510055","SummaCare Silver 5000 40 with SCConnect Network","52664OH151",,"OHN001","OHS001","OHF006","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510055-04","SummaCare Silver 5000-73 40 with SCConnect Network","73% AV Level Silver Plan",,"0.721471230930896","No","Yes","No","100%",,"$2,064","$0","$3,436","$60","$1,781","$315","$2,287","$55","$1,155","$0","$770","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$100,000","$100000 per person","$200000 per group","$105,500","$105500 per person","$211000 per group","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"$20,000","$20000 per person","$40000 per group","$23,500","$23500 per person","$47000 per group","$500","$500 per person","per group not applicable","40.00%",,,,,"$1,500","$1500 per person","per group not applicable","$2,000","$2000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver5000-7340SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver5000-7340SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510055","SummaCare Silver 5000 40 with SCConnect Network","52664OH151",,"OHN001","OHS001","OHF006","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510055-05","SummaCare Silver 5000-87 40 with SCConnect Network","87% AV Level Silver Plan",,"0.860680580569276","No","Yes","No","100%",,"$500","$0","$1,950","$60","$1,000","$195","$1,143","$55","$500","$0","$385","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$100,000","$100000 per person","$200000 per group","$102,450","$102450 per person","$204900 per group","$500","$500 per person","$1000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,500","$5500 per person","$11000 per group","$200","$200 per person","per group not applicable","20.00%",,,,,"$600","$600 per person","per group not applicable","$800","$800 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver5000-8740SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver5000-8740SCConnectNetwork.sflb"
"2018","OH","52664","SERFF","2017-09-06 20:16:09","Individual","No","34-1809108","52664OH1510055","SummaCare Silver 5000 40 with SCConnect Network","52664OH151",,"OHN001","OHS001","OHF006","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9971",,,"2018-01-01",,"Yes","Emergency Coverage Only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2018Formulary.sflb","52664OH1510055-06","SummaCare Silver 5000-94 40 with SCConnect Network","94% AV Level Silver Plan",,"0.932058955490077","No","Yes","No","100%",,"$100","$0","$90","$60","$200","$195","$572","$55","$100","$0","$193","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$100,000","$100000 per person","$200000 per group","$101,000","$101000 per person","$202000 per group","$100","$100 per person","$200 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","$100","$100 per person","per group not applicable","10.00%",,,,,"$300","$300 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/2018SummaCareSilver5000-9440SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/2018SummaCareSilver5000-9440SCConnectNetwork.sflb"
"2018","OH","55371","SERFF","2017-06-20 20:15:45","Individual","Yes","75-1233841","55371OH0010007","Dentegra Dental PPO Pediatric Basic Plan","55371OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","55371OH0010007-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","$65 per person","per group not applicable",,,,,,"$65","$65 per person","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/oh/55371oh0010007-18"
"2018","OH","55371","SERFF","2017-06-20 20:15:45","Individual","Yes","75-1233841","55371OH0010011","Dentegra Dental PPO Family Basic Plan","55371OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","55371OH0010011-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","$65 per person","per group not applicable",,,,,,"$65","$65 per person","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/oh/55371oh0010011-18"
"2018","OH","55371","SERFF","2017-06-20 20:15:45","Individual","Yes","75-1233841","55371OH0010012","Dentegra Dental PPO Family Preferred Plan","55371OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","55371OH0010012-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/oh/55371oh0010012-18"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0010001","Molina Marketplace Gold Plan","64353OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0010001-00","Molina Marketplace Gold Plan","Standard Gold Off Exchange Plan",,"0.770138560314203","No","Yes","No","100%",,"$3,800","$279","$2,271","$60","$1,382","$123","$346","$55","$59","$429","$166","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-gold-2018.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0010001","Molina Marketplace Gold Plan","64353OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0010001-01","Molina Marketplace Gold Plan","Standard Gold On Exchange Plan",,"0.770138560314203","No","Yes","No","100%",,"$3,800","$279","$2,271","$60","$1,382","$123","$346","$55","$59","$429","$166","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-gold-2018.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0010001","Molina Marketplace Gold Plan","64353OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0010001-02","Molina Marketplace Gold Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-gold-zero-2018.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0010001","Molina Marketplace Gold Plan","64353OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0010001-03","Molina Marketplace Gold Plan","Limited Cost Sharing Plan Variation",,"0.770138560314203","No","Yes","No","100%",,"$3,800","$279","$2,271","$60","$1,382","$123","$346","$55","$59","$429","$166","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,800","$3800 per person","$7600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-gold-2018.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0010002-00","Molina Marketplace Silver Plan","Standard Silver Off Exchange Plan",,"0.678048193152746","No","Yes","No","100%",,"$2,054","$379","$2,271","$60","$1,037","$1,730","$691","$55","$44","$653","$331","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,950","$4950 per person","$9900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,950","$4950 per person","$9900 per group","$400","$400 per person","$800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2018.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0010002-01","Molina Marketplace Silver Plan","Standard Silver On Exchange Plan",,"0.678048193152746","No","Yes","No","100%",,"$2,054","$379","$2,271","$60","$1,037","$1,730","$691","$55","$44","$653","$331","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,950","$4950 per person","$9900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,950","$4950 per person","$9900 per group","$400","$400 per person","$800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2018.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0010002-02","Molina Marketplace Silver Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-silver-zero-2018.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0010002-03","Molina Marketplace Silver Plan","Limited Cost Sharing Plan Variation",,"0.678048193152746","No","Yes","No","100%",,"$2,054","$379","$2,271","$60","$1,037","$1,730","$691","$55","$44","$653","$331","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$4,950","$4950 per person","$9900 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,950","$4950 per person","$9900 per group","$400","$400 per person","$800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-silver-250-2018.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0010002-04","Molina Marketplace Silver Plan","73% AV Level Silver Plan",,"0.739709064127067","No","Yes","No","100%",,"$1,437","$369","$3,668","$60","$1,037","$1,493","$691","$55","$44","$565","$331","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$2,500","$2500 per person","$5000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$400","$400 per person","$800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-silver-200-2018.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0010002-05","Molina Marketplace Silver Plan","87% AV Level Silver Plan",,"0.879609893257353","No","Yes","No","100%",,"$525","$172","$1,725","$60","$525","$803","$346","$55","$59","$330","$166","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$525","$525 per person","$1050 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$525","$525 per person","$1050 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-silver-150-2018.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0010002-06","Molina Marketplace Silver Plan","94% AV Level Silver Plan",,"0.949265703364465","No","Yes","No","100%",,"$0","$152","$1,070","$60","$0","$395","$173","$55","$0","$125","$83","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-silver-100-2018.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0010003","Molina Marketplace Bronze Plan","64353OH001",,"OHN001","OHS002","OHF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0010003-00","Molina Marketplace Bronze Plan","Standard Bronze Off Exchange Plan",,"0.625077353580658","Yes","Yes","No","100%",,"$2,099","$384","$4,491","$60","$3,952","$1,780","$691","$5","$1,060","$447","$418","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-bronze-2018.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0010003","Molina Marketplace Bronze Plan","64353OH001",,"OHN001","OHS002","OHF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0010003-01","Molina Marketplace Bronze Plan","Standard Bronze On Exchange Plan",,"0.625077353580658","Yes","Yes","No","100%",,"$2,099","$384","$4,491","$60","$3,952","$1,780","$691","$5","$1,060","$447","$418","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-bronze-2018.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0010003","Molina Marketplace Bronze Plan","64353OH001",,"OHN001","OHS002","OHF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0010003-02","Molina Marketplace Bronze Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-bronze-zero-2018.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0010003","Molina Marketplace Bronze Plan","64353OH001",,"OHN001","OHS002","OHF003","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0010003-03","Molina Marketplace Bronze Plan","Limited Cost Sharing Plan Variation",,"0.625077353580658","Yes","Yes","No","100%",,"$2,099","$384","$4,491","$60","$3,952","$1,780","$691","$5","$1,060","$447","$418","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-bronze-2018.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0030001","Molina Marketplace Options Silver Plan","64353OH003",,"OHN001","OHS003","OHF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0030001-00","Molina Marketplace Options Silver Plan","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$96","$2,480","$60","$1,489","$1,409","$372","$55","$859","$379","$215","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0030001","Molina Marketplace Options Silver Plan","64353OH003",,"OHN001","OHS003","OHF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0030001-01","Molina Marketplace Options Silver Plan","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$96","$2,480","$60","$1,489","$1,409","$372","$55","$859","$379","$215","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0030001","Molina Marketplace Options Silver Plan","64353OH003",,"OHN001","OHS003","OHF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0030001-02","Molina Marketplace Options Silver Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-silver-zero-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0030001","Molina Marketplace Options Silver Plan","64353OH003",,"OHN001","OHS003","OHF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0030001-03","Molina Marketplace Options Silver Plan","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$96","$2,480","$60","$1,489","$1,409","$372","$55","$859","$379","$215","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-silver-250-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0030001","Molina Marketplace Options Silver Plan","64353OH003",,"OHN001","OHS003","OHF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0030001-04","Molina Marketplace Options Silver Plan","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$96","$2,480","$60","$1,489","$1,409","$372","$55","$859","$379","$215","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-silver-200-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0030001","Molina Marketplace Options Silver Plan","64353OH003",,"OHN001","OHS003","OHF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0030001-05","Molina Marketplace Options Silver Plan","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$700","$610","$113","$55","$700","$189","$209","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-silver-150-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0030001","Molina Marketplace Options Silver Plan","64353OH003",,"OHN001","OHS003","OHF004","New","HMO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0030001-06","Molina Marketplace Options Silver Plan","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$22","$620","$60","$250","$218","$93","$55","$250","$105","$54","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-silver-100-2017.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0030002","Molina Marketplace Options Bronze Plan","64353OH003",,"OHN001","OHS002","OHF005","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0030002-00","Molina Marketplace Options Bronze Plan","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,930","$0","$4,960","$60","$3,445","$895","$1,998","$55","$645","$407","$430","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2018.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0030002","Molina Marketplace Options Bronze Plan","64353OH003",,"OHN001","OHS002","OHF005","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0030002-01","Molina Marketplace Options Bronze Plan","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,930","$0","$4,960","$60","$3,445","$895","$1,998","$55","$645","$407","$430","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2018.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0030002","Molina Marketplace Options Bronze Plan","64353OH003",,"OHN001","OHS002","OHF005","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0030002-02","Molina Marketplace Options Bronze Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-zero-2018.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","64353","SERFF","2017-09-06 20:16:09","Individual","No","20-0750134","64353OH0030002","Molina Marketplace Options Bronze Plan","64353OH003",,"OHN001","OHS002","OHF005","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent are covered","Yes","Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/formulary-2018.pdf","64353OH0030002-03","Molina Marketplace Options Bronze Plan","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$2,930","$0","$4,960","$60","$3,445","$895","$1,998","$55","$645","$407","$430","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/summary-of-benefits-options-bronze-2018.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/Marketplace/brochure-2018.pdf"
"2018","OH","65869","SERFF","2017-08-11 20:15:53","Individual","Yes","47-0397286","65869OH0040001","Delta Dental Individual PPO, EHB Certified","65869OH004",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","65869OH0040001-00","Delta Dental Individual PPO, EHB Certified","Standard High Off Exchange Plan","84.86%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","65869","SERFF","2017-08-11 20:15:53","Individual","Yes","47-0397286","65869OH0040002","Delta Dental Individual PPO, EHB Certified","65869OH004",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","65869OH0040002-00","Delta Dental Individual PPO, EHB Certified","Standard Low Off Exchange Plan","69.12%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","68158","SERFF","2017-06-14 20:15:39","Individual","Yes","13-5123390","68158OH0190001","Guardian Essentials for Families and Individuals","68158OH019",,"OHN002","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","68158OH0190001-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/ohio/","https://dentalexchange.guardianlife.com/our-plans/ohio/"
"2018","OH","68158","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","13-5123390","68158OH0130003","Guardian Pediatric Advantage","68158OH013",,"OHN001","OHS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is allowed outside of the Service Area.","Yes",,"","68158OH0130003-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","68158","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","13-5123390","68158OH0140004","Guardian Pediatric Essentials","68158OH014",,"OHN001","OHS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is allowed outside of the Service Area.","Yes",,"","68158OH0140004-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","68158","SERFF","2017-06-14 20:15:39","Individual","Yes","13-5123390","68158OH0190001","Guardian Essentials for Families and Individuals","68158OH019",,"OHN002","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","68158OH0190001-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/ohio/","https://dentalexchange.guardianlife.com/our-plans/ohio/"
"2018","OH","68158","SERFF","2017-06-14 20:15:39","Individual","Yes","13-5123390","68158OH0200001","Guardian Select for Families and Individuals","68158OH020",,"OHN002","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","68158OH0200001-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/ohio/","https://dentalexchange.guardianlife.com/our-plans/ohio/"
"2018","OH","68158","SERFF","2017-06-14 20:15:39","Individual","Yes","13-5123390","68158OH0200001","Guardian Select for Families and Individuals","68158OH020",,"OHN002","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","68158OH0200001-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/ohio/","https://dentalexchange.guardianlife.com/our-plans/ohio/"
"2018","OH","68158","SERFF","2017-06-14 20:15:39","Individual","Yes","13-5123390","68158OH0210001","Guardian Basics for Families and Individuals","68158OH021",,"OHN002","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","68158OH0210001-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/ohio/","https://dentalexchange.guardianlife.com/our-plans/ohio/"
"2018","OH","68158","SERFF","2017-06-14 20:15:39","Individual","Yes","13-5123390","68158OH0210001","Guardian Basics for Families and Individuals","68158OH021",,"OHN002","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","68158OH0210001-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/ohio/","https://dentalexchange.guardianlife.com/our-plans/ohio/"
"2018","OH","73292","SERFF","2017-06-13 20:15:36","SHOP (Small Group)","Yes","44-0308260","73292OH0010001","KCL EHB Low PPO","73292OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010001-00","KCL EHB Low PPO","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","73292","SERFF","2017-06-13 20:15:36","SHOP (Small Group)","Yes","44-0308260","73292OH0010003","KCL EHB Low MAC","73292OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010003-00","KCL EHB Low MAC","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","73292","SERFF","2017-06-13 20:15:36","SHOP (Small Group)","Yes","44-0308260","73292OH0010005","KCL FAM Low PPO","73292OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010005-00","KCL FAM Low PPO","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","73292","SERFF","2017-06-13 20:15:36","SHOP (Small Group)","Yes","44-0308260","73292OH0010007","KCL FAM Low MAC","73292OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010007-00","KCL FAM Low MAC","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210012","Paramount Silver 4","74313OH021",,"OHN001","OHS001","OHF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210012-04","Paramount Silver 4","73% AV Level Silver Plan",,"0.739952240216714","No","Yes","No","100%",,"$2,064","$0","$3,786","$60","$1,117","$410","$745","$55","$979","$30","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Siver4-CSR73.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210012","Paramount Silver 4","74313OH021",,"OHN001","OHS001","OHF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210012-05","Paramount Silver 4","87% AV Level Silver Plan",,"0.879706519497361","No","Yes","No","100%",,"$800","$0","$1,650","$60","$800","$214","$558","$55","$800","$15","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Siver4-CSR87.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210012","Paramount Silver 4","74313OH021",,"OHN001","OHS001","OHF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210012-06","Paramount Silver 4","94% AV Level Silver Plan",,"0.947594981267166","No","Yes","No","100%",,"$250","$0","$750","$60","$250","$247","$186","$55","$250","$12","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Siver4-CSR94.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210008","Paramount Bronze 1 HSA","74313OH021",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210008-00","Paramount Bronze 1 HSA","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Bronze1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210002-05","Paramount Silver 1","87% AV Level Silver Plan","87.87%","0.880030091411858","No","Yes","No","100%",,"$1,000","$0","$1,000","$60","$1,000","$673","$327","$55","$1,000","$45","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver1-CSR87.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210002-06","Paramount Silver 1","94% AV Level Silver Plan","94.95%","0.94969060278792","No","Yes","No","100%",,"$225","$0","$475","$60","$225","$268","$186","$55","$225","$30","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$225","$225 per person","$450 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver1-CSR94.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210006-00","Paramount Silver 2","Standard Silver Off Exchange Plan","68.27%","0.686685363764949","No","Yes","No","100%",,"$6,250","$120","$3,720","$60","$1,303","$1,505","$558","$55","$1,142","$225","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver2.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210006-01","Paramount Silver 2","Standard Silver On Exchange Plan","68.27%","0.686685363764949","No","Yes","No","100%",,"$6,250","$120","$3,720","$60","$1,303","$1,505","$558","$55","$1,142","$225","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver2.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210006-02","Paramount Silver 2","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver2-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210006-03","Paramount Silver 2","Limited Cost Sharing Plan Variation","68.27%","0.686685363764949","No","Yes","No","100%",,"$6,250","$120","$3,720","$60","$1,303","$1,505","$558","$55","$1,142","$225","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver2-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210014","Paramount Silver 6","74313OH021",,"OHN001","OHS003","OHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210014-04","Paramount Silver 6","73% AV Level Silver Plan","73.85%","0.741808589640086","No","Yes","No","100%",,"$2,408","$0","$3,092","$60","$1,303","$1,085","$558","$55","$1,142","$105","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver2-CSR73.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","73292","SERFF","2017-06-13 20:15:36","SHOP (Small Group)","Yes","44-0308260","73292OH0010002","KCL EHB High PPO","73292OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010002-00","KCL EHB High PPO","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","73292","SERFF","2017-06-13 20:15:36","SHOP (Small Group)","Yes","44-0308260","73292OH0010004","KCL EHB High MAC","73292OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010004-00","KCL EHB High MAC","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","73292","SERFF","2017-06-13 20:15:36","SHOP (Small Group)","Yes","44-0308260","73292OH0010006","KCL FAM High PPO","73292OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010006-00","KCL FAM High PPO","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","73292","SERFF","2017-06-13 20:15:36","SHOP (Small Group)","Yes","44-0308260","73292OH0010008","KCL FAM High MAC","73292OH001",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law. This list is not all inclusive, see the Master Policy for details.",,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010008-00","KCL FAM High MAC","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210001","Paramount Gold 1","74313OH021",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210001-00","Paramount Gold 1","Standard Gold Off Exchange Plan",,"0.796852502675413","No","Yes","No","100%",,"$2,000","$70","$2,480","$60","$1,489","$955","$372","$55","$1,305","$105","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Gold1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210001","Paramount Gold 1","74313OH021",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210001-01","Paramount Gold 1","Standard Gold On Exchange Plan",,"0.796852502675413","No","Yes","No","100%",,"$2,000","$70","$2,480","$60","$1,489","$955","$372","$55","$1,305","$105","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Gold1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210001","Paramount Gold 1","74313OH021",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210001-02","Paramount Gold 1","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Gold1-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210001","Paramount Gold 1","74313OH021",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210001-03","Paramount Gold 1","Limited Cost Sharing Plan Variation",,"0.796852502675413","No","Yes","No","100%",,"$2,000","$70","$2,480","$60","$1,489","$955","$372","$55","$1,305","$105","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Gold1-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210002-00","Paramount Silver 1","Standard Silver Off Exchange Plan","70.04%","0.704603152569071","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$1,117","$1,385","$754","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210002-01","Paramount Silver 1","Standard Silver On Exchange Plan","70.04%","0.704603152569071","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$1,117","$1,385","$754","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210002-02","Paramount Silver 1","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver1-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210002-03","Paramount Silver 1","Limited Cost Sharing Plan Variation","70.04%","0.704603152569071","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$1,117","$1,385","$754","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver1-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210002-04","Paramount Silver 1","73% AV Level Silver Plan","73.99%","0.743149176288051","No","Yes","No","100%",,"$2,064","$0","$3,686","$60","$1,117","$1,245","$745","$55","$979","$75","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver1-CSR73.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210006-04","Paramount Silver 2","73% AV Level Silver Plan","73.85%","0.741808589640086","No","Yes","No","100%",,"$2,408","$0","$3,092","$60","$1,303","$1,085","$558","$55","$1,142","$105","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver2-CSR73.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210006-05","Paramount Silver 2","87% AV Level Silver Plan","87.85%","0.879420500611715","No","Yes","No","100%",,"$1,086","$0","$514","$60","$1,025","$305","$270","$55","$1,238","$45","$317","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver2-CSR87.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210006-06","Paramount Silver 2","94% AV Level Silver Plan","94.94%","0.94951680875479","No","Yes","No","100%",,"$250","$0","$550","$60","$250","$190","$186","$55","$250","$15","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver2-CSR94.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210012","Paramount Silver 4","74313OH021",,"OHN001","OHS001","OHF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210012-00","Paramount Silver 4","Standard Silver Off Exchange Plan",,"0.672498396048505","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$1,117","$1,700","$745","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Siver4.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210012","Paramount Silver 4","74313OH021",,"OHN001","OHS001","OHF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210012-01","Paramount Silver 4","Standard Silver On Exchange Plan",,"0.672498396048505","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$1,117","$1,700","$745","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Siver4.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210012","Paramount Silver 4","74313OH021",,"OHN001","OHS001","OHF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210012-02","Paramount Silver 4","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Siver4-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210012","Paramount Silver 4","74313OH021",,"OHN001","OHS001","OHF004","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210012-03","Paramount Silver 4","Limited Cost Sharing Plan Variation",,"0.672498396048505","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$1,117","$1,700","$745","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Siver4-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210008","Paramount Bronze 1 HSA","74313OH021",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210008-01","Paramount Bronze 1 HSA","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Bronze1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210008","Paramount Bronze 1 HSA","74313OH021",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210008-02","Paramount Bronze 1 HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Bronze1-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210008","Paramount Bronze 1 HSA","74313OH021",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210008-03","Paramount Bronze 1 HSA","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Bronze1-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210013","Paramount Silver 5","74313OH021",,"OHN001","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210013-00","Paramount Silver 5","Standard Silver Off Exchange Plan","70.04%","0.704603152569071","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$1,117","$1,385","$754","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210013","Paramount Silver 5","74313OH021",,"OHN001","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210013-01","Paramount Silver 5","Standard Silver On Exchange Plan","70.04%","0.704603152569071","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$1,117","$1,385","$754","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210013","Paramount Silver 5","74313OH021",,"OHN001","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210013-02","Paramount Silver 5","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver1-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210013","Paramount Silver 5","74313OH021",,"OHN001","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210013-03","Paramount Silver 5","Limited Cost Sharing Plan Variation","70.04%","0.704603152569071","No","Yes","No","100%",,"$2,390","$0","$4,960","$60","$1,117","$1,385","$754","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver1-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210013","Paramount Silver 5","74313OH021",,"OHN001","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210013-04","Paramount Silver 5","73% AV Level Silver Plan","73.99%","0.743149176288051","No","Yes","No","100%",,"$2,064","$0","$3,686","$60","$1,117","$1,245","$745","$55","$979","$75","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver1-CSR73.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210013","Paramount Silver 5","74313OH021",,"OHN001","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210013-05","Paramount Silver 5","87% AV Level Silver Plan","87.87%","0.880030091411858","No","Yes","No","100%",,"$1,000","$0","$1,000","$60","$1,000","$673","$327","$55","$1,000","$45","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver1-CSR87.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210013","Paramount Silver 5","74313OH021",,"OHN001","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210013-06","Paramount Silver 5","94% AV Level Silver Plan","94.95%","0.94969060278792","No","Yes","No","100%",,"$225","$0","$475","$60","$225","$268","$186","$55","$225","$30","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$225","$225 per person","$450 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver1-CSR94.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210014","Paramount Silver 6","74313OH021",,"OHN001","OHS003","OHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210014-00","Paramount Silver 6","Standard Silver Off Exchange Plan","68.27%","0.686685363764949","No","Yes","No","100%",,"$6,250","$120","$3,720","$60","$1,303","$1,505","$558","$55","$1,142","$225","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver2.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210014","Paramount Silver 6","74313OH021",,"OHN001","OHS003","OHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210014-01","Paramount Silver 6","Standard Silver On Exchange Plan","68.27%","0.686685363764949","No","Yes","No","100%",,"$6,250","$120","$3,720","$60","$1,303","$1,505","$558","$55","$1,142","$225","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver2.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210014","Paramount Silver 6","74313OH021",,"OHN001","OHS003","OHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210014-02","Paramount Silver 6","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver2-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210014","Paramount Silver 6","74313OH021",,"OHN001","OHS003","OHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210014-03","Paramount Silver 6","Limited Cost Sharing Plan Variation","68.27%","0.686685363764949","No","Yes","No","100%",,"$6,250","$120","$3,720","$60","$1,303","$1,505","$558","$55","$1,142","$225","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver2-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210014","Paramount Silver 6","74313OH021",,"OHN001","OHS003","OHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210014-05","Paramount Silver 6","87% AV Level Silver Plan","87.85%","0.879420500611715","No","Yes","No","100%",,"$1,086","$0","$514","$60","$1,025","$305","$270","$55","$1,238","$45","$317","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver2-CSR87.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210014","Paramount Silver 6","74313OH021",,"OHN001","OHS003","OHF003","Existing","HMO","Silver","Not Applicable","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210014-06","Paramount Silver 6","94% AV Level Silver Plan","94.94%","0.94951680875479","No","Yes","No","100%",,"$250","$0","$550","$60","$250","$190","$186","$55","$250","$15","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Silver2-CSR94.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210015","Paramount Gold 3","74313OH021",,"OHN001","OHS002","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210015-00","Paramount Gold 3","Standard Gold Off Exchange Plan",,"0.796852502675413","No","Yes","No","100%",,"$2,000","$70","$2,480","$60","$1,489","$955","$372","$55","$1,305","$105","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Gold1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210015","Paramount Gold 3","74313OH021",,"OHN001","OHS002","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210015-01","Paramount Gold 3","Standard Gold On Exchange Plan",,"0.796852502675413","No","Yes","No","100%",,"$2,000","$70","$2,480","$60","$1,489","$955","$372","$55","$1,305","$105","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Gold1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010203","CareSource Silver","77552OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010203-02","CareSource Silver Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-silverzero-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010203","CareSource Silver","77552OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010203-03","CareSource Silver Limited","Limited Cost Sharing Plan Variation",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-silverltd-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010203","CareSource Silver","77552OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010203-04","CareSource Silver 1","73% AV Level Silver Plan",,"0.735310449914442","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,320","$518","$55","$970","$430","$416","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-silver1-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010203","CareSource Silver","77552OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010203-05","CareSource Silver 2","87% AV Level Silver Plan",,"0.877634618592318","Yes","Yes","No","100%",,"$950","$591","$359","$60","$781","$980","$139","$55","$950","$145","$208","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-silver2-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210015","Paramount Gold 3","74313OH021",,"OHN001","OHS002","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210015-02","Paramount Gold 3","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Gold1-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","74313","SERFF","2017-09-06 20:16:09","Individual","No","01-0580404","74313OH0210015","Paramount Gold 3","74313OH021",,"OHN001","OHS002","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.999",,,"2018-01-01","2018-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2018-Marketplace-Formulary.pdf","74313OH0210015-03","Paramount Gold 3","Limited Cost Sharing Plan Variation",,"0.796852502675413","No","Yes","No","100%",,"$2,000","$70","$2,480","$60","$1,489","$955","$372","$55","$1,305","$105","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2018-Gold1-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2018.pdf"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010200","CareSource HSA Bronze","77552OH001",,"OHN001","OHS001","OHF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9936",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010200-00","CareSource HSA Bronze","Standard Bronze Off Exchange Plan",,"0.618651277477805","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"https://www.caresource.com/document/MP-2018-oh-hsa-bronze-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010200","CareSource HSA Bronze","77552OH001",,"OHN001","OHS001","OHF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9936",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010200-01","CareSource HSA Bronze","Standard Bronze On Exchange Plan",,"0.618651277477805","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"https://www.caresource.com/document/MP-2018-oh-hsa-bronze-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010200","CareSource HSA Bronze","77552OH001",,"OHN001","OHS001","OHF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9936",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010200-02","CareSource HSA Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-hsa-bronzezero-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010200","CareSource HSA Bronze","77552OH001",,"OHN001","OHS001","OHF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9936",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010200-03","CareSource HSA Bronze Limited","Limited Cost Sharing Plan Variation",,"0.618651277477805","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"https://www.caresource.com/document/MP-2018-oh-hsa-bronzeltd-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010201","CareSource Low Premium Silver","77552OH001",,"OHN001","OHS001","OHF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010201-00","CareSource Low Premium Silver","Standard Silver Off Exchange Plan",,"0.6859280333684","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-lp-silver-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010201","CareSource Low Premium Silver","77552OH001",,"OHN001","OHS001","OHF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010201-01","CareSource Low Premium Silver","Standard Silver On Exchange Plan",,"0.6859280333684","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-lp-silver-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010201","CareSource Low Premium Silver","77552OH001",,"OHN001","OHS001","OHF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010201-02","CareSource Low Premium Silver Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-lp-silverzero-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010201","CareSource Low Premium Silver","77552OH001",,"OHN001","OHS001","OHF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010201-03","CareSource Low Premium Silver Limited","Limited Cost Sharing Plan Variation",,"0.6859280333684","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-lp-silverltd-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010201","CareSource Low Premium Silver","77552OH001",,"OHN001","OHS001","OHF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010201-04","CareSource Low Premium Silver 1","73% AV Level Silver Plan",,"0.724944892077978","Yes","Yes","No","100%",,"$4,800","$465","$516","$60","$1,582","$1,305","$279","$55","$1,387","$105","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,800","$5800 per person","$11600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,800","$4800 per person","$9600 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-lp-silver1-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010201","CareSource Low Premium Silver","77552OH001",,"OHN001","OHS001","OHF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010201-05","CareSource Low Premium Silver 2","87% AV Level Silver Plan",,"0.87726632792384","Yes","Yes","No","100%",,"$950","$306","$344","$60","$909","$590","$101","$55","$950","$90","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-lp-silver2-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010201","CareSource Low Premium Silver","77552OH001",,"OHN001","OHS001","OHF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010201-06","CareSource Low Premium Silver 3","94% AV Level Silver Plan",,"0.932542887793143","Yes","Yes","No","100%",,"$571","$0","$129","$60","$517","$155","$28","$55","$600","$33","$67","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-lp-silver3-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010202","CareSource Gold","77552OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9956",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010202-00","CareSource Gold","Standard Gold Off Exchange Plan",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-gold-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010202","CareSource Gold","77552OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9956",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010202-01","CareSource Gold","Standard Gold On Exchange Plan",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-gold-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010202","CareSource Gold","77552OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9956",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010202-02","CareSource Gold Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-goldzero-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010202","CareSource Gold","77552OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9956",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010202-03","CareSource Gold Limited","Limited Cost Sharing Plan Variation",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-goldltd-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010204","CareSource Bronze","77552OH001",,"OHN001","OHS001","OHF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.993",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010204-00","CareSource Bronze","Standard Bronze Off Exchange Plan",,"0.617591503457577","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-bronze-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010204","CareSource Bronze","77552OH001",,"OHN001","OHS001","OHF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.993",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010204-01","CareSource Bronze","Standard Bronze On Exchange Plan",,"0.617591503457577","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-bronze-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010204","CareSource Bronze","77552OH001",,"OHN001","OHS001","OHF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.993",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010204-02","CareSource Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-bronzezero-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010204","CareSource Bronze","77552OH001",,"OHN001","OHS001","OHF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.993",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010204-03","CareSource Bronze Limited","Limited Cost Sharing Plan Variation",,"0.617591503457577","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-bronzeltd-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010203","CareSource Silver","77552OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010203-00","CareSource Silver","Standard Silver Off Exchange Plan",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-silver-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010203","CareSource Silver","77552OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010203-01","CareSource Silver","Standard Silver On Exchange Plan",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-silver-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0010203","CareSource Silver","77552OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9951",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0010203-06","CareSource Silver 3","94% AV Level Silver Plan",,"0.945421805242358","Yes","Yes","No","100%",,"$205","$300","$120","$60","$244","$369","$13","$55","$325","$75","$69","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$625","$625 per person","$1250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$625","$625 per person","$1250 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$325","$325 per person","$650 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$325","$325 per person","$650 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-silver3-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020201","CareSource Low Premium Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.955",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020201-00","CareSource Low Premium Silver Dental and Vision","Standard Silver Off Exchange Plan",,"0.6859280333684","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-lp-silver-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020201","CareSource Low Premium Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.955",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020201-01","CareSource Low Premium Silver Dental and Vision","Standard Silver On Exchange Plan",,"0.6859280333684","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-lp-silver-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020201","CareSource Low Premium Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.955",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020201-02","CareSource Low Premium Silver Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-lp-silverzero-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020201","CareSource Low Premium Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.955",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020201-03","CareSource Low Premium Silver Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.6859280333684","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-lp-silverltd-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020201","CareSource Low Premium Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.955",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020201-04","CareSource Low Premium Silver 1 Dental and Vision","73% AV Level Silver Plan",,"0.724944892077978","Yes","Yes","No","100%",,"$4,800","$465","$516","$60","$1,582","$1,305","$279","$55","$1,387","$105","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,800","$5800 per person","$11600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,800","$4800 per person","$9600 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-lp-silver1-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020201","CareSource Low Premium Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.955",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020201-05","CareSource Low Premium Silver 2 Dental and Vision","87% AV Level Silver Plan",,"0.87726632792384","Yes","Yes","No","100%",,"$950","$306","$344","$60","$909","$590","$101","$55","$950","$90","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-lp-silver2-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020201","CareSource Low Premium Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF005","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.955",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020201-06","CareSource Low Premium Silver 3 Dental and Vision","94% AV Level Silver Plan",,"0.932542887793143","Yes","Yes","No","100%",,"$571","$0","$129","$60","$517","$155","$28","$55","$600","$33","$67","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-lp-silver3-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020202","CareSource Gold Dental and Vision","77552OH002",,"OHN001","OHS001","OHF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.961",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020202-00","CareSource Gold Dental and Vision","Standard Gold Off Exchange Plan",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-gold-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020202","CareSource Gold Dental and Vision","77552OH002",,"OHN001","OHS001","OHF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.961",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020202-01","CareSource Gold Dental and Vision","Standard Gold On Exchange Plan",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-gold-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020202","CareSource Gold Dental and Vision","77552OH002",,"OHN001","OHS001","OHF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.961",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020202-02","CareSource Gold Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-goldzero-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020202","CareSource Gold Dental and Vision","77552OH002",,"OHN001","OHS001","OHF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.961",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020202-03","CareSource Gold Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-goldltd-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020204","CareSource Bronze Dental and Vision","77552OH002",,"OHN001","OHS001","OHF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9396",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020204-00","CareSource Bronze Dental and Vision","Standard Bronze Off Exchange Plan",,"0.617591503457577","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-bronze-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020204","CareSource Bronze Dental and Vision","77552OH002",,"OHN001","OHS001","OHF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9396",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020204-01","CareSource Bronze Dental and Vision","Standard Bronze On Exchange Plan",,"0.617591503457577","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-bronze-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020204","CareSource Bronze Dental and Vision","77552OH002",,"OHN001","OHS001","OHF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9396",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020204-02","CareSource Bronze Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-bronzezero-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020204","CareSource Bronze Dental and Vision","77552OH002",,"OHN001","OHS001","OHF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9396",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020204-03","CareSource Bronze Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.617591503457577","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-bronzeltd-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020203","CareSource Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.957",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020203-00","CareSource Silver Dental and Vision","Standard Silver Off Exchange Plan",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-silver-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020203","CareSource Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.957",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020203-01","CareSource Silver Dental and Vision","Standard Silver On Exchange Plan",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-silver-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020203","CareSource Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.957",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020203-02","CareSource Silver Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-silverzero-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020203","CareSource Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.957",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020203-03","CareSource Silver Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-silverltd-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020203","CareSource Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.957",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020203-04","CareSource Silver 1 Dental and Vision","73% AV Level Silver Plan",,"0.735310449914442","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,320","$518","$55","$970","$430","$416","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-silver1-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020203","CareSource Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.957",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020203-05","CareSource Silver 2 Dental and Vision","87% AV Level Silver Plan",,"0.877634618592318","Yes","Yes","No","100%",,"$950","$591","$359","$60","$781","$980","$139","$55","$950","$145","$208","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-silver2-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0020203","CareSource Silver Dental and Vision","77552OH002",,"OHN001","OHS001","OHF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.957",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0020203-06","CareSource Silver 3 Dental and Vision","94% AV Level Silver Plan",,"0.945421805242358","Yes","Yes","No","100%",,"$205","$300","$120","$60","$244","$369","$13","$55","$325","$75","$69","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$625","$625 per person","$1250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$625","$625 per person","$1250 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$325","$325 per person","$650 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$325","$325 per person","$650 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-silver3-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0030004","CareSource Federal Simple Choice Silver","77552OH003",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0030004-00","CareSource Federal Simple Choice Silver","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-silver-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0030004","CareSource Federal Simple Choice Silver","77552OH003",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0030004-01","CareSource Federal Simple Choice Silver","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-silver-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0030004","CareSource Federal Simple Choice Silver","77552OH003",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0030004-02","CareSource Federal Simple Choice Silver Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-silverzero-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0030004","CareSource Federal Simple Choice Silver","77552OH003",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0030004-03","CareSource Federal Simple Choice Silver Limited","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-silverltd-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0030004","CareSource Federal Simple Choice Silver","77552OH003",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0030004-04","CareSource Federal Simple Choice Silver 1","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-silver1-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0030004","CareSource Federal Simple Choice Silver","77552OH003",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0030004-05","CareSource Federal Simple Choice Silver 2","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$700","$610","$372","$55","$700","$75","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-silver2-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0030004","CareSource Federal Simple Choice Silver","77552OH003",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0030004-06","CareSource Federal Simple Choice Silver 3","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$22","$620","$60","$250","$218","$93","$55","$250","$30","$82","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-silver3-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0030005","CareSource Federal Simple Choice Bronze","77552OH003",,"OHN001","OHS001","OHF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9939",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0030005-00","CareSource Federal Simple Choice Bronze","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,445","$1,515","$1,998","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-bronze-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0030005","CareSource Federal Simple Choice Bronze","77552OH003",,"OHN001","OHS001","OHF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9939",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0030005-01","CareSource Federal Simple Choice Bronze","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,445","$1,515","$1,998","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-bronze-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0030005","CareSource Federal Simple Choice Bronze","77552OH003",,"OHN001","OHS001","OHF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9939",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0030005-02","CareSource Federal Simple Choice Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-bronzezero-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0030005","CareSource Federal Simple Choice Bronze","77552OH003",,"OHN001","OHS001","OHF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9939",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0030005-03","CareSource Federal Simple Choice Bronze Limited","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,445","$1,515","$1,998","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-bronzeltd-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0050004","CareSource Federal Simple Choice Silver Dental and Vision","77552OH005",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9585",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0050004-00","CareSource Federal Simple Choice Silver Dental and Vision","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-silver-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0050004","CareSource Federal Simple Choice Silver Dental and Vision","77552OH005",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9585",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0050004-01","CareSource Federal Simple Choice Silver Dental and Vision","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-silver-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0050004","CareSource Federal Simple Choice Silver Dental and Vision","77552OH005",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9585",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0050004-02","CareSource Federal Simple Choice Silver Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-silverzero-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0050004","CareSource Federal Simple Choice Silver Dental and Vision","77552OH005",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9585",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0050004-03","CareSource Federal Simple Choice Silver Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-silverltd-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0050004","CareSource Federal Simple Choice Silver Dental and Vision","77552OH005",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9585",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0050004-04","CareSource Federal Simple Choice Silver 1 Dental and Vision","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-silver1-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0050004","CareSource Federal Simple Choice Silver Dental and Vision","77552OH005",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9585",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0050004-05","CareSource Federal Simple Choice Silver 2 Dental and Vision","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$700","$610","$372","$55","$700","$75","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-silver2-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0050004","CareSource Federal Simple Choice Silver Dental and Vision","77552OH005",,"OHN001","OHS001","OHF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9585",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0050004-06","CareSource Federal Simple Choice Silver 3 Dental and Vision","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$22","$620","$60","$250","$218","$93","$55","$250","$30","$82","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-silver3-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0050005","CareSource Federal Simple Choice Bronze Dental and Vision","77552OH005",,"OHN001","OHS001","OHF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9465",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0050005-00","CareSource Federal Simple Choice Bronze Dental and Vision","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,445","$1,515","$1,998","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-bronze-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0050005","CareSource Federal Simple Choice Bronze Dental and Vision","77552OH005",,"OHN001","OHS001","OHF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9465",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0050005-01","CareSource Federal Simple Choice Bronze Dental and Vision","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,445","$1,515","$1,998","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-bronze-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0050005","CareSource Federal Simple Choice Bronze Dental and Vision","77552OH005",,"OHN001","OHS001","OHF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9465",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0050005-02","CareSource Federal Simple Choice Bronze Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-bronzezero-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","77552","SERFF","2017-10-31 20:15:29","Individual","No","31-1143265","77552OH0050005","CareSource Federal Simple Choice Bronze Dental and Vision","77552OH005",,"OHN001","OHS001","OHF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9465",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","77552OH0050005-03","CareSource Federal Simple Choice Bronze Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,445","$1,515","$1,998","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-oh-fedstd-bronzeltd-dv-sum","https://www.caresource.com/document/MP-2018-oh-a-broch"
"2018","OH","79539","SERFF","2017-08-11 20:15:53","SHOP (Small Group)","Yes","47-0098400","79539OH0040002","EHB High PPO","79539OH004",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","79539OH0040002-00","EHB High PPO","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","OH","79539","SERFF","2017-08-11 20:15:53","SHOP (Small Group)","Yes","47-0098400","79539OH0040001","EHB Low PPO","79539OH004",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","79539OH0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150039","Dental Plan 6 - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150039-00","Dental Plan 6 - Non-Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","79539","SERFF","2017-08-11 20:15:53","SHOP (Small Group)","Yes","47-0098400","79539OH0030002","EHB High Passive","79539OH003",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","79539OH0030002-00","EHB High Passive","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","OH","91261","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","57-0523959","91261OH0020002","Group  Dental Policy","91261OH002",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","traditional with inside maximum","Yes","traditional with inside maximum","yes",,"","91261OH0020002-00","Group  Dental Policy","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","97596","SERFF","2017-06-13 20:15:36","Individual","Yes","39-1263473","97596OH0580002","Humana Dental Smart Choice","97596OH058",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9869","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","97596OH0580002-00","Humana Dental Smart Choice","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110393"
"2018","OH","97596","SERFF","2017-06-13 20:15:36","Individual","Yes","39-1263473","97596OH0580002","Humana Dental Smart Choice","97596OH058",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9869","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","97596OH0580002-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110393"
"2018","OH","99734","SERFF","2017-06-16 20:15:40","SHOP (Small Group)","Yes","31-1185262","99734OH0040005","DentaSpan Dental-Family High Option","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.  Non-contracting dentists are permitted to charge for the difference between the fee schedule and non-contracting dentist’s billed charges.  You may be required to pay more for services obtained from a non-contracting dentist than the same services provided by a contracting dentist.","No","https://hixenroll.insxcloud.com/payment","","99734OH0040005-00","DentaSpan Dental-Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsoh.dentalcareplus.com","http://hixpbdsoh.dentalcareplus.com"
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080059","Market HMO 2000/25 - ProMedica","99969OH008",,"OHN007","OHS006","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080059-01","Market HMO 2000/25 - ProMedica","Standard Gold On Exchange Plan",,"0.762545158278016","No","Yes","No","100%",,"$2,000","$40","$2,100","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005989000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080059","Market HMO 2000/25 - ProMedica","99969OH008",,"OHN007","OHS006","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080059-02","Market HMO 2000/25 - ProMedica","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005990000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080059","Market HMO 2000/25 - ProMedica","99969OH008",,"OHN007","OHS006","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080059-03","Market HMO 2000/25 - ProMedica","Limited Cost Sharing Plan Variation",,"0.762545158278016","No","Yes","No","100%",,"$2,000","$40","$2,100","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005991000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080068","Market HMO 2000/25 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080068-00","Market HMO 2000/25 - NE Ohio","Standard Gold Off Exchange Plan",,"0.762545158278016","No","Yes","No","100%",,"$2,000","$40","$2,100","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005989000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080068","Market HMO 2000/25 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080068-01","Market HMO 2000/25 - NE Ohio","Standard Gold On Exchange Plan",,"0.762545158278016","No","Yes","No","100%",,"$2,000","$40","$2,100","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005989000000000",
"2018","OH","79539","SERFF","2017-08-11 20:15:53","SHOP (Small Group)","Yes","47-0098400","79539OH0030001","EHB Low Passive","79539OH003",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","79539OH0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","OH","80627","SERFF","2017-07-25 20:15:54","Individual","Yes","34-0648820","80627OH0140005","MedMutual Pediatric Dental","80627OH014",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0140005-00","MedMutual Pediatric Dental","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150015","Pediatric Dental - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150015-00","Pediatric Dental - Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150032","Pediatric Dental - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150032-00","Pediatric Dental - Non-Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","Individual","Yes","34-0648820","80627OH0140006","MedMutual Dental 1","80627OH014",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0140006-00","MedMutual Dental 1","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150021","Dental Plan 5 - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150021-00","Dental Plan 5 - Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150050","Dental Plan 5 (Voluntary) - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150050-00","Dental Plan 5 (Voluntary) - Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150038","Dental Plan 5 - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150038-00","Dental Plan 5 - Non-Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150053","Dental Plan 5 (Voluntary) - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150053-00","Dental Plan 5 (Voluntary) - Non-Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","Individual","Yes","34-0648820","80627OH0140007","MedMutual Dental 2","80627OH014",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0140007-00","MedMutual Dental 2","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150019","Dental Plan 4 - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150019-00","Dental Plan 4 - Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150049","Dental Plan 4 (Voluntary) - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150049-00","Dental Plan 4 (Voluntary) - Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150022","Dental Plan 6 - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150022-00","Dental Plan 6 - Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150024","Dental Plan 6 (Voluntary) - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150024-00","Dental Plan 6 (Voluntary) - Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150025","Dental Plan 7 - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150025-00","Dental Plan 7 - Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150027","Dental Plan 7 (Voluntary) - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150027-00","Dental Plan 7 (Voluntary) - Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150028","Dental Plan 8 - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150028-00","Dental Plan 8 - Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150051","Dental Plan 8 (Voluntary) - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150051-00","Dental Plan 8 (Voluntary) - Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","Individual","Yes","34-0648820","80627OH0140008","MedMutual Dental 3","80627OH014",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0140008-00","MedMutual Dental 3","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150036","Dental Plan 4 - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150036-00","Dental Plan 4 - Non-Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150052","Dental Plan 4 (Voluntary) - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150052-00","Dental Plan 4 (Voluntary) - Non-Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150041","Dental Plan 6 (Voluntary) - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150041-00","Dental Plan 6 (Voluntary) - Non-Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150042","Dental Plan 7 - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150042-00","Dental Plan 7 - Non-Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150044","Dental Plan 7 (Voluntary) - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150044-00","Dental Plan 7 (Voluntary) - Non-Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150045","Dental Plan 8 - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150045-00","Dental Plan 8 - Non-Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150054","Dental Plan 8 (Voluntary) - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150054-00","Dental Plan 8 (Voluntary) - Non-Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150020","Dental Plan 4 with Ortho Rider - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150020-00","Dental Plan 4 with Ortho Rider - Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150023","Dental Plan 6 with Ortho Rider - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150023-00","Dental Plan 6 with Ortho Rider - Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150026","Dental Plan 7 with Ortho Rider - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150026-00","Dental Plan 7 with Ortho Rider - Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150029","Dental Plan 8 with Ortho Rider - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150029-00","Dental Plan 8 with Ortho Rider - Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150037","Dental Plan 4 with Ortho Rider - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150037-00","Dental Plan 4 with Ortho Rider - Non-Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150040","Dental Plan 6 with Ortho Rider - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150040-00","Dental Plan 6 with Ortho Rider - Non-Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150043","Dental Plan 7 with Ortho Rider - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150043-00","Dental Plan 7 with Ortho Rider - Non-Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","80627","SERFF","2017-07-25 20:15:54","SHOP (Small Group)","Yes","34-0648820","80627OH0150046","Dental Plan 8 with Ortho Rider - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2017-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150046-00","Dental Plan 8 with Ortho Rider - Non-Alliance","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","86728","SERFF","2017-07-26 20:15:54","Individual","Yes","31-0685339","86728OH0260001","Delta Dental Individual PPO, EHB Certified","86728OH026",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0260001-00","Delta Dental Individual PPO, EHB Certified","Standard High Off Exchange Plan","84.79%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","86728","SERFF","2017-07-26 20:15:54","SHOP (Small Group)","Yes","31-0685339","86728OH0290001","Delta Dental Group PPO, EHB Certified","86728OH029",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0290001-00","Delta Dental Group PPO, EHB Certified","Standard High Off Exchange Plan","84.44%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","86728","SERFF","2017-07-26 20:15:54","Individual","Yes","31-0685339","86728OH0260002","Delta Dental Individual PPO, EHB Certified","86728OH026",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0260002-00","Delta Dental Individual PPO, EHB Certified","Standard Low Off Exchange Plan","70.72%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","86728","SERFF","2017-07-26 20:15:54","SHOP (Small Group)","Yes","31-0685339","86728OH0290002","Delta Dental Group PPO, EHB Certified","86728OH029",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0290002-00","Delta Dental Group PPO, EHB Certified","Standard Low Off Exchange Plan","69.12%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","86728","SERFF","2017-07-26 20:15:54","Individual","Yes","31-0685339","86728OH0340001","Delta Dental Individual PPO, EHB Certified (Exchange)","86728OH034",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/86728","","86728OH0340001-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","84.79%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaloh.com/OH_EHB_High_2018","http://www.deltadentaloh.com/OH_EHB_High_2018"
"2018","OH","86728","SERFF","2017-07-26 20:15:54","SHOP (Small Group)","Yes","31-0685339","86728OH0290005","Delta Dental Group PPO, EHB Certified","86728OH029",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0290005-00","Delta Dental Group PPO, EHB Certified","Standard High Off Exchange Plan","84.85%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","86728","SERFF","2017-07-26 20:15:54","Individual","Yes","31-0685339","86728OH0340002","Delta Dental Individual PPO, EHB Certified (Exchange)","86728OH034",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/86728","","86728OH0340002-01","Delta Dental Individual PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.72%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaloh.com/OH_EHB_Low_2018","http://www.deltadentaloh.com/OH_EHB_Low_2018"
"2018","OH","86728","SERFF","2017-07-26 20:15:54","SHOP (Small Group)","Yes","31-0685339","86728OH0290006","Delta Dental Group PPO, EHB Certified","86728OH029",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0290006-00","Delta Dental Group PPO, EHB Certified","Standard Low Off Exchange Plan","68.63%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","86728","SERFF","2017-07-26 20:15:54","SHOP (Small Group)","Yes","31-0685339","86728OH0300001","Delta Dental Group Pediatric-Only, EHB Certified","86728OH030",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0300001-00","Delta Dental Group Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","84.85%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","86728","SERFF","2017-07-26 20:15:54","Individual","Yes","31-0685339","86728OH0310001","Delta Dental Individual Pediatric-Only PPO, EHB Certified","86728OH031",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0310001-00","Delta Dental Individual Pediatric-Only PPO, EHB Certified","Standard High Off Exchange Plan","84.79%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","86728","SERFF","2017-07-26 20:15:54","Individual","Yes","31-0685339","86728OH0310002","Delta Dental Individual Pediatric-Only PPO, EHB Certified","86728OH031",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0310002-00","Delta Dental Individual Pediatric-Only PPO, EHB Certified","Standard Low Off Exchange Plan","70.72%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","86728","SERFF","2017-07-26 20:15:54","SHOP (Small Group)","Yes","31-0685339","86728OH0300002","Delta Dental Group Pediatric-Only, EHB Certified","86728OH030",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0300002-00","Delta Dental Group Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","68.63%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","86728","SERFF","2017-07-26 20:15:54","SHOP (Small Group)","Yes","31-0685339","86728OH0300003","Delta Dental Group Pediatric-Only, EHB Certified","86728OH030",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0300003-00","Delta Dental Group Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","84.44%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","86728","SERFF","2017-07-26 20:15:54","Individual","Yes","31-0685339","86728OH0360001","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","86728OH036",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/86728","","86728OH0360001-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","84.79%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaloh.com/OH_Ped_High_2018","http://www.deltadentaloh.com/OH_Ped_High_2018"
"2018","OH","86728","SERFF","2017-07-26 20:15:54","Individual","Yes","31-0685339","86728OH0360002","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","86728OH036",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/86728","","86728OH0360002-01","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.72%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaloh.com/OH_Ped_Low_2018","http://www.deltadentaloh.com/OH_Ped_Low_2018"
"2018","OH","86728","SERFF","2017-07-26 20:15:54","SHOP (Small Group)","Yes","31-0685339","86728OH0300004","Delta Dental Group Pediatric-Only, EHB Certified","86728OH030",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","86728OH0300004-00","Delta Dental Group Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","69.12%",,,,"Yes","25%","75%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","89819","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","36-3757528","89819OH0030001","TruAssure Dental Small Group Basic Plan","89819OH003",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.94","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","89819OH0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","89819","SERFF","2017-08-16 20:15:58","Individual","Yes","36-3757528","89819OH0010001","TruAssure Basic Adult or Child Dental Plan","89819OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","89819OH0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OH","https://www.truassure.com/brochure?state=OH"
"2018","OH","89819","SERFF","2017-08-16 20:15:58","Individual","Yes","36-3757528","89819OH0010001","TruAssure Basic Adult or Child Dental Plan","89819OH001",,"OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","89819OH0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OH","https://www.truassure.com/brochure?state=OH"
"2018","OH","89819","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","36-3757528","89819OH0040001","TruAssure Dental Small Group Preferred Plan","89819OH004",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.94","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","89819OH0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","89819","SERFF","2017-08-16 20:15:58","Individual","Yes","36-3757528","89819OH0020001","TruAssure Preferred Adult or Child Dental Plan","89819OH002",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","89819OH0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OH","https://www.truassure.com/brochure?state=OH"
"2018","OH","89819","SERFF","2017-08-16 20:15:58","Individual","Yes","36-3757528","89819OH0020001","TruAssure Preferred Adult or Child Dental Plan","89819OH002",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","89819OH0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OH","https://www.truassure.com/brochure?state=OH"
"2018","OH","91261","SERFF","2017-06-14 20:15:39","SHOP (Small Group)","Yes","57-0523959","91261OH0020001","Group  Dental Policy","91261OH002",,"OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","traditional with inside maximum","Yes","traditional with inside maximum","Yes",,"","91261OH0020001-00","Group  Dental Policy","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","99734","SERFF","2017-06-16 20:15:40","SHOP (Small Group)","Yes","31-1185262","99734OH0040009","DentaSpan Dental-Child Only High Option-Off Exchange","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.  Non-contracting dentists are permitted to charge for the difference between the fee schedule and non-contracting dentist’s billed charges.  You may be required to pay more for services obtained from a non-contracting dentist than the same services provided by a contracting dentist.","No","https://hixenroll.insxcloud.com/payment","","99734OH0040009-00","DentaSpan Dental-Child Only High Option-Off Exchange","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsoh.dentalcareplus.com","http://hiopbdsoh.dentalcareplus.com"
"2018","OH","99734","SERFF","2017-06-16 20:15:40","Individual","Yes","31-1185262","99734OH0050007","Ohio DentaTrust PPO - Family High Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.  Non-contracting dentists are permitted to charge for the difference between the fee schedule and non-contracting dentist’s billed charges.  You may be required to pay more for services obtained from a non-contracting dentist than the same services provided by a contracting dentist.","No","https://hixenroll.insxcloud.com/payment","","99734OH0050007-01","Ohio DentaTrust PPO - Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtoh.dentalcareplus.com","http://hixpbdtoh.dentalcareplus.com"
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080003","Market HMO 2000/30 - Mercy","99969OH008",,"OHN002","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-02","Market HMO 2000/30 - Mercy","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005993000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080003","Market HMO 2000/30 - Mercy","99969OH008",,"OHN002","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-03","Market HMO 2000/30 - Mercy","Limited Cost Sharing Plan Variation",,"0.713988140119513","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005994000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080003","Market HMO 2000/30 - Mercy","99969OH008",,"OHN002","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-04","Market HMO 2000/30 - Mercy","73% AV Level Silver Plan",,"0.734519941297869","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$5550 per person","$11100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005995000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080003","Market HMO 2000/30 - Mercy","99969OH008",,"OHN002","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-05","Market HMO 2000/30 - Mercy","87% AV Level Silver Plan",,"0.865275634085345","No","Yes","No","100%",,"$500","$40","$1,200","$60","$100","$1,700","$0","$60","$500","$400","$60","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005996000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080003","Market HMO 2000/30 - Mercy","99969OH008",,"OHN002","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-06","Market HMO 2000/30 - Mercy","94% AV Level Silver Plan",,"0.945856486216121","No","Yes","No","100%",,"$100","$0","$400","$60","$100","$400","$0","$60","$100","$300","$100","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005997000000000",
"2018","OH","99734","SERFF","2017-06-16 20:15:40","Individual","Yes","31-1185262","99734OH0050005","Ohio DentaTrust PPO - Pediatric High Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.  Non-contracting dentists are permitted to charge for the difference between the fee schedule and non-contracting dentist’s billed charges.  You may be required to pay more for services obtained from a non-contracting dentist than the same services provided by a contracting dentist.","No","https://hixenroll.insxcloud.com/payment","","99734OH0050005-00","Ohio DentaTrust PPO - Pediatric High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtoh.dentalcareplus.com","http://hixpbdtoh.dentalcareplus.com"
"2018","OH","99734","SERFF","2017-06-16 20:15:40","Individual","Yes","31-1185262","99734OH0050005","Ohio DentaTrust PPO - Pediatric High Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.  Non-contracting dentists are permitted to charge for the difference between the fee schedule and non-contracting dentist’s billed charges.  You may be required to pay more for services obtained from a non-contracting dentist than the same services provided by a contracting dentist.","No","https://hixenroll.insxcloud.com/payment","","99734OH0050005-01","Ohio DentaTrust PPO - Pediatric High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtoh.dentalcareplus.com","http://hixpbdtoh.dentalcareplus.com"
"2018","OH","99734","SERFF","2017-06-16 20:15:40","SHOP (Small Group)","Yes","31-1185262","99734OH0040005","DentaSpan Dental-Family High Option","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.  Non-contracting dentists are permitted to charge for the difference between the fee schedule and non-contracting dentist’s billed charges.  You may be required to pay more for services obtained from a non-contracting dentist than the same services provided by a contracting dentist.","No","https://hixenroll.insxcloud.com/payment","","99734OH0040005-01","DentaSpan Dental-Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsoh.dentalcareplus.com","http://hixpbdsoh.dentalcareplus.com"
"2018","OH","99734","SERFF","2017-06-16 20:15:40","SHOP (Small Group)","Yes","31-1185262","99734OH0040006","DentaSpan Dental-Family Low Option","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.  Non-contracting dentists are permitted to charge for the difference between the fee schedule and non-contracting dentist’s billed charges.  You may be required to pay more for services obtained from a non-contracting dentist than the same services provided by a contracting dentist.","No","https://hixenroll.insxcloud.com/payment","","99734OH0040006-00","DentaSpan Dental-Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsoh.dentalcareplus.com","http://hixpbdsoh.dentalcareplus.com"
"2018","OH","99734","SERFF","2017-06-16 20:15:40","Individual","Yes","31-1185262","99734OH0050006","Ohio DentaTrust PPO - Pediatric Low Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.  Non-contracting dentists are permitted to charge for the difference between the fee schedule and non-contracting dentist’s billed charges.  You may be required to pay more for services obtained from a non-contracting dentist than the same services provided by a contracting dentist.","No","https://hixenroll.insxcloud.com/payment","","99734OH0050006-00","Ohio DentaTrust PPO - Pediatric Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtoh.dentalcareplus.com","http://hixpbdtoh.dentalcareplus.com"
"2018","OH","99734","SERFF","2017-06-16 20:15:40","Individual","Yes","31-1185262","99734OH0050006","Ohio DentaTrust PPO - Pediatric Low Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.  Non-contracting dentists are permitted to charge for the difference between the fee schedule and non-contracting dentist’s billed charges.  You may be required to pay more for services obtained from a non-contracting dentist than the same services provided by a contracting dentist.","No","https://hixenroll.insxcloud.com/payment","","99734OH0050006-01","Ohio DentaTrust PPO - Pediatric Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtoh.dentalcareplus.com","http://hixpbdtoh.dentalcareplus.com"
"2018","OH","99734","SERFF","2017-06-16 20:15:40","SHOP (Small Group)","Yes","31-1185262","99734OH0040006","DentaSpan Dental-Family Low Option","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.  Non-contracting dentists are permitted to charge for the difference between the fee schedule and non-contracting dentist’s billed charges.  You may be required to pay more for services obtained from a non-contracting dentist than the same services provided by a contracting dentist.","No","https://hixenroll.insxcloud.com/payment","","99734OH0040006-01","DentaSpan Dental-Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsoh.dentalcareplus.com","http://hixpbdsoh.dentalcareplus.com"
"2018","OH","99734","SERFF","2017-06-16 20:15:40","SHOP (Small Group)","Yes","31-1185262","99734OH0040011","DentaSpan Dental-Family High Option-Off Exchange","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.  Non-contracting dentists are permitted to charge for the difference between the fee schedule and non-contracting dentist’s billed charges.  You may be required to pay more for services obtained from a non-contracting dentist than the same services provided by a contracting dentist.","No","https://hixenroll.insxcloud.com/payment","","99734OH0040011-00","DentaSpan Dental-Family High Option-Off Exchange","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsoh.dentalcareplus.com","http://hiopbdsoh.dentalcareplus.com"
"2018","OH","99734","SERFF","2017-06-16 20:15:40","SHOP (Small Group)","Yes","31-1185262","99734OH0040012","DentaSpan Dental-Family Low Option-Off Exchange","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.  Non-contracting dentists are permitted to charge for the difference between the fee schedule and non-contracting dentist’s billed charges.  You may be required to pay more for services obtained from a non-contracting dentist than the same services provided by a contracting dentist.","No","https://hixenroll.insxcloud.com/payment","","99734OH0040012-00","DentaSpan Dental-Family Low Option-Off Exchange","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsoh.dentalcareplus.com","http://hiopbdsoh.dentalcareplus.com"
"2018","OH","99734","SERFF","2017-06-16 20:15:40","Individual","Yes","31-1185262","99734OH0050007","Ohio DentaTrust PPO - Family High Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.  Non-contracting dentists are permitted to charge for the difference between the fee schedule and non-contracting dentist’s billed charges.  You may be required to pay more for services obtained from a non-contracting dentist than the same services provided by a contracting dentist.","No","https://hixenroll.insxcloud.com/payment","","99734OH0050007-00","Ohio DentaTrust PPO - Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtoh.dentalcareplus.com","http://hixpbdtoh.dentalcareplus.com"
"2018","OH","99734","SERFF","2017-06-16 20:15:40","SHOP (Small Group)","Yes","31-1185262","99734OH0040010","DentaSpan Dental-Child Only Low Option-Off Exchange","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.  Non-contracting dentists are permitted to charge for the difference between the fee schedule and non-contracting dentist’s billed charges.  You may be required to pay more for services obtained from a non-contracting dentist than the same services provided by a contracting dentist.","No","https://hixenroll.insxcloud.com/payment","","99734OH0040010-00","DentaSpan Dental-Child Only Low Option-Off Exchange","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsoh.dentalcareplus.com","http://hiopbdsoh.dentalcareplus.com"
"2018","OH","99734","SERFF","2017-06-16 20:15:40","Individual","Yes","31-1185262","99734OH0050008","Ohio DentaTrust PPO - Family Low Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific level exclusions.",,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.  Non-contracting dentists are permitted to charge for the difference between the fee schedule and non-contracting dentist’s billed charges.  You may be required to pay more for services obtained from a non-contracting dentist than the same services provided by a contracting dentist.","No","https://hixenroll.insxcloud.com/payment","","99734OH0050008-00","Ohio DentaTrust PPO - Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtoh.dentalcareplus.com","http://hixpbdtoh.dentalcareplus.com"
"2018","OH","99734","SERFF","2017-06-16 20:15:40","Individual","Yes","31-1185262","99734OH0050008","Ohio DentaTrust PPO - Family Low Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific level exclusions.",,"Yes","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.  Non-contracting dentists are permitted to charge for the difference between the fee schedule and non-contracting dentist’s billed charges.  You may be required to pay more for services obtained from a non-contracting dentist than the same services provided by a contracting dentist.","No","https://hixenroll.insxcloud.com/payment","","99734OH0050008-01","Ohio DentaTrust PPO - Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtoh.dentalcareplus.com","http://hixpbdtoh.dentalcareplus.com"
"2018","OH","99734","SERFF","2017-06-16 20:15:40","SHOP (Small Group)","Yes","31-1185262","99734OH0010016","HMO - Plan #16","99734OH001","7083617077","OHN002","OHS002",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out of Service Area coverage is limited to relief of pain, bleeding, swelling or other acute conditions.","No",,"","99734OH0010016-00","HMO - Plan #16","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","99734","SERFF","2017-06-16 20:15:40","SHOP (Small Group)","Yes","31-1185262","99734OH0010017","HMO - Plan #017","99734OH001","7083617077","OHN002","OHS002",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out of Service Area coverage is limited to relief of pain, bleeding, swelling or other acute conditions.","No",,"","99734OH0010017-00","HMO - Plan #017","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","99734","SERFF","2017-06-16 20:15:40","SHOP (Small Group)","Yes","31-1185262","99734OH0020021","PPO - Plan #017 - 900","99734OH002","7083617077","OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020021-00","PPO - Plan #017 - 900","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","99734","SERFF","2017-06-16 20:15:40","SHOP (Small Group)","Yes","31-1185262","99734OH0020022","PPO - Plan #018 - 900","99734OH002","7083617077","OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020022-00","PPO - Plan #018 - 900","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","99734","SERFF","2017-06-16 20:15:40","SHOP (Small Group)","Yes","31-1185262","99734OH0020023","PPO - Plan #019 - 900","99734OH002","7083617077","OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020023-00","PPO - Plan #019 - 900","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","99734","SERFF","2017-06-16 20:15:40","SHOP (Small Group)","Yes","31-1185262","99734OH0020024","PPO - Plan #020 - 900","99734OH002","7083617077","OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020024-00","PPO - Plan #020 - 900","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","99734","SERFF","2017-06-16 20:15:40","SHOP (Small Group)","Yes","31-1185262","99734OH0020025","PPO - Plan #017 - 600","99734OH002","7083617077","OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020025-00","PPO - Plan #017 - 600","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","99734","SERFF","2017-06-16 20:15:40","SHOP (Small Group)","Yes","31-1185262","99734OH0020026","PPO - Plan #018 - 600","99734OH002","7083617077","OHN001","OHS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020026-00","PPO - Plan #018 - 600","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","99734","SERFF","2017-06-16 20:15:40","SHOP (Small Group)","Yes","31-1185262","99734OH0020027","PPO - Plan #019 - 600","99734OH002","7083617077","OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020027-00","PPO - Plan #019 - 600","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","99734","SERFF","2017-06-16 20:15:40","SHOP (Small Group)","Yes","31-1185262","99734OH0020028","PPO - Plan #020 - 600","99734OH002","7083617077","OHN001","OHS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020028-00","PPO - Plan #020 - 600","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","Yes","34-1442712","99969OH0060002","MedMutual Pediatric Dental","99969OH006",,"OHN008","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","99969OH0060002-00","MedMutual Pediatric Dental","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080001","Market HMO 2000/25 - Mercy","99969OH008",,"OHN002","OHS008","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080001-00","Market HMO 2000/25 - Mercy","Standard Gold Off Exchange Plan",,"0.762545158278016","No","Yes","No","100%",,"$2,000","$40","$2,100","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005989000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080001","Market HMO 2000/25 - Mercy","99969OH008",,"OHN002","OHS008","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080001-01","Market HMO 2000/25 - Mercy","Standard Gold On Exchange Plan",,"0.762545158278016","No","Yes","No","100%",,"$2,000","$40","$2,100","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005989000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080001","Market HMO 2000/25 - Mercy","99969OH008",,"OHN002","OHS008","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080001-02","Market HMO 2000/25 - Mercy","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005990000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080001","Market HMO 2000/25 - Mercy","99969OH008",,"OHN002","OHS008","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080001-03","Market HMO 2000/25 - Mercy","Limited Cost Sharing Plan Variation",,"0.762545158278016","No","Yes","No","100%",,"$2,000","$40","$2,100","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005991000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080021","Market HMO 2000/25 - OhioHealth","99969OH008",,"OHN003","OHS009","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080021-00","Market HMO 2000/25 - OhioHealth","Standard Gold Off Exchange Plan",,"0.762545158278016","No","Yes","No","100%",,"$2,000","$40","$2,100","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005989000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080021","Market HMO 2000/25 - OhioHealth","99969OH008",,"OHN003","OHS009","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080021-01","Market HMO 2000/25 - OhioHealth","Standard Gold On Exchange Plan",,"0.762545158278016","No","Yes","No","100%",,"$2,000","$40","$2,100","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005989000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080021","Market HMO 2000/25 - OhioHealth","99969OH008",,"OHN003","OHS009","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080021-02","Market HMO 2000/25 - OhioHealth","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005990000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080021","Market HMO 2000/25 - OhioHealth","99969OH008",,"OHN003","OHS009","OHF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080021-03","Market HMO 2000/25 - OhioHealth","Limited Cost Sharing Plan Variation",,"0.762545158278016","No","Yes","No","100%",,"$2,000","$40","$2,100","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005991000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080059","Market HMO 2000/25 - ProMedica","99969OH008",,"OHN007","OHS006","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080059-00","Market HMO 2000/25 - ProMedica","Standard Gold Off Exchange Plan",,"0.762545158278016","No","Yes","No","100%",,"$2,000","$40","$2,100","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005989000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080068","Market HMO 2000/25 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080068-02","Market HMO 2000/25 - NE Ohio","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005990000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080068","Market HMO 2000/25 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF001","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080068-03","Market HMO 2000/25 - NE Ohio","Limited Cost Sharing Plan Variation",,"0.762545158278016","No","Yes","No","100%",,"$2,000","$40","$2,100","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005991000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","Yes","34-1442712","99969OH0060003","MedMutual Dental 1","99969OH006",,"OHN008","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","99969OH0060003-00","MedMutual Dental 1","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","Yes","34-1442712","99969OH0060004","MedMutual Dental 2","99969OH006",,"OHN008","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","99969OH0060004-00","MedMutual Dental 2","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","Yes","34-1442712","99969OH0060005","MedMutual Dental 3","99969OH006",,"OHN008","OHS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","99969OH0060005-00","MedMutual Dental 3","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080003","Market HMO 2000/30 - Mercy","99969OH008",,"OHN002","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-00","Market HMO 2000/30 - Mercy","Standard Silver Off Exchange Plan",,"0.713988140119513","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005992000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080003","Market HMO 2000/30 - Mercy","99969OH008",,"OHN002","OHS003","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-01","Market HMO 2000/30 - Mercy","Standard Silver On Exchange Plan",,"0.713988140119513","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005992000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080022","Market HMO 2000/30 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080022-00","Market HMO 2000/30 - OhioHealth","Standard Silver Off Exchange Plan",,"0.713988140119513","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005992000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080022","Market HMO 2000/30 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080022-01","Market HMO 2000/30 - OhioHealth","Standard Silver On Exchange Plan",,"0.713988140119513","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005992000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080022","Market HMO 2000/30 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080022-02","Market HMO 2000/30 - OhioHealth","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005993000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080022","Market HMO 2000/30 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080022-03","Market HMO 2000/30 - OhioHealth","Limited Cost Sharing Plan Variation",,"0.713988140119513","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005994000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080022","Market HMO 2000/30 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080022-04","Market HMO 2000/30 - OhioHealth","73% AV Level Silver Plan",,"0.734519941297869","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$5550 per person","$11100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005995000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080022","Market HMO 2000/30 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080022-05","Market HMO 2000/30 - OhioHealth","87% AV Level Silver Plan",,"0.865275634085345","No","Yes","No","100%",,"$500","$40","$1,200","$60","$100","$1,700","$0","$60","$500","$400","$60","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005996000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080022","Market HMO 2000/30 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF002","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080022-06","Market HMO 2000/30 - OhioHealth","94% AV Level Silver Plan",,"0.945856486216121","No","Yes","No","100%",,"$100","$0","$400","$60","$100","$400","$0","$60","$100","$300","$100","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005997000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080060","Market HMO 2000/30 - ProMedica","99969OH008",,"OHN007","OHS006","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080060-00","Market HMO 2000/30 - ProMedica","Standard Silver Off Exchange Plan",,"0.713988140119513","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005992000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080060","Market HMO 2000/30 - ProMedica","99969OH008",,"OHN007","OHS006","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080060-01","Market HMO 2000/30 - ProMedica","Standard Silver On Exchange Plan",,"0.713988140119513","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005992000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080060","Market HMO 2000/30 - ProMedica","99969OH008",,"OHN007","OHS006","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080060-02","Market HMO 2000/30 - ProMedica","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005993000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080060","Market HMO 2000/30 - ProMedica","99969OH008",,"OHN007","OHS006","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080060-03","Market HMO 2000/30 - ProMedica","Limited Cost Sharing Plan Variation",,"0.713988140119513","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005994000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080060","Market HMO 2000/30 - ProMedica","99969OH008",,"OHN007","OHS006","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080060-04","Market HMO 2000/30 - ProMedica","73% AV Level Silver Plan",,"0.734519941297869","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$5550 per person","$11100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005995000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080060","Market HMO 2000/30 - ProMedica","99969OH008",,"OHN007","OHS006","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080060-05","Market HMO 2000/30 - ProMedica","87% AV Level Silver Plan",,"0.865275634085345","No","Yes","No","100%",,"$500","$40","$1,200","$60","$100","$1,700","$0","$60","$500","$400","$60","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005996000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080060","Market HMO 2000/30 - ProMedica","99969OH008",,"OHN007","OHS006","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080060-06","Market HMO 2000/30 - ProMedica","94% AV Level Silver Plan",,"0.945856486216121","No","Yes","No","100%",,"$100","$0","$400","$60","$100","$400","$0","$60","$100","$300","$100","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005997000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080069","Market HMO 2000/30 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080069-00","Market HMO 2000/30 - NE Ohio","Standard Silver Off Exchange Plan",,"0.713988140119513","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005992000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080069","Market HMO 2000/30 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080069-01","Market HMO 2000/30 - NE Ohio","Standard Silver On Exchange Plan",,"0.713988140119513","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005992000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080069","Market HMO 2000/30 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080069-02","Market HMO 2000/30 - NE Ohio","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005993000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080069","Market HMO 2000/30 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080069-03","Market HMO 2000/30 - NE Ohio","Limited Cost Sharing Plan Variation",,"0.713988140119513","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005994000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080069","Market HMO 2000/30 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080069-04","Market HMO 2000/30 - NE Ohio","73% AV Level Silver Plan",,"0.734519941297869","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$5550 per person","$11100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005995000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080069","Market HMO 2000/30 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080069-05","Market HMO 2000/30 - NE Ohio","87% AV Level Silver Plan",,"0.865275634085345","No","Yes","No","100%",,"$500","$40","$1,200","$60","$100","$1,700","$0","$60","$500","$400","$60","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005996000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080069","Market HMO 2000/30 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080069-06","Market HMO 2000/30 - NE Ohio","94% AV Level Silver Plan",,"0.945856486216121","No","Yes","No","100%",,"$100","$0","$400","$60","$100","$400","$0","$60","$100","$300","$100","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005997000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080078","Market HMO 2000/30 - Mercy","99969OH008",,"OHN002","OHS007","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080078-00","Market HMO 2000/30 - Mercy","Standard Silver Off Exchange Plan",,"0.713988140119513","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005992000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080078","Market HMO 2000/30 - Mercy","99969OH008",,"OHN002","OHS007","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080078-01","Market HMO 2000/30 - Mercy","Standard Silver On Exchange Plan",,"0.713988140119513","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005992000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080078","Market HMO 2000/30 - Mercy","99969OH008",,"OHN002","OHS007","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080078-02","Market HMO 2000/30 - Mercy","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005993000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080078","Market HMO 2000/30 - Mercy","99969OH008",,"OHN002","OHS007","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080078-03","Market HMO 2000/30 - Mercy","Limited Cost Sharing Plan Variation",,"0.713988140119513","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005994000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080078","Market HMO 2000/30 - Mercy","99969OH008",,"OHN002","OHS007","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080078-04","Market HMO 2000/30 - Mercy","73% AV Level Silver Plan",,"0.734519941297869","No","Yes","No","100%",,"$2,000","$40","$3,200","$60","$100","$1,900","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$5550 per person","$11100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005995000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080078","Market HMO 2000/30 - Mercy","99969OH008",,"OHN002","OHS007","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080078-05","Market HMO 2000/30 - Mercy","87% AV Level Silver Plan",,"0.865275634085345","No","Yes","No","100%",,"$500","$40","$1,200","$60","$100","$1,700","$0","$60","$500","$400","$60","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005996000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080078","Market HMO 2000/30 - Mercy","99969OH008",,"OHN002","OHS007","OHF002","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080078-06","Market HMO 2000/30 - Mercy","94% AV Level Silver Plan",,"0.945856486216121","No","Yes","No","100%",,"$100","$0","$400","$60","$100","$400","$0","$60","$100","$300","$100","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005005997000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080042","Market HMO 2400 - Mercy","99969OH008",,"OHN002","OHS003","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080042-00","Market HMO 2400 - Mercy","Standard Silver Off Exchange Plan",,"0.692459238950112","Yes","Yes","No","100%",,"$2,400","$0","$2,000","$60","$2,400","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005005998000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080042","Market HMO 2400 - Mercy","99969OH008",,"OHN002","OHS003","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080042-01","Market HMO 2400 - Mercy","Standard Silver On Exchange Plan",,"0.692459238950112","Yes","Yes","No","100%",,"$2,400","$0","$2,000","$60","$2,400","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005005998000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080042","Market HMO 2400 - Mercy","99969OH008",,"OHN002","OHS003","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080042-02","Market HMO 2400 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005005999000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080042","Market HMO 2400 - Mercy","99969OH008",,"OHN002","OHS003","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080042-03","Market HMO 2400 - Mercy","Limited Cost Sharing Plan Variation",,"0.692459238950112","Yes","Yes","No","100%",,"$2,400","$0","$2,000","$60","$2,400","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006000000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080042","Market HMO 2400 - Mercy","99969OH008",,"OHN002","OHS003","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080042-04","Market HMO 2400 - Mercy","73% AV Level Silver Plan",,"0.732001408158429","Yes","Yes","No","100%",,"$1,800","$0","$2,200","$60","$1,800","$0","$1,000","$60","$1,800","$0","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006001000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080042","Market HMO 2400 - Mercy","99969OH008",,"OHN002","OHS003","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080042-05","Market HMO 2400 - Mercy","87% AV Level Silver Plan",,"0.869384135216985","Yes","Yes","No","100%",,"$350","$0","$1,900","$60","$350","$0","$1,300","$60","$350","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006002000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080042","Market HMO 2400 - Mercy","99969OH008",,"OHN002","OHS003","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080042-06","Market HMO 2400 - Mercy","94% AV Level Silver Plan",,"0.943518531900987","Yes","Yes","No","100%",,"$100","$0","$900","$60","$100","$0","$700","$60","$100","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006003000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080046","Market HMO 2400 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080046-00","Market HMO 2400 - OhioHealth","Standard Silver Off Exchange Plan",,"0.692459238950112","Yes","Yes","No","100%",,"$2,400","$0","$2,000","$60","$2,400","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005005998000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080046","Market HMO 2400 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080046-01","Market HMO 2400 - OhioHealth","Standard Silver On Exchange Plan",,"0.692459238950112","Yes","Yes","No","100%",,"$2,400","$0","$2,000","$60","$2,400","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005005998000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080046","Market HMO 2400 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080046-02","Market HMO 2400 - OhioHealth","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005005999000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080046","Market HMO 2400 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080046-03","Market HMO 2400 - OhioHealth","Limited Cost Sharing Plan Variation",,"0.692459238950112","Yes","Yes","No","100%",,"$2,400","$0","$2,000","$60","$2,400","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006000000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080046","Market HMO 2400 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080046-04","Market HMO 2400 - OhioHealth","73% AV Level Silver Plan",,"0.732001408158429","Yes","Yes","No","100%",,"$1,800","$0","$2,200","$60","$1,800","$0","$1,000","$60","$1,800","$0","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006001000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080046","Market HMO 2400 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080046-05","Market HMO 2400 - OhioHealth","87% AV Level Silver Plan",,"0.869384135216985","Yes","Yes","No","100%",,"$350","$0","$1,900","$60","$350","$0","$1,300","$60","$350","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006002000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080046","Market HMO 2400 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080046-06","Market HMO 2400 - OhioHealth","94% AV Level Silver Plan",,"0.943518531900987","Yes","Yes","No","100%",,"$100","$0","$900","$60","$100","$0","$700","$60","$100","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006003000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080061","Market HMO 2400 - ProMedica","99969OH008",,"OHN007","OHS006","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080061-00","Market HMO 2400 - ProMedica","Standard Silver Off Exchange Plan",,"0.692459238950112","Yes","Yes","No","100%",,"$2,400","$0","$2,000","$60","$2,400","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005005998000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080061","Market HMO 2400 - ProMedica","99969OH008",,"OHN007","OHS006","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080061-01","Market HMO 2400 - ProMedica","Standard Silver On Exchange Plan",,"0.692459238950112","Yes","Yes","No","100%",,"$2,400","$0","$2,000","$60","$2,400","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005005998000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080061","Market HMO 2400 - ProMedica","99969OH008",,"OHN007","OHS006","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080061-02","Market HMO 2400 - ProMedica","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005005999000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080061","Market HMO 2400 - ProMedica","99969OH008",,"OHN007","OHS006","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080061-03","Market HMO 2400 - ProMedica","Limited Cost Sharing Plan Variation",,"0.692459238950112","Yes","Yes","No","100%",,"$2,400","$0","$2,000","$60","$2,400","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006000000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080061","Market HMO 2400 - ProMedica","99969OH008",,"OHN007","OHS006","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080061-04","Market HMO 2400 - ProMedica","73% AV Level Silver Plan",,"0.732001408158429","Yes","Yes","No","100%",,"$1,800","$0","$2,200","$60","$1,800","$0","$1,000","$60","$1,800","$0","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006001000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080061","Market HMO 2400 - ProMedica","99969OH008",,"OHN007","OHS006","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080061-05","Market HMO 2400 - ProMedica","87% AV Level Silver Plan",,"0.869384135216985","Yes","Yes","No","100%",,"$350","$0","$1,900","$60","$350","$0","$1,300","$60","$350","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006002000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080061","Market HMO 2400 - ProMedica","99969OH008",,"OHN007","OHS006","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080061-06","Market HMO 2400 - ProMedica","94% AV Level Silver Plan",,"0.943518531900987","Yes","Yes","No","100%",,"$100","$0","$900","$60","$100","$0","$700","$60","$100","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006003000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080070","Market HMO 2400 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080070-00","Market HMO 2400 - NE Ohio","Standard Silver Off Exchange Plan",,"0.692459238950112","Yes","Yes","No","100%",,"$2,400","$0","$2,000","$60","$2,400","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005005998000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080070","Market HMO 2400 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080070-01","Market HMO 2400 - NE Ohio","Standard Silver On Exchange Plan",,"0.692459238950112","Yes","Yes","No","100%",,"$2,400","$0","$2,000","$60","$2,400","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005005998000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080070","Market HMO 2400 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080070-02","Market HMO 2400 - NE Ohio","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005005999000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080070","Market HMO 2400 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080070-03","Market HMO 2400 - NE Ohio","Limited Cost Sharing Plan Variation",,"0.692459238950112","Yes","Yes","No","100%",,"$2,400","$0","$2,000","$60","$2,400","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006000000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080070","Market HMO 2400 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080070-04","Market HMO 2400 - NE Ohio","73% AV Level Silver Plan",,"0.732001408158429","Yes","Yes","No","100%",,"$1,800","$0","$2,200","$60","$1,800","$0","$1,000","$60","$1,800","$0","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006001000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080070","Market HMO 2400 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080070-05","Market HMO 2400 - NE Ohio","87% AV Level Silver Plan",,"0.869384135216985","Yes","Yes","No","100%",,"$350","$0","$1,900","$60","$350","$0","$1,300","$60","$350","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006002000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080070","Market HMO 2400 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080070-06","Market HMO 2400 - NE Ohio","94% AV Level Silver Plan",,"0.943518531900987","Yes","Yes","No","100%",,"$100","$0","$900","$60","$100","$0","$700","$60","$100","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006003000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080079","Market HMO 2400 - Mercy","99969OH008",,"OHN002","OHS007","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080079-00","Market HMO 2400 - Mercy","Standard Silver Off Exchange Plan",,"0.692459238950112","Yes","Yes","No","100%",,"$2,400","$0","$2,000","$60","$2,400","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005005998000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080079","Market HMO 2400 - Mercy","99969OH008",,"OHN002","OHS007","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080079-01","Market HMO 2400 - Mercy","Standard Silver On Exchange Plan",,"0.692459238950112","Yes","Yes","No","100%",,"$2,400","$0","$2,000","$60","$2,400","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005005998000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080079","Market HMO 2400 - Mercy","99969OH008",,"OHN002","OHS007","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080079-02","Market HMO 2400 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005005999000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080079","Market HMO 2400 - Mercy","99969OH008",,"OHN002","OHS007","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080079-03","Market HMO 2400 - Mercy","Limited Cost Sharing Plan Variation",,"0.692459238950112","Yes","Yes","No","100%",,"$2,400","$0","$2,000","$60","$2,400","$0","$900","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006000000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080079","Market HMO 2400 - Mercy","99969OH008",,"OHN002","OHS007","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080079-04","Market HMO 2400 - Mercy","73% AV Level Silver Plan",,"0.732001408158429","Yes","Yes","No","100%",,"$1,800","$0","$2,200","$60","$1,800","$0","$1,000","$60","$1,800","$0","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006001000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080079","Market HMO 2400 - Mercy","99969OH008",,"OHN002","OHS007","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080079-05","Market HMO 2400 - Mercy","87% AV Level Silver Plan",,"0.869384135216985","Yes","Yes","No","100%",,"$350","$0","$1,900","$60","$350","$0","$1,300","$60","$350","$0","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006002000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080079","Market HMO 2400 - Mercy","99969OH008",,"OHN002","OHS007","OHF004","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080079-06","Market HMO 2400 - Mercy","94% AV Level Silver Plan",,"0.943518531900987","Yes","Yes","No","100%",,"$100","$0","$900","$60","$100","$0","$700","$60","$100","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006003000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080043","Market HMO 3500 - Mercy","99969OH008",,"OHN002","OHS003","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080043-00","Market HMO 3500 - Mercy","Standard Silver Off Exchange Plan",,"0.708254607955166","No","Yes","No","100%",,"$3,500","$40","$2,700","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006004000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080043","Market HMO 3500 - Mercy","99969OH008",,"OHN002","OHS003","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080043-01","Market HMO 3500 - Mercy","Standard Silver On Exchange Plan",,"0.708254607955166","No","Yes","No","100%",,"$3,500","$40","$2,700","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006004000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080043","Market HMO 3500 - Mercy","99969OH008",,"OHN002","OHS003","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080043-02","Market HMO 3500 - Mercy","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006005000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080043","Market HMO 3500 - Mercy","99969OH008",,"OHN002","OHS003","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080043-03","Market HMO 3500 - Mercy","Limited Cost Sharing Plan Variation",,"0.708254607955166","No","Yes","No","100%",,"$3,500","$40","$2,700","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006006000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080043","Market HMO 3500 - Mercy","99969OH008",,"OHN002","OHS003","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080043-04","Market HMO 3500 - Mercy","73% AV Level Silver Plan",,"0.73017503301925","No","Yes","No","100%",,"$3,000","$0","$2,900","$60","$100","$2,000","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006007000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080043","Market HMO 3500 - Mercy","99969OH008",,"OHN002","OHS003","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080043-05","Market HMO 3500 - Mercy","87% AV Level Silver Plan",,"0.873374263688469","No","Yes","No","100%",,"$500","$0","$1,000","$60","$100","$1,400","$0","$60","$500","$400","$200","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006008000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080043","Market HMO 3500 - Mercy","99969OH008",,"OHN002","OHS003","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080043-06","Market HMO 3500 - Mercy","94% AV Level Silver Plan",,"0.946536683089195","No","Yes","No","100%",,"$100","$0","$400","$60","$100","$400","$0","$60","$100","$300","$100","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006009000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080047","Market HMO 3500 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080047-00","Market HMO 3500 - OhioHealth","Standard Silver Off Exchange Plan",,"0.708254607955166","No","Yes","No","100%",,"$3,500","$40","$2,700","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006004000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080047","Market HMO 3500 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080047-01","Market HMO 3500 - OhioHealth","Standard Silver On Exchange Plan",,"0.708254607955166","No","Yes","No","100%",,"$3,500","$40","$2,700","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006004000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080047","Market HMO 3500 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080047-02","Market HMO 3500 - OhioHealth","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006005000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080047","Market HMO 3500 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080047-03","Market HMO 3500 - OhioHealth","Limited Cost Sharing Plan Variation",,"0.708254607955166","No","Yes","No","100%",,"$3,500","$40","$2,700","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006006000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080047","Market HMO 3500 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080047-04","Market HMO 3500 - OhioHealth","73% AV Level Silver Plan",,"0.73017503301925","No","Yes","No","100%",,"$3,000","$0","$2,900","$60","$100","$2,000","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006007000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080047","Market HMO 3500 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080047-05","Market HMO 3500 - OhioHealth","87% AV Level Silver Plan",,"0.873374263688469","No","Yes","No","100%",,"$500","$0","$1,000","$60","$100","$1,400","$0","$60","$500","$400","$200","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006008000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080047","Market HMO 3500 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080047-06","Market HMO 3500 - OhioHealth","94% AV Level Silver Plan",,"0.946536683089195","No","Yes","No","100%",,"$100","$0","$400","$60","$100","$400","$0","$60","$100","$300","$100","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006009000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080062","Market HMO 3500 - ProMedica","99969OH008",,"OHN007","OHS006","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080062-00","Market HMO 3500 - ProMedica","Standard Silver Off Exchange Plan",,"0.708254607955166","No","Yes","No","100%",,"$3,500","$40","$2,700","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006004000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080062","Market HMO 3500 - ProMedica","99969OH008",,"OHN007","OHS006","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080062-01","Market HMO 3500 - ProMedica","Standard Silver On Exchange Plan",,"0.708254607955166","No","Yes","No","100%",,"$3,500","$40","$2,700","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006004000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080062","Market HMO 3500 - ProMedica","99969OH008",,"OHN007","OHS006","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080062-02","Market HMO 3500 - ProMedica","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006005000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080062","Market HMO 3500 - ProMedica","99969OH008",,"OHN007","OHS006","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080062-03","Market HMO 3500 - ProMedica","Limited Cost Sharing Plan Variation",,"0.708254607955166","No","Yes","No","100%",,"$3,500","$40","$2,700","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006006000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080062","Market HMO 3500 - ProMedica","99969OH008",,"OHN007","OHS006","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080062-04","Market HMO 3500 - ProMedica","73% AV Level Silver Plan",,"0.73017503301925","No","Yes","No","100%",,"$3,000","$0","$2,900","$60","$100","$2,000","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006007000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080062","Market HMO 3500 - ProMedica","99969OH008",,"OHN007","OHS006","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080062-05","Market HMO 3500 - ProMedica","87% AV Level Silver Plan",,"0.873374263688469","No","Yes","No","100%",,"$500","$0","$1,000","$60","$100","$1,400","$0","$60","$500","$400","$200","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006008000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080062","Market HMO 3500 - ProMedica","99969OH008",,"OHN007","OHS006","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080062-06","Market HMO 3500 - ProMedica","94% AV Level Silver Plan",,"0.946536683089195","No","Yes","No","100%",,"$100","$0","$400","$60","$100","$400","$0","$60","$100","$300","$100","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006009000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080071","Market HMO 3500 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080071-00","Market HMO 3500 - NE Ohio","Standard Silver Off Exchange Plan",,"0.708254607955166","No","Yes","No","100%",,"$3,500","$40","$2,700","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006004000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080071","Market HMO 3500 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080071-01","Market HMO 3500 - NE Ohio","Standard Silver On Exchange Plan",,"0.708254607955166","No","Yes","No","100%",,"$3,500","$40","$2,700","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006004000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080071","Market HMO 3500 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080071-02","Market HMO 3500 - NE Ohio","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006005000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080071","Market HMO 3500 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080071-03","Market HMO 3500 - NE Ohio","Limited Cost Sharing Plan Variation",,"0.708254607955166","No","Yes","No","100%",,"$3,500","$40","$2,700","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006006000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080071","Market HMO 3500 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080071-04","Market HMO 3500 - NE Ohio","73% AV Level Silver Plan",,"0.73017503301925","No","Yes","No","100%",,"$3,000","$0","$2,900","$60","$100","$2,000","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006007000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080071","Market HMO 3500 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080071-05","Market HMO 3500 - NE Ohio","87% AV Level Silver Plan",,"0.873374263688469","No","Yes","No","100%",,"$500","$0","$1,000","$60","$100","$1,400","$0","$60","$500","$400","$200","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006008000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080071","Market HMO 3500 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080071-06","Market HMO 3500 - NE Ohio","94% AV Level Silver Plan",,"0.946536683089195","No","Yes","No","100%",,"$100","$0","$400","$60","$100","$400","$0","$60","$100","$300","$100","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006009000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080080","Market HMO 3500 - Mercy","99969OH008",,"OHN002","OHS007","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080080-00","Market HMO 3500 - Mercy","Standard Silver Off Exchange Plan",,"0.708254607955166","No","Yes","No","100%",,"$3,500","$40","$2,700","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006004000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080080","Market HMO 3500 - Mercy","99969OH008",,"OHN002","OHS007","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080080-01","Market HMO 3500 - Mercy","Standard Silver On Exchange Plan",,"0.708254607955166","No","Yes","No","100%",,"$3,500","$40","$2,700","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006004000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080080","Market HMO 3500 - Mercy","99969OH008",,"OHN002","OHS007","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080080-02","Market HMO 3500 - Mercy","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006005000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080080","Market HMO 3500 - Mercy","99969OH008",,"OHN002","OHS007","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080080-03","Market HMO 3500 - Mercy","Limited Cost Sharing Plan Variation",,"0.708254607955166","No","Yes","No","100%",,"$3,500","$40","$2,700","$60","$100","$1,500","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006006000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080080","Market HMO 3500 - Mercy","99969OH008",,"OHN002","OHS007","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080080-04","Market HMO 3500 - Mercy","73% AV Level Silver Plan",,"0.73017503301925","No","Yes","No","100%",,"$3,000","$0","$2,900","$60","$100","$2,000","$0","$60","$1,100","$400","$0","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006007000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080080","Market HMO 3500 - Mercy","99969OH008",,"OHN002","OHS007","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080080-05","Market HMO 3500 - Mercy","87% AV Level Silver Plan",,"0.873374263688469","No","Yes","No","100%",,"$500","$0","$1,000","$60","$100","$1,400","$0","$60","$500","$400","$200","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006008000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080080","Market HMO 3500 - Mercy","99969OH008",,"OHN002","OHS007","OHF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080080-06","Market HMO 3500 - Mercy","94% AV Level Silver Plan",,"0.946536683089195","No","Yes","No","100%",,"$100","$0","$400","$60","$100","$400","$0","$60","$100","$300","$100","$0","$350","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://mybrokerlink.com/GetSbc?mmi=005006009000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-00","Market HMO 4000 HSA - Mercy","Standard Silver Off Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006010000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-01","Market HMO 4000 HSA - Mercy","Standard Silver On Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006010000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-02","Market HMO 4000 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006011000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-03","Market HMO 4000 - Mercy","Limited Cost Sharing Plan Variation",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006012000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-04","Market HMO 4000 HSA - Mercy","73% AV Level Silver Plan",,"0.722667595838822","Yes","Yes","No","100%",,"$3,500","$0","$0","$60","$3,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006013000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-05","Market HMO 4000 - Mercy","87% AV Level Silver Plan",,"0.862986557484674","Yes","Yes","No","100%",,"$1,250","$0","$0","$60","$1,250","$0","$0","$60","$1,250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006014000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-06","Market HMO 4000 - Mercy","94% AV Level Silver Plan",,"0.937977329745955","Yes","Yes","No","100%",,"$500","$0","$0","$60","$500","$0","$0","$60","$500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006015000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080023","Market HMO 4000 HSA - OhioHealth","99969OH008",,"OHN003","OHS004","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080023-00","Market HMO 4000 HSA - OhioHealth","Standard Silver Off Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006010000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080023","Market HMO 4000 HSA - OhioHealth","99969OH008",,"OHN003","OHS004","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080023-01","Market HMO 4000 HSA - OhioHealth","Standard Silver On Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006010000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080023","Market HMO 4000 HSA - OhioHealth","99969OH008",,"OHN003","OHS004","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080023-02","Market HMO 4000 - OhioHealth","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006011000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080023","Market HMO 4000 HSA - OhioHealth","99969OH008",,"OHN003","OHS004","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080023-03","Market HMO 4000 - OhioHealth","Limited Cost Sharing Plan Variation",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006012000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080023","Market HMO 4000 HSA - OhioHealth","99969OH008",,"OHN003","OHS004","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080023-04","Market HMO 4000 HSA - OhioHealth","73% AV Level Silver Plan",,"0.722667595838822","Yes","Yes","No","100%",,"$3,500","$0","$0","$60","$3,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006013000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080023","Market HMO 4000 HSA - OhioHealth","99969OH008",,"OHN003","OHS004","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080023-05","Market HMO 4000 - OhioHealth","87% AV Level Silver Plan",,"0.862986557484674","Yes","Yes","No","100%",,"$1,250","$0","$0","$60","$1,250","$0","$0","$60","$1,250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006014000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080023","Market HMO 4000 HSA - OhioHealth","99969OH008",,"OHN003","OHS004","OHF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080023-06","Market HMO 4000 - OhioHealth","94% AV Level Silver Plan",,"0.937977329745955","Yes","Yes","No","100%",,"$500","$0","$0","$60","$500","$0","$0","$60","$500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006015000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080063","Market HMO 4000 HSA - ProMedica","99969OH008",,"OHN007","OHS006","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080063-00","Market HMO 4000 HSA - ProMedica","Standard Silver Off Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006010000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080063","Market HMO 4000 HSA - ProMedica","99969OH008",,"OHN007","OHS006","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080063-01","Market HMO 4000 HSA - ProMedica","Standard Silver On Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006010000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080063","Market HMO 4000 HSA - ProMedica","99969OH008",,"OHN007","OHS006","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080063-02","Market HMO 4000 - ProMedica","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006011000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080063","Market HMO 4000 HSA - ProMedica","99969OH008",,"OHN007","OHS006","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080063-03","Market HMO 4000 - ProMedica","Limited Cost Sharing Plan Variation",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006012000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080063","Market HMO 4000 HSA - ProMedica","99969OH008",,"OHN007","OHS006","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080063-04","Market HMO 4000 HSA - ProMedica","73% AV Level Silver Plan",,"0.722667595838822","Yes","Yes","No","100%",,"$3,500","$0","$0","$60","$3,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006013000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080063","Market HMO 4000 HSA - ProMedica","99969OH008",,"OHN007","OHS006","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080063-05","Market HMO 4000 - ProMedica","87% AV Level Silver Plan",,"0.862986557484674","Yes","Yes","No","100%",,"$1,250","$0","$0","$60","$1,250","$0","$0","$60","$1,250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006014000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080063","Market HMO 4000 HSA - ProMedica","99969OH008",,"OHN007","OHS006","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080063-06","Market HMO 4000 - ProMedica","94% AV Level Silver Plan",,"0.937977329745955","Yes","Yes","No","100%",,"$500","$0","$0","$60","$500","$0","$0","$60","$500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006015000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080072","Market HMO 4000 HSA - NE Ohio","99969OH008",,"OHN005","OHS002","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080072-00","Market HMO 4000 HSA - NE Ohio","Standard Silver Off Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006010000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080072","Market HMO 4000 HSA - NE Ohio","99969OH008",,"OHN005","OHS002","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080072-01","Market HMO 4000 HSA - NE Ohio","Standard Silver On Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006010000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080072","Market HMO 4000 HSA - NE Ohio","99969OH008",,"OHN005","OHS002","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080072-02","Market HMO 4000 - NE Ohio","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006011000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080072","Market HMO 4000 HSA - NE Ohio","99969OH008",,"OHN005","OHS002","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080072-03","Market HMO 4000 - NE Ohio","Limited Cost Sharing Plan Variation",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006012000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080072","Market HMO 4000 HSA - NE Ohio","99969OH008",,"OHN005","OHS002","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080072-04","Market HMO 4000 HSA - NE Ohio","73% AV Level Silver Plan",,"0.722667595838822","Yes","Yes","No","100%",,"$3,500","$0","$0","$60","$3,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006013000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080072","Market HMO 4000 HSA - NE Ohio","99969OH008",,"OHN005","OHS002","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080072-05","Market HMO 4000 - NE Ohio","87% AV Level Silver Plan",,"0.862986557484674","Yes","Yes","No","100%",,"$1,250","$0","$0","$60","$1,250","$0","$0","$60","$1,250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006014000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080072","Market HMO 4000 HSA - NE Ohio","99969OH008",,"OHN005","OHS002","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080072-06","Market HMO 4000 - NE Ohio","94% AV Level Silver Plan",,"0.937977329745955","Yes","Yes","No","100%",,"$500","$0","$0","$60","$500","$0","$0","$60","$500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006015000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080081","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS007","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080081-00","Market HMO 4000 HSA - Mercy","Standard Silver Off Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006010000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080081","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS007","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080081-01","Market HMO 4000 HSA - Mercy","Standard Silver On Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006010000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080081","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS007","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080081-02","Market HMO 4000 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006011000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080081","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS007","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080081-03","Market HMO 4000 - Mercy","Limited Cost Sharing Plan Variation",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006012000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080081","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS007","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080081-04","Market HMO 4000 HSA - Mercy","73% AV Level Silver Plan",,"0.722667595838822","Yes","Yes","No","100%",,"$3,500","$0","$0","$60","$3,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006013000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080081","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS007","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080081-05","Market HMO 4000 - Mercy","87% AV Level Silver Plan",,"0.862986557484674","Yes","Yes","No","100%",,"$1,250","$0","$0","$60","$1,250","$0","$0","$60","$1,250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006014000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080081","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS007","OHF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080081-06","Market HMO 4000 - Mercy","94% AV Level Silver Plan",,"0.937977329745955","Yes","Yes","No","100%",,"$500","$0","$0","$60","$500","$0","$0","$60","$500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006015000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080044","Market HMO 5250 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080044-00","Market HMO 5250 HSA - Mercy","Standard Bronze Off Exchange Plan",,"0.617665028321858","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$5,250","$0","$0","$60","$1,900","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006016000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080044","Market HMO 5250 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080044-01","Market HMO 5250 HSA - Mercy","Standard Bronze On Exchange Plan",,"0.617665028321858","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$5,250","$0","$0","$60","$1,900","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006016000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080044","Market HMO 5250 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080044-02","Market HMO 5250 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006017000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080044","Market HMO 5250 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080044-03","Market HMO 5250 - Mercy","Limited Cost Sharing Plan Variation",,"0.617665028321858","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$5,250","$0","$0","$60","$1,900","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006018000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080048","Market HMO 5250 HSA - OhioHealth","99969OH008",,"OHN003","OHS004","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080048-00","Market HMO 5250 HSA - OhioHealth","Standard Bronze Off Exchange Plan",,"0.617665028321858","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$5,250","$0","$0","$60","$1,900","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006016000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080048","Market HMO 5250 HSA - OhioHealth","99969OH008",,"OHN003","OHS004","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080048-01","Market HMO 5250 HSA - OhioHealth","Standard Bronze On Exchange Plan",,"0.617665028321858","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$5,250","$0","$0","$60","$1,900","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006016000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080048","Market HMO 5250 HSA - OhioHealth","99969OH008",,"OHN003","OHS004","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080048-02","Market HMO 5250 - OhioHealth","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006017000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080048","Market HMO 5250 HSA - OhioHealth","99969OH008",,"OHN003","OHS004","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080048-03","Market HMO 5250 - OhioHealth","Limited Cost Sharing Plan Variation",,"0.617665028321858","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$5,250","$0","$0","$60","$1,900","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006018000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080064","Market HMO 5250 HSA - ProMedica","99969OH008",,"OHN007","OHS006","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080064-00","Market HMO 5250 HSA - ProMedica","Standard Bronze Off Exchange Plan",,"0.617665028321858","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$5,250","$0","$0","$60","$1,900","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006016000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080064","Market HMO 5250 HSA - ProMedica","99969OH008",,"OHN007","OHS006","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080064-01","Market HMO 5250 HSA - ProMedica","Standard Bronze On Exchange Plan",,"0.617665028321858","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$5,250","$0","$0","$60","$1,900","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006016000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080064","Market HMO 5250 HSA - ProMedica","99969OH008",,"OHN007","OHS006","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080064-02","Market HMO 5250 - ProMedica","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006017000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080064","Market HMO 5250 HSA - ProMedica","99969OH008",,"OHN007","OHS006","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080064-03","Market HMO 5250 - ProMedica","Limited Cost Sharing Plan Variation",,"0.617665028321858","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$5,250","$0","$0","$60","$1,900","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006018000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080073","Market HMO 5250 HSA - NE Ohio","99969OH008",,"OHN005","OHS002","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080073-00","Market HMO 5250 HSA - NE Ohio","Standard Bronze Off Exchange Plan",,"0.617665028321858","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$5,250","$0","$0","$60","$1,900","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006016000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080073","Market HMO 5250 HSA - NE Ohio","99969OH008",,"OHN005","OHS002","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080073-01","Market HMO 5250 HSA - NE Ohio","Standard Bronze On Exchange Plan",,"0.617665028321858","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$5,250","$0","$0","$60","$1,900","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006016000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080073","Market HMO 5250 HSA - NE Ohio","99969OH008",,"OHN005","OHS002","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080073-02","Market HMO 5250 - NE Ohio","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006017000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080073","Market HMO 5250 HSA - NE Ohio","99969OH008",,"OHN005","OHS002","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080073-03","Market HMO 5250 - NE Ohio","Limited Cost Sharing Plan Variation",,"0.617665028321858","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$5,250","$0","$0","$60","$1,900","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006018000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080082","Market HMO 5250 HSA - Mercy","99969OH008",,"OHN002","OHS007","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080082-00","Market HMO 5250 HSA - Mercy","Standard Bronze Off Exchange Plan",,"0.617665028321858","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$5,250","$0","$0","$60","$1,900","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006016000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080082","Market HMO 5250 HSA - Mercy","99969OH008",,"OHN002","OHS007","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080082-01","Market HMO 5250 HSA - Mercy","Standard Bronze On Exchange Plan",,"0.617665028321858","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$5,250","$0","$0","$60","$1,900","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006016000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080082","Market HMO 5250 HSA - Mercy","99969OH008",,"OHN002","OHS007","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080082-02","Market HMO 5250 HSA - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006017000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080082","Market HMO 5250 HSA - Mercy","99969OH008",,"OHN002","OHS007","OHF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080082-03","Market HMO 5250 HSA - Mercy","Limited Cost Sharing Plan Variation",,"0.617665028321858","Yes","Yes","No","100%",,"$5,250","$0","$0","$60","$5,250","$0","$0","$60","$1,900","$0","$0","$0","$350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006018000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080007","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080007-00","Market HMO 6400 HSA - Mercy","Standard Bronze Off Exchange Plan",,"0.608957768456605","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006019000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080007","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080007-01","Market HMO 6400 HSA - Mercy","Standard Bronze On Exchange Plan",,"0.608957768456605","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006019000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080007","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080007-02","Market HMO 6400 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006020000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080007","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS003","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080007-03","Market HMO 6400 - Mercy","Limited Cost Sharing Plan Variation",,"0.608957768456605","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006021000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080025","Market HMO 6400 HSA - OhioHealth","99969OH008",,"OHN003","OHS004","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080025-00","Market HMO 6400 HSA - OhioHealth","Standard Bronze Off Exchange Plan",,"0.608957768456605","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006019000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080025","Market HMO 6400 HSA - OhioHealth","99969OH008",,"OHN003","OHS004","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080025-01","Market HMO 6400 HSA - OhioHealth","Standard Bronze On Exchange Plan",,"0.608957768456605","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006019000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080025","Market HMO 6400 HSA - OhioHealth","99969OH008",,"OHN003","OHS004","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080025-02","Market HMO 6400 - OhioHealth","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006020000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080025","Market HMO 6400 HSA - OhioHealth","99969OH008",,"OHN003","OHS004","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080025-03","Market HMO 6400 - OhioHealth","Limited Cost Sharing Plan Variation",,"0.608957768456605","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006021000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080065","Market HMO 6400 HSA - ProMedica","99969OH008",,"OHN007","OHS006","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080065-00","Market HMO 6400 HSA - ProMedica","Standard Bronze Off Exchange Plan",,"0.608957768456605","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006019000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080065","Market HMO 6400 HSA - ProMedica","99969OH008",,"OHN007","OHS006","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080065-01","Market HMO 6400 HSA - ProMedica","Standard Bronze On Exchange Plan",,"0.608957768456605","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006019000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080065","Market HMO 6400 HSA - ProMedica","99969OH008",,"OHN007","OHS006","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080065-02","Market HMO 6400 - ProMedica","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006020000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080065","Market HMO 6400 HSA - ProMedica","99969OH008",,"OHN007","OHS006","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080065-03","Market HMO 6400 - ProMedica","Limited Cost Sharing Plan Variation",,"0.608957768456605","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006021000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080074","Market HMO 6400 HSA - NE Ohio","99969OH008",,"OHN005","OHS002","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080074-00","Market HMO 6400 HSA - NE Ohio","Standard Bronze Off Exchange Plan",,"0.608957768456605","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006019000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080074","Market HMO 6400 HSA - NE Ohio","99969OH008",,"OHN005","OHS002","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080074-01","Market HMO 6400 HSA - NE Ohio","Standard Bronze On Exchange Plan",,"0.608957768456605","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006019000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080074","Market HMO 6400 HSA - NE Ohio","99969OH008",,"OHN005","OHS002","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080074-02","Market HMO 6400 - NE Ohio","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006020000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080074","Market HMO 6400 HSA - NE Ohio","99969OH008",,"OHN005","OHS002","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080074-03","Market HMO 6400 - NE Ohio","Limited Cost Sharing Plan Variation",,"0.608957768456605","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006021000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080083","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS007","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080083-00","Market HMO 6400 HSA - Mercy","Standard Bronze Off Exchange Plan",,"0.608957768456605","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006019000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080083","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS007","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080083-01","Market HMO 6400 HSA - Mercy","Standard Bronze On Exchange Plan",,"0.608957768456605","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://mybrokerlink.com/GetSbc?mmi=005006019000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080083","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS007","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080083-02","Market HMO 6400 HSA - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006020000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080083","Market HMO 6400 HSA - Mercy","99969OH008",,"OHN002","OHS007","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080083-03","Market HMO 6400 HSA - Mercy","Limited Cost Sharing Plan Variation",,"0.608957768456605","Yes","Yes","No","100%",,"$6,400","$0","$0","$60","$6,400","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006021000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080012","Market HMO 7350 - Mercy","99969OH008",,"OHN002","OHS003","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080012-00","Market HMO 7350 - Mercy","Standard Bronze Off Exchange Plan",,"0.603717004480747","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006022000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080012","Market HMO 7350 - Mercy","99969OH008",,"OHN002","OHS003","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080012-01","Market HMO 7350 - Mercy","Standard Bronze On Exchange Plan",,"0.603717004480747","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006022000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080012","Market HMO 7350 - Mercy","99969OH008",,"OHN002","OHS003","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080012-02","Market HMO 7350 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006023000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080012","Market HMO 7350 - Mercy","99969OH008",,"OHN002","OHS003","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080012-03","Market HMO 7350 - Mercy","Limited Cost Sharing Plan Variation",,"0.603717004480747","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006024000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080026","Market HMO 7350 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080026-00","Market HMO 7350 - OhioHealth","Standard Bronze Off Exchange Plan",,"0.603717004480747","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006022000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080026","Market HMO 7350 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080026-01","Market HMO 7350 - OhioHealth","Standard Bronze On Exchange Plan",,"0.603717004480747","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006022000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080026","Market HMO 7350 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080026-02","Market HMO 7350 - OhioHealth","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006023000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080026","Market HMO 7350 - OhioHealth","99969OH008",,"OHN003","OHS004","OHF005","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080026-03","Market HMO 7350 - OhioHealth","Limited Cost Sharing Plan Variation",,"0.603717004480747","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006024000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080066","Market HMO 7350 - ProMedica","99969OH008",,"OHN007","OHS006","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080066-00","Market HMO 7350 - ProMedica","Standard Bronze Off Exchange Plan",,"0.603717004480747","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006022000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080066","Market HMO 7350 - ProMedica","99969OH008",,"OHN007","OHS006","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080066-01","Market HMO 7350 - ProMedica","Standard Bronze On Exchange Plan",,"0.603717004480747","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006022000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080066","Market HMO 7350 - ProMedica","99969OH008",,"OHN007","OHS006","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080066-02","Market HMO 7350 - ProMedica","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006023000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080066","Market HMO 7350 - ProMedica","99969OH008",,"OHN007","OHS006","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080066-03","Market HMO 7350 - ProMedica","Limited Cost Sharing Plan Variation",,"0.603717004480747","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006024000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080075","Market HMO 7350 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080075-00","Market HMO 7350 - NE Ohio","Standard Bronze Off Exchange Plan",,"0.603717004480747","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006022000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080075","Market HMO 7350 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080075-01","Market HMO 7350 - NE Ohio","Standard Bronze On Exchange Plan",,"0.603717004480747","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006022000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080075","Market HMO 7350 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080075-02","Market HMO 7350 - NE Ohio","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006023000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080075","Market HMO 7350 - NE Ohio","99969OH008",,"OHN005","OHS002","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080075-03","Market HMO 7350 - NE Ohio","Limited Cost Sharing Plan Variation",,"0.603717004480747","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006024000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080084","Market HMO 7350 - Mercy","99969OH008",,"OHN005","OHS007","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080084-00","Market HMO 7350 - Mercy","Standard Bronze Off Exchange Plan",,"0.603717004480747","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006022000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080084","Market HMO 7350 - Mercy","99969OH008",,"OHN005","OHS007","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080084-01","Market HMO 7350 - Mercy","Standard Bronze On Exchange Plan",,"0.603717004480747","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006022000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080084","Market HMO 7350 - Mercy","99969OH008",,"OHN005","OHS007","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080084-02","Market HMO 7350 - Mercy","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006023000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080084","Market HMO 7350 - Mercy","99969OH008",,"OHN005","OHS007","OHF005","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080084-03","Market HMO 7350 - Mercy","Limited Cost Sharing Plan Variation",,"0.603717004480747","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006024000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080045","Market HMO Young Adult Essentials - Mercy","99969OH008",,"OHN002","OHS003","OHF005","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080045-00","Market HMO Young Adult Essentials - Mercy","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006025000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080045","Market HMO Young Adult Essentials - Mercy","99969OH008",,"OHN002","OHS003","OHF005","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080045-01","Market HMO Young Adult Essentials - Mercy","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006025000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080049","Market HMO Young Adult Essentials - OhioHealth","99969OH008",,"OHN003","OHS004","OHF005","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080049-00","Market HMO Young Adult Essentials - OhioHealth","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006025000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080049","Market HMO Young Adult Essentials - OhioHealth","99969OH008",,"OHN003","OHS004","OHF005","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080049-01","Market HMO Young Adult Essentials - OhioHealth","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006025000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080067","Market HMO Young Adult Essentials - ProMedica","99969OH008",,"OHN007","OHS006","OHF005","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080067-00","Market HMO Young Adult Essentials - ProMedica","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006025000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080067","Market HMO Young Adult Essentials - ProMedica","99969OH008",,"OHN007","OHS006","OHF005","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080067-01","Market HMO Young Adult Essentials - ProMedica","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006025000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080076","Market HMO Young Adult Essentials - NE Ohio","99969OH008",,"OHN005","OHS002","OHF005","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080076-00","Market HMO Young Adult Essentials - NE Ohio","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006025000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080076","Market HMO Young Adult Essentials - NE Ohio","99969OH008",,"OHN005","OHS002","OHF005","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080076-01","Market HMO Young Adult Essentials - NE Ohio","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006025000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080085","Market HMO Young Adult Essentials - Mercy","99969OH008",,"OHN002","OHS007","OHF005","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080085-00","Market HMO Young Adult Essentials - Mercy","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006025000000000",
"2018","OH","99969","SERFF","2017-09-21 20:16:21","Individual","No","34-1442712","99969OH0080085","Market HMO Young Adult Essentials - Mercy","99969OH008",,"OHN002","OHS007","OHF005","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,"2018-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","No","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080085-01","Market HMO Young Adult Essentials - Mercy","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,400","$200","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://mybrokerlink.com/GetSbc?mmi=005006025000000000",
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","Yes","93-0245545","10091OR0720001","Dental Advantage 0-20-50","10091OR072",,"ORN005","ORS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Non-participating providers","No","https://www.exchangepay.pacificsource.com/FFE/Individual/","","10091OR0720001-00","Dental Advantage 0-20-50","Standard High Off Exchange Plan","86.53%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/oregon/individual-dental-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680001","SmartChoice Catastrophic","10091OR068",,"ORN002","ORS005","ORF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680001-00","SmartChoice Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/10091OR0680001-00.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","Yes","93-0245545","10091OR0720001","Dental Advantage 0-20-50","10091OR072",,"ORN005","ORS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Non-participating providers","No","https://www.exchangepay.pacificsource.com/FFE/Individual/","","10091OR0720001-01","Dental Advantage 0-20-50","Standard High On Exchange Plan","86.53%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/oregon/individual-dental-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680001","SmartChoice Catastrophic","10091OR068",,"ORN002","ORS005","ORF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680001-01","SmartChoice Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/10091OR0680001-01.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680005","Legacy Catastrophic","10091OR068",,"ORN003","ORS003","ORF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680005-00","Legacy Catastrophic","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/10091OR0680005-00.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680005","Legacy Catastrophic","10091OR068",,"ORN003","ORS003","ORF001","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680005-01","Legacy Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,184","$0","$0","$55","$1,925","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/10091OR0680005-01.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","Yes","93-0245545","10091OR0720002","Kids Dental Advantage 0-20-50","10091OR072",,"ORN005","ORS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Non-participating providers","No","https://www.exchangepay.pacificsource.com/FFE/Individual/","","10091OR0720002-00","Kids Dental Advantage 0-20-50","Standard High Off Exchange Plan","86.53%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/oregon/individual-dental-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680002","PacificSource Oregon Standard Bronze HSA Plan SCN","10091OR068",,"ORN002","ORS005","ORF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680002-00","PacificSource Oregon Standard Bronze HSA Plan SCN","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2018/SBC/10091OR0680002-00.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680002","PacificSource Oregon Standard Bronze HSA Plan SCN","10091OR068",,"ORN002","ORS005","ORF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680002-01","PacificSource Oregon Standard Bronze HSA Plan SCN","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2018/SBC/10091OR0680002-01.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","Yes","93-0245545","10091OR0720002","Kids Dental Advantage 0-20-50","10091OR072",,"ORN005","ORS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency care only","Yes","Non-participating providers","No","https://www.exchangepay.pacificsource.com/FFE/Individual/","","10091OR0720002-01","Kids Dental Advantage 0-20-50","Standard High On Exchange Plan","86.53%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://pacificsource.com/oregon/individual-dental-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680002","PacificSource Oregon Standard Bronze HSA Plan SCN","10091OR068",,"ORN002","ORS005","ORF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680002-02","PacificSource Oregon Standard Bronze Plan SCN","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://pacificsource.com/2018/SBC/10091OR0680002-02.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680002","PacificSource Oregon Standard Bronze HSA Plan SCN","10091OR068",,"ORN002","ORS005","ORF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680002-03","PacificSource Oregon Standard Bronze Plan SCN","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/10091OR0680002-03.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680006","PacificSource Oregon Standard Bronze HSA Plan LHN","10091OR068",,"ORN003","ORS003","ORF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680006-00","PacificSource Oregon Standard Bronze HSA Plan LHN","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2018/SBC/10091OR0680006-00.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680006","PacificSource Oregon Standard Bronze HSA Plan LHN","10091OR068",,"ORN003","ORS003","ORF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680006-01","PacificSource Oregon Standard Bronze HSA Plan LHN","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://pacificsource.com/2018/SBC/10091OR0680006-01.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680006","PacificSource Oregon Standard Bronze HSA Plan LHN","10091OR068",,"ORN003","ORS003","ORF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680006-02","PacificSource Oregon Standard Bronze Plan LHN","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://pacificsource.com/2018/SBC/10091OR0680006-02.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680006","PacificSource Oregon Standard Bronze HSA Plan LHN","10091OR068",,"ORN003","ORS003","ORF001","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680006-03","PacificSource Oregon Standard Bronze Plan LHN","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$55","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://pacificsource.com/2018/SBC/10091OR0680006-03.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680003","PacificSource Oregon Standard Silver Plan SCN","10091OR068",,"ORN002","ORS005","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680003-00","PacificSource Oregon Standard Silver Plan SCN","Standard Silver Off Exchange Plan",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$140","$3,720","$60","$1,303","$1,725","$558","$55","$991","$400","$425","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680003-00.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680003","PacificSource Oregon Standard Silver Plan SCN","10091OR068",,"ORN002","ORS005","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680003-01","PacificSource Oregon Standard Silver Plan SCN","Standard Silver On Exchange Plan",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$140","$3,720","$60","$1,303","$1,725","$558","$55","$991","$400","$425","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680003-01.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680003","PacificSource Oregon Standard Silver Plan SCN","10091OR068",,"ORN002","ORS005","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680003-02","PacificSource Oregon Standard Silver Plan SCN","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680003-02.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680003","PacificSource Oregon Standard Silver Plan SCN","10091OR068",,"ORN002","ORS005","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680003-03","PacificSource Oregon Standard Silver Plan SCN","Limited Cost Sharing Plan Variation",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$140","$3,720","$60","$1,303","$1,725","$558","$55","$991","$400","$425","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680003-03.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680003","PacificSource Oregon Standard Silver Plan SCN","10091OR068",,"ORN002","ORS005","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680003-04","PacificSource Oregon Standard Silver Plan SCN","73% AV Level Silver Plan",,"0.739705728444532","No","Yes","No","100%",,"$2,408","$0","$3,442","$60","$1,303","$1,435","$640","$55","$991","$280","$513","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680003-04.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680003","PacificSource Oregon Standard Silver Plan SCN","10091OR068",,"ORN002","ORS005","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680003-05","PacificSource Oregon Standard Silver Plan SCN","87% AV Level Silver Plan",,"0.879317618154505","No","Yes","No","100%",,"$850","$0","$1,150","$60","$850","$755","$213","$55","$850","$120","$171","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680003-05.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680003","PacificSource Oregon Standard Silver Plan SCN","10091OR068",,"ORN002","ORS005","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680003-06","PacificSource Oregon Standard Silver Plan SCN","94% AV Level Silver Plan",,"0.948751888340639","No","Yes","No","100%",,"$100","$0","$700","$60","$100","$365","$213","$55","$100","$80","$171","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680003-06.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680007","PacificSource Oregon Standard Silver Plan LHN","10091OR068",,"ORN003","ORS003","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680007-00","PacificSource Oregon Standard Silver Plan LHN","Standard Silver Off Exchange Plan",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$140","$3,720","$60","$1,303","$1,725","$558","$55","$991","$400","$425","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680007-00.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680007","PacificSource Oregon Standard Silver Plan LHN","10091OR068",,"ORN003","ORS003","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680007-01","PacificSource Oregon Standard Silver Plan LHN","Standard Silver On Exchange Plan",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$140","$3,720","$60","$1,303","$1,725","$558","$55","$991","$400","$425","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680007-01.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680007","PacificSource Oregon Standard Silver Plan LHN","10091OR068",,"ORN003","ORS003","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680007-02","PacificSource Oregon Standard Silver Plan LHN","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680007-02.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680007","PacificSource Oregon Standard Silver Plan LHN","10091OR068",,"ORN003","ORS003","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680007-03","PacificSource Oregon Standard Silver Plan LHN","Limited Cost Sharing Plan Variation",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$140","$3,720","$60","$1,303","$1,725","$558","$55","$991","$400","$425","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680007-03.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680007","PacificSource Oregon Standard Silver Plan LHN","10091OR068",,"ORN003","ORS003","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680007-04","PacificSource Oregon Standard Silver Plan LHN","73% AV Level Silver Plan",,"0.739705728444532","No","Yes","No","100%",,"$2,408","$0","$3,442","$60","$1,303","$1,435","$640","$55","$991","$280","$513","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680007-04.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680007","PacificSource Oregon Standard Silver Plan LHN","10091OR068",,"ORN003","ORS003","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680007-05","PacificSource Oregon Standard Silver Plan LHN","87% AV Level Silver Plan",,"0.879317618154505","No","Yes","No","100%",,"$850","$0","$1,150","$60","$850","$755","$213","$55","$850","$120","$171","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680007-05.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680007","PacificSource Oregon Standard Silver Plan LHN","10091OR068",,"ORN003","ORS003","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680007-06","PacificSource Oregon Standard Silver Plan LHN","94% AV Level Silver Plan",,"0.948751888340639","No","Yes","No","100%",,"$100","$0","$700","$60","$100","$365","$213","$55","$100","$80","$171","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680007-06.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680004","PacificSource Oregon Standard Gold Plan SCN","10091OR068",,"ORN002","ORS005","ORF007","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680004-00","PacificSource Oregon Standard Gold Plan SCN","Standard Gold Off Exchange Plan",,"0.806653050101976","No","Yes","No","100%",,"$1,000","$80","$2,480","$60","$1,000","$940","$372","$55","$1,000","$200","$359","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680004-00.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680004","PacificSource Oregon Standard Gold Plan SCN","10091OR068",,"ORN002","ORS005","ORF007","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680004-01","PacificSource Oregon Standard Gold Plan SCN","Standard Gold On Exchange Plan",,"0.806653050101976","No","Yes","No","100%",,"$1,000","$80","$2,480","$60","$1,000","$940","$372","$55","$1,000","$200","$359","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680004-01.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680004","PacificSource Oregon Standard Gold Plan SCN","10091OR068",,"ORN002","ORS005","ORF007","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680004-02","PacificSource Oregon Standard Gold Plan SCN","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680004-02.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680004","PacificSource Oregon Standard Gold Plan SCN","10091OR068",,"ORN002","ORS005","ORF007","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680004-03","PacificSource Oregon Standard Gold Plan SCN","Limited Cost Sharing Plan Variation",,"0.806653050101976","No","Yes","No","100%",,"$1,000","$80","$2,480","$60","$1,000","$940","$372","$55","$1,000","$200","$359","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680004-03.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680008","PacificSource Oregon Standard Gold Plan LHN","10091OR068",,"ORN003","ORS003","ORF007","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680008-00","PacificSource Oregon Standard Gold Plan LHN","Standard Gold Off Exchange Plan",,"0.806653050101976","No","Yes","No","100%",,"$1,000","$80","$2,480","$60","$1,000","$940","$372","$55","$1,000","$200","$359","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680008-00.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680008","PacificSource Oregon Standard Gold Plan LHN","10091OR068",,"ORN003","ORS003","ORF007","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680008-01","PacificSource Oregon Standard Gold Plan LHN","Standard Gold On Exchange Plan",,"0.806653050101976","No","Yes","No","100%",,"$1,000","$80","$2,480","$60","$1,000","$940","$372","$55","$1,000","$200","$359","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680008-01.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680008","PacificSource Oregon Standard Gold Plan LHN","10091OR068",,"ORN003","ORS003","ORF007","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680008-02","PacificSource Oregon Standard Gold Plan LHN","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680008-02.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","10091","SERFF","2017-10-16 20:15:22","Individual","No","93-0245545","10091OR0680008","PacificSource Oregon Standard Gold Plan LHN","10091OR068",,"ORN003","ORS003","ORF007","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,"2018-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","Yes","https://www.exchangepay.pacificsource.com/FFE/Individual/","https://www.pacificsource.com/drug-list/","10091OR0680008-03","PacificSource Oregon Standard Gold Plan LHN","Limited Cost Sharing Plan Variation",,"0.806653050101976","No","Yes","No","100%",,"$1,000","$80","$2,480","$60","$1,000","$940","$372","$55","$1,000","$200","$359","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://pacificsource.com/2018/SBC/10091OR0680008-03.pdf","https://pacificsource.com/oregon/individual-medical-brochure-2018.pdf"
"2018","OR","25486","SERFF","2017-09-21 20:16:21","Individual","Yes","93-0896677","25486OR0020001","SmartSmile-EC","25486OR002",,"ORN001","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.455","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","No","https://www.dentalhealthservices.com/OR/","","25486OR0020001-00","SmartSmile-EC","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dentalhealthservices.com/OR/","http://www.dentalhealthservices.com/or/or-copay.cfm"
"2018","OR","25486","SERFF","2017-09-21 20:16:21","Individual","Yes","93-0896677","25486OR0020001","SmartSmile-EC","25486OR002",,"ORN001","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.455","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","No","https://www.dentalhealthservices.com/OR/","","25486OR0020001-01","SmartSmile-EC","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dentalhealthservices.com/OR/","http://www.dentalhealthservices.com/or/or-copay.cfm"
"2018","OR","25486","SERFF","2017-09-21 20:16:21","Individual","Yes","93-0896677","25486OR0020002","Super SmartSmile-EC","25486OR002",,"ORN001","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.365","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","No","https://www.dentalhealthservices.com/OR/","","25486OR0020002-00","Super SmartSmile-EC","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dentalhealthservices.com/OR/","http://www.dentalhealthservices.com/or/or-copay.cfm"
"2018","OR","25486","SERFF","2017-09-21 20:16:21","Individual","Yes","93-0896677","25486OR0020002","Super SmartSmile-EC","25486OR002",,"ORN001","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.365","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","No","https://www.dentalhealthservices.com/OR/","","25486OR0020002-01","Super SmartSmile-EC","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dentalhealthservices.com/OR/","http://www.dentalhealthservices.com/or/or-copay.cfm"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560001","Moda Health Oregon Standard Gold (Beacon)","39424OR156",,"ORN001","ORS001","ORF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560001-02","Moda Health Oregon Standard Gold (Beacon)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$300","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_CSV0_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_CSV0_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560001","Moda Health Oregon Standard Gold (Beacon)","39424OR156",,"ORN001","ORS001","ORF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560001-03","Moda Health Oregon Standard Gold (Beacon)","Limited Cost Sharing Plan Variation",,"0.806653050101976","No","Yes","No","100%",,"$1,000","$30","$2,300","$300","$1,000","$900","$200","$60","$1,000","$100","$100","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560002","Moda Health Oregon Standard Silver (Beacon)","39424OR156",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9982",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560002-00","Moda Health Oregon Standard Silver (Beacon)","Standard Silver Off Exchange Plan",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$40","$3,000","$300","$1,860","$1,600","$0","$60","$1,530","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560002","Moda Health Oregon Standard Silver (Beacon)","39424OR156",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9982",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560002-01","Moda Health Oregon Standard Silver (Beacon)","Standard Silver On Exchange Plan",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$40","$3,000","$300","$1,860","$1,600","$0","$60","$1,530","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560002","Moda Health Oregon Standard Silver (Beacon)","39424OR156",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9982",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560002-02","Moda Health Oregon Standard Silver (Beacon)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$300","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV0_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV0_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560002","Moda Health Oregon Standard Silver (Beacon)","39424OR156",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9982",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560002-03","Moda Health Oregon Standard Silver (Beacon)","Limited Cost Sharing Plan Variation",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$40","$3,000","$300","$1,860","$1,600","$0","$60","$1,530","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560002","Moda Health Oregon Standard Silver (Beacon)","39424OR156",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9982",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560002-04","Moda Health Oregon Standard Silver (Beacon)","73% AV Level Silver Plan",,"0.739705728444532","No","Yes","No","100%",,"$2,500","$40","$3,000","$300","$1,860","$1,400","$0","$60","$1,530","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV1_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV1_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560002","Moda Health Oregon Standard Silver (Beacon)","39424OR156",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9982",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560002-05","Moda Health Oregon Standard Silver (Beacon)","87% AV Level Silver Plan",,"0.879317618154505","No","Yes","No","100%",,"$850","$0","$1,200","$300","$850","$800","$100","$60","$850","$90","$70","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV2_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV2_2018_OR.pdf"
"2018","OR","25486","SERFF","2017-09-21 20:16:21","Individual","Yes","93-0896677","25486OR0020003","SmartSmile Plus-EC","25486OR002",,"ORN001","ORS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.411","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","No","https://www.dentalhealthservices.com/OR/","","25486OR0020003-00","SmartSmile Plus-EC","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dentalhealthservices.com/OR/","http://www.dentalhealthservices.com/or/or-copay.cfm"
"2018","OR","25486","SERFF","2017-09-21 20:16:21","Individual","Yes","93-0896677","25486OR0020003","SmartSmile Plus-EC","25486OR002",,"ORN001","ORS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.411","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","Yes","Emergency coverage only - for the relief of pain, swelling, and bleeding.","No","https://www.dentalhealthservices.com/OR/","","25486OR0020003-01","SmartSmile Plus-EC","Standard High On Exchange Plan","83.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dentalhealthservices.com/OR/","http://www.dentalhealthservices.com/or/or-copay.cfm"
"2018","OR","28415","SERFF","2017-08-16 20:15:58","Individual","Yes","93-0438772","28415OR0010001","Delta Dental PPO","28415OR001",,"ORN001","ORS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","providers treated as out of network","Yes","national network","Yes",,"","28415OR0010001-00","Delta Dental PPO","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO_2018_OR.pdf"
"2018","OR","28415","SERFF","2017-08-16 20:15:58","Individual","Yes","93-0438772","28415OR0010001","Delta Dental PPO","28415OR001",,"ORN001","ORS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","providers treated as out of network","Yes","national network","Yes",,"","28415OR0010001-01","Delta Dental PPO","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO_2018_OR.pdf"
"2018","OR","28415","SERFF","2017-08-16 20:15:58","Individual","Yes","93-0438772","28415OR0010002","Delta Dental Exclusive PPO","28415OR001",,"ORN001","ORS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","National Network","Yes","Providers treated as out of network","Yes",,"","28415OR0010002-00","Delta Dental Exclusive PPO","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalExclusivePPO_2018_OR.pdf"
"2018","OR","28415","SERFF","2017-08-16 20:15:58","Individual","Yes","93-0438772","28415OR0010002","Delta Dental Exclusive PPO","28415OR001",,"ORN001","ORS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","National Network","Yes","Providers treated as out of network","Yes",,"","28415OR0010002-01","Delta Dental Exclusive PPO","Standard High On Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalExclusivePPO_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1580001","Moda Health Beacon Be Protected Gold 1000","39424OR158",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580001-00","Moda Health Beacon Be Protected Gold 1000","Standard Gold Off Exchange Plan",,"0.800034357544914","Yes","Yes","No","100%",,"$1,000","$30","$1,700","$300","$1,000","$400","$1,600","$60","$1,000","$90","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtectedGold_1000_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtectedGold_1000_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1580001","Moda Health Beacon Be Protected Gold 1000","39424OR158",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580001-01","Moda Health Beacon Be Protected Gold 1000","Standard Gold On Exchange Plan",,"0.800034357544914","Yes","Yes","No","100%",,"$1,000","$30","$1,700","$300","$1,000","$400","$1,600","$60","$1,000","$90","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtectedGold_1000_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtectedGold_1000_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1580001","Moda Health Beacon Be Protected Gold 1000","39424OR158",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580001-02","Moda Health Beacon Be Protected Gold 1000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$300","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtectedGold_1000_CSV0_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtectedGold_1000_CSV0_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1580001","Moda Health Beacon Be Protected Gold 1000","39424OR158",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580001-03","Moda Health Beacon Be Protected Gold 1000","Limited Cost Sharing Plan Variation",,"0.800034357544914","Yes","Yes","No","100%",,"$1,000","$30","$1,700","$300","$1,000","$400","$1,600","$60","$1,000","$90","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtectedGold_1000_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtectedGold_1000_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1580002","Moda Health Beacon Be Prepared Silver 3000","39424OR158",,"ORN001","ORS001","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580002-00","Moda Health Beacon Be Prepared Silver 3000","Standard Silver Off Exchange Plan",,"0.706554880809081","Yes","Yes","No","100%",,"$3,000","$40","$2,800","$300","$1,860","$800","$1,400","$60","$1,530","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePreparedSilver_3000_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePreparedSilver_3000_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1580002","Moda Health Beacon Be Prepared Silver 3000","39424OR158",,"ORN001","ORS001","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580002-01","Moda Health Beacon Be Prepared Silver 3000","Standard Silver On Exchange Plan",,"0.706554880809081","Yes","Yes","No","100%",,"$3,000","$40","$2,800","$300","$1,860","$800","$1,400","$60","$1,530","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePreparedSilver_3000_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePreparedSilver_3000_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1580002","Moda Health Beacon Be Prepared Silver 3000","39424OR158",,"ORN001","ORS001","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580002-02","Moda Health Beacon Be Prepared Silver 3000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$300","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePreparedSilver_3000_CSV0_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePreparedSilver_3000_CSV0_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1580002","Moda Health Beacon Be Prepared Silver 3000","39424OR158",,"ORN001","ORS001","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580002-03","Moda Health Beacon Be Prepared Silver 3000","Limited Cost Sharing Plan Variation",,"0.706554880809081","Yes","Yes","No","100%",,"$3,000","$40","$2,800","$300","$1,860","$800","$1,400","$60","$1,530","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePreparedSilver_3000_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePreparedSilver_3000_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1580002","Moda Health Beacon Be Prepared Silver 3000","39424OR158",,"ORN001","ORS001","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580002-04","Moda Health Beacon Be Prepared Silver 3000","73% AV Level Silver Plan",,"0.729252628964129","Yes","Yes","No","100%",,"$3,000","$40","$2,700","$300","$1,860","$800","$1,400","$60","$1,530","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePreparedSilver_3000_CSV1_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePreparedSilver_3000_CSV1_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1580002","Moda Health Beacon Be Prepared Silver 3000","39424OR158",,"ORN001","ORS001","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580002-05","Moda Health Beacon Be Prepared Silver 3000","87% AV Level Silver Plan",,"0.866757503288941","Yes","Yes","No","100%",,"$750","$0","$800","$300","$690","$400","$400","$60","$750","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePreparedSilver_3000_CSV2_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePreparedSilver_3000_CSV2_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1580002","Moda Health Beacon Be Prepared Silver 3000","39424OR158",,"ORN001","ORS001","ORF003","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1580002-06","Moda Health Beacon Be Prepared Silver 3000","94% AV Level Silver Plan",,"0.943855630395434","Yes","Yes","No","100%",,"$100","$0","$400","$300","$100","$200","$200","$60","$100","$30","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","30.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePreparedSilver_3000_CSV3_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePreparedSilver_3000_CSV3_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1460005","Moda Health Beacon Gold 1500","39424OR146",,"ORN001","ORS001","ORF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9983",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460005-00","Moda Health Beacon Gold 1500","Standard Gold Off Exchange Plan",,"0.765263027469168","Yes","Yes","No","100%",,"$1,500","$30","$2,700","$300","$1,500","$500","$1,500","$60","$1,500","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconGold_1500_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconGold_1500_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1460005","Moda Health Beacon Gold 1500","39424OR146",,"ORN001","ORS001","ORF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9983",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460005-01","Moda Health Beacon Gold 1500","Standard Gold On Exchange Plan",,"0.765263027469168","Yes","Yes","No","100%",,"$1,500","$30","$2,700","$300","$1,500","$500","$1,500","$60","$1,500","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconGold_1500_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconGold_1500_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1460005","Moda Health Beacon Gold 1500","39424OR146",,"ORN001","ORS001","ORF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9983",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460005-02","Moda Health Beacon Gold 1500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$300","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconGold_1500_CSV0_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconGold_1500_CSV0_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1460005","Moda Health Beacon Gold 1500","39424OR146",,"ORN001","ORS001","ORF001","New","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9983",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460005-03","Moda Health Beacon Gold 1500","Limited Cost Sharing Plan Variation",,"0.765263027469168","Yes","Yes","No","100%",,"$1,500","$30","$2,700","$300","$1,500","$500","$1,500","$60","$1,500","$200","$10","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$26,000","$26000 per person","$52000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconGold_1500_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconGold_1500_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1460006","Moda Health Beacon Silver 3500","39424OR146",,"ORN001","ORS001","ORF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460006-00","Moda Health Beacon Silver 3500","Standard Silver Off Exchange Plan",,"0.699308068198211","Yes","Yes","No","100%",,"$3,500","$40","$3,100","$300","$1,860","$800","$1,400","$60","$1,530","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","35.00%",,,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconSilver_3500_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconSilver_3500_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1460006","Moda Health Beacon Silver 3500","39424OR146",,"ORN001","ORS001","ORF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460006-01","Moda Health Beacon Silver 3500","Standard Silver On Exchange Plan",,"0.699308068198211","Yes","Yes","No","100%",,"$3,500","$40","$3,100","$300","$1,860","$800","$1,400","$60","$1,530","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","35.00%",,,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconSilver_3500_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconSilver_3500_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1460006","Moda Health Beacon Silver 3500","39424OR146",,"ORN001","ORS001","ORF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460006-02","Moda Health Beacon Silver 3500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$300","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconSilver_3500_CSV0_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconSilver_3500_CSV0_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1460006","Moda Health Beacon Silver 3500","39424OR146",,"ORN001","ORS001","ORF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460006-03","Moda Health Beacon Silver 3500","Limited Cost Sharing Plan Variation",,"0.699308068198211","Yes","Yes","No","100%",,"$3,500","$40","$3,100","$300","$1,860","$800","$1,400","$60","$1,530","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","35.00%",,,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconSilver_3500_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconSilver_3500_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1460006","Moda Health Beacon Silver 3500","39424OR146",,"ORN001","ORS001","ORF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460006-04","Moda Health Beacon Silver 3500","73% AV Level Silver Plan",,"0.724374986483172","Yes","Yes","No","100%",,"$3,500","$0","$2,200","$300","$1,860","$800","$1,400","$60","$1,530","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","35.00%",,,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconSilver_3500_CSV1_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconSilver_3500_CSV1_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1460006","Moda Health Beacon Silver 3500","39424OR146",,"ORN001","ORS001","ORF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460006-05","Moda Health Beacon Silver 3500","87% AV Level Silver Plan",,"0.866295511603322","Yes","Yes","No","100%",,"$660","$0","$800","$300","$690","$400","$400","$60","$750","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","35.00%",,,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconSilver_3500_CSV2_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconSilver_3500_CSV2_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1460006","Moda Health Beacon Silver 3500","39424OR146",,"ORN001","ORS001","ORF003","New","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460006-06","Moda Health Beacon Silver 3500","94% AV Level Silver Plan",,"0.943642830212195","Yes","Yes","No","100%",,"$100","$0","$400","$300","$100","$200","$200","$60","$100","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","35.00%",,,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconSilver_3500_CSV3_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconSilver_3500_CSV3_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1460007","Moda Health Beacon Bronze 6250","39424OR146",,"ORN001","ORS001","ORF005","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460007-00","Moda Health Beacon Bronze 6250","Standard Bronze Off Exchange Plan",,"0.645244710291435","Yes","Yes","No","100%",,"$6,250","$0","$1,100","$300","$5,440","$600","$300","$60","$1,530","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","40.00%",,,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconBronze_6250_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconBronze_6250_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1460007","Moda Health Beacon Bronze 6250","39424OR146",,"ORN001","ORS001","ORF005","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460007-01","Moda Health Beacon Bronze 6250","Standard Bronze On Exchange Plan",,"0.645244710291435","Yes","Yes","No","100%",,"$6,250","$0","$1,100","$300","$5,440","$600","$300","$60","$1,530","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","40.00%",,,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconBronze_6250_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconBronze_6250_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1460007","Moda Health Beacon Bronze 6250","39424OR146",,"ORN001","ORS001","ORF005","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460007-02","Moda Health Beacon Bronze 6250","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$300","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconBronze_6250_CSV0_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconBronze_6250_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1460007","Moda Health Beacon Bronze 6250","39424OR146",,"ORN001","ORS001","ORF005","New","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460007-03","Moda Health Beacon Bronze 6250","Limited Cost Sharing Plan Variation",,"0.645244710291435","Yes","Yes","No","100%",,"$6,250","$0","$1,100","$300","$5,440","$600","$300","$60","$1,530","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","40.00%",,,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconBronze_6250_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_BeaconBronze_6250_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560001","Moda Health Oregon Standard Gold (Beacon)","39424OR156",,"ORN001","ORS001","ORF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560001-00","Moda Health Oregon Standard Gold (Beacon)","Standard Gold Off Exchange Plan",,"0.806653050101976","No","Yes","No","100%",,"$1,000","$30","$2,300","$300","$1,000","$900","$200","$60","$1,000","$100","$100","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560001","Moda Health Oregon Standard Gold (Beacon)","39424OR156",,"ORN001","ORS001","ORF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560001-01","Moda Health Oregon Standard Gold (Beacon)","Standard Gold On Exchange Plan",,"0.806653050101976","No","Yes","No","100%",,"$1,000","$30","$2,300","$300","$1,000","$900","$200","$60","$1,000","$100","$100","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560002","Moda Health Oregon Standard Silver (Beacon)","39424OR156",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9982",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560002-06","Moda Health Oregon Standard Silver (Beacon)","94% AV Level Silver Plan",,"0.948751888340639","No","Yes","No","100%",,"$100","$0","$700","$300","$100","$400","$200","$60","$100","$60","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV3_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV3_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560003","Moda Health Oregon Standard Bronze HSA Plan (Beacon)","39424OR156",,"ORN001","ORS001","ORF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560003-00","Moda Health Oregon Standard Bronze HSA Plan (Beacon)","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$300","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560003","Moda Health Oregon Standard Bronze HSA Plan (Beacon)","39424OR156",,"ORN001","ORS001","ORF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560003-01","Moda Health Oregon Standard Bronze HSA Plan (Beacon)","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$300","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560003","Moda Health Oregon Standard Bronze HSA Plan (Beacon)","39424OR156",,"ORN001","ORS001","ORF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560003-02","Moda Health Oregon Standard Bronze HSA Plan (Beacon)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$300","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_CSV0_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_CSV0_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560003","Moda Health Oregon Standard Bronze HSA Plan (Beacon)","39424OR156",,"ORN001","ORS001","ORF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560003-03","Moda Health Oregon Standard Bronze HSA Plan (Beacon)","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$300","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560004","Moda Health Oregon Standard Gold (Affinity)","39424OR156",,"ORN002","ORS002","ORF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560004-00","Moda Health Oregon Standard Gold (Affinity)","Standard Gold Off Exchange Plan",,"0.806653050101976","No","Yes","No","100%",,"$1,000","$30","$2,300","$300","$1,000","$900","$200","$60","$1,000","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardGold_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardGold_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560004","Moda Health Oregon Standard Gold (Affinity)","39424OR156",,"ORN002","ORS002","ORF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560004-01","Moda Health Oregon Standard Gold (Affinity)","Standard Gold On Exchange Plan",,"0.806653050101976","No","Yes","No","100%",,"$1,000","$30","$2,300","$300","$1,000","$900","$200","$60","$1,000","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardGold_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardGold_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560004","Moda Health Oregon Standard Gold (Affinity)","39424OR156",,"ORN002","ORS002","ORF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560004-02","Moda Health Oregon Standard Gold (Affinity)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$300","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardGold_CSV0_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardGold_CSV0_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560004","Moda Health Oregon Standard Gold (Affinity)","39424OR156",,"ORN002","ORS002","ORF006","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560004-03","Moda Health Oregon Standard Gold (Affinity)","Limited Cost Sharing Plan Variation",,"0.806653050101976","No","Yes","No","100%",,"$1,000","$30","$2,300","$300","$1,000","$900","$200","$60","$1,000","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardGold_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardGold_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560005","Moda Health Oregon Standard Silver (Affinity)","39424OR156",,"ORN002","ORS002","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560005-00","Moda Health Oregon Standard Silver (Affinity)","Standard Silver Off Exchange Plan",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$40","$3,000","$300","$1,860","$1,600","$0","$60","$1,530","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560005","Moda Health Oregon Standard Silver (Affinity)","39424OR156",,"ORN002","ORS002","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560005-01","Moda Health Oregon Standard Silver (Affinity)","Standard Silver On Exchange Plan",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$40","$3,000","$300","$1,860","$1,600","$0","$60","$1,530","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560005","Moda Health Oregon Standard Silver (Affinity)","39424OR156",,"ORN002","ORS002","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560005-02","Moda Health Oregon Standard Silver (Affinity)","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$300","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_CSV0_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_CSV0_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560005","Moda Health Oregon Standard Silver (Affinity)","39424OR156",,"ORN002","ORS002","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560005-03","Moda Health Oregon Standard Silver (Affinity)","Limited Cost Sharing Plan Variation",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$40","$3,000","$300","$1,860","$1,600","$0","$60","$1,530","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560005","Moda Health Oregon Standard Silver (Affinity)","39424OR156",,"ORN002","ORS002","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560005-04","Moda Health Oregon Standard Silver (Affinity)","73% AV Level Silver Plan",,"0.739705728444532","No","Yes","No","100%",,"$2,500","$40","$3,000","$300","$1,860","$1,400","$0","$60","$1,530","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_CSV1_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_CSV1_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560005","Moda Health Oregon Standard Silver (Affinity)","39424OR156",,"ORN002","ORS002","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560005-05","Moda Health Oregon Standard Silver (Affinity)","87% AV Level Silver Plan",,"0.879317618154505","No","Yes","No","100%",,"$850","$0","$1,200","$300","$850","$800","$100","$60","$850","$90","$70","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_CSV2_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_CSV2_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560005","Moda Health Oregon Standard Silver (Affinity)","39424OR156",,"ORN002","ORS002","ORF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560005-06","Moda Health Oregon Standard Silver (Affinity)","94% AV Level Silver Plan",,"0.948751888340639","No","Yes","No","100%",,"$100","$0","$700","$300","$100","$400","$200","$60","$100","$60","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$29,400","$29400 per person","$58800 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_CSV3_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardSilver_CSV3_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560006","Moda Health Oregon Standard Bronze HSA Plan (Affinity)","39424OR156",,"ORN002","ORS002","ORF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560006-00","Moda Health Oregon Standard Bronze HSA Plan (Affinity)","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$300","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardBronze_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardBronze_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560006","Moda Health Oregon Standard Bronze HSA Plan (Affinity)","39424OR156",,"ORN002","ORS002","ORF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560006-01","Moda Health Oregon Standard Bronze HSA Plan (Affinity)","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$300","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardBronze_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardBronze_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560006","Moda Health Oregon Standard Bronze HSA Plan (Affinity)","39424OR156",,"ORN002","ORS002","ORF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560006-02","Moda Health Oregon Standard Bronze HSA Plan (Affinity)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$300","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardBronze_CSV0_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardBronze_CSV0_2018_OR.pdf"
"2018","OR","39424","SERFF","2017-10-16 20:15:22","Individual","No","93-0989307","39424OR1560006","Moda Health Oregon Standard Bronze HSA Plan (Affinity)","39424OR156",,"ORN002","ORS002","ORF004","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,"2018-01-01",,"No",,"No",,"No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1560006-03","Moda Health Oregon Standard Bronze HSA Plan (Affinity)","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$300","$6,550","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$26,200","$26200 per person","$52400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardBronze_SBC_2018_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Affinity_OregonStandardBronze_2018_OR.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1350001","Providence Oregon Standard Gold Signature Network","56707OR135",,"ORN001","ORS001","ORF003","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.991",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1350001-00","Providence Oregon Standard Gold Signature Network","Standard Gold Off Exchange Plan",,"0.805929779898703","No","Yes","No","100%",,"$1,000","$80","$2,480","$60","$110","$940","$30","$60","$1,000","$200","$280","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Signature/2018 OR IND Providence Oregon Standard Gold Plan  Signature Network00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1350001","Providence Oregon Standard Gold Signature Network","56707OR135",,"ORN001","ORS001","ORF003","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.991",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1350001-01","Providence Oregon Standard Gold Signature Network","Standard Gold On Exchange Plan",,"0.805929779898703","No","Yes","No","100%",,"$1,000","$80","$2,480","$60","$110","$940","$30","$60","$1,000","$200","$280","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Signature/2018 OR IND Providence Oregon Standard Gold Plan  Signature Network01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1350001","Providence Oregon Standard Gold Signature Network","56707OR135",,"ORN001","ORS001","ORF003","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.991",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1350001-02","Providence Oregon Standard Gold Signature Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Signature/2018 OR IND Providence Oregon Standard Gold Plan  Signature Network02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1350001","Providence Oregon Standard Gold Signature Network","56707OR135",,"ORN001","ORS001","ORF003","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.991",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1350001-03","Providence Oregon Standard Gold Signature Network","Limited Cost Sharing Plan Variation",,"0.805929779898703","No","Yes","No","100%",,"$1,000","$80","$2,480","$60","$110","$940","$30","$60","$1,000","$200","$280","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Signature/2018 OR IND Providence Oregon Standard Gold Plan  Signature Network03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1360001","Providence Oregon Standard Silver Signature Network","56707OR136",,"ORN001","ORS001","ORF004","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9892",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1360001-00","Providence Oregon Standard Silver Signature Network","Standard Silver Off Exchange Plan",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$140","$3,720","$60","$90","$1,730","$40","$60","$990","$400","$420","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Choice/2018 OR IND Providence Oregon Standard Silver Plan  Choice Network00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1360001","Providence Oregon Standard Silver Signature Network","56707OR136",,"ORN001","ORS001","ORF004","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9892",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1360001-01","Providence Oregon Standard Silver Signature Network","Standard Silver On Exchange Plan",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$140","$3,720","$60","$90","$1,730","$40","$60","$990","$400","$420","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Choice/2018 OR IND Providence Oregon Standard Silver Plan  Choice Network01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1360001","Providence Oregon Standard Silver Signature Network","56707OR136",,"ORN001","ORS001","ORF004","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9892",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1360001-02","Providence Oregon Standard Silver Signature Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Choice/2018 OR IND Providence Oregon Standard Silver Plan  Choice Network02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1360001","Providence Oregon Standard Silver Signature Network","56707OR136",,"ORN001","ORS001","ORF004","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9892",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1360001-03","Providence Oregon Standard Silver Signature Network","Limited Cost Sharing Plan Variation",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$140","$3,720","$60","$90","$1,730","$40","$60","$990","$400","$420","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Choice/2018 OR IND Providence Oregon Standard Silver Plan  Choice Network03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1360001","Providence Oregon Standard Silver Signature Network","56707OR136",,"ORN001","ORS001","ORF004","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9892",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1360001-04","Providence Oregon Standard Silver Signature Network","73% AV Level Silver Plan",,"0.739705728444532","No","Yes","No","100%",,"$2,410","$0","$3,440","$60","$90","$1,580","$40","$60","$990","$370","$420","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Choice/2018 OR IND Providence Oregon Standard Silver Plan  Choice Network04 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1360001","Providence Oregon Standard Silver Signature Network","56707OR136",,"ORN001","ORS001","ORF004","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9892",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1360001-05","Providence Oregon Standard Silver Signature Network","87% AV Level Silver Plan",,"0.879317618154505","No","Yes","No","100%",,"$850","$0","$1,150","$60","$120","$820","$10","$60","$850","$150","$140","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Choice/2018 OR IND Providence Oregon Standard Silver Plan  Choice Network05 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1360001","Providence Oregon Standard Silver Signature Network","56707OR136",,"ORN001","ORS001","ORF004","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9892",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1360001-06","Providence Oregon Standard Silver Signature Network","94% AV Level Silver Plan",,"0.948751888340639","No","Yes","No","100%",,"$100","$0","$700","$60","$100","$410","$10","$60","$100","$100","$140","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Choice/2018 OR IND Providence Oregon Standard Silver Plan  Choice Network06 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1370001","Providence Oregon Standard Bronze HSA Signature Network","56707OR137",,"ORN001","ORS001","ORF005","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1370001-00","Providence Oregon Standard Bronze HSA Signature Network","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Choice/2018 OR IND Providence Oregon Standard Bronze HSA Plan  Choice Network00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1370001","Providence Oregon Standard Bronze HSA Signature Network","56707OR137",,"ORN001","ORS001","ORF005","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1370001-01","Providence Oregon Standard Bronze HSA Signature Network","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Choice/2018 OR IND Providence Oregon Standard Bronze HSA Plan  Choice Network01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1370001","Providence Oregon Standard Bronze HSA Signature Network","56707OR137",,"ORN001","ORS001","ORF005","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1370001-02","Providence Oregon Standard Bronze HSA Signature Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Choice/2018 OR IND Providence Oregon Standard Bronze HSA Plan  Choice Network02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1370001","Providence Oregon Standard Bronze HSA Signature Network","56707OR137",,"ORN001","ORS001","ORF005","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9867",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1370001-03","Providence Oregon Standard Bronze HSA Signature Network","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Choice/2018 OR IND Providence Oregon Standard Bronze HSA Plan  Choice Network03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1320001","Providence Oregon Standard Gold Choice Network","56707OR132",,"ORN002","ORS002","ORF003","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99147",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1320001-00","Providence Oregon Standard Gold Choice Network","Standard Gold Off Exchange Plan",,"0.805929779898703","No","Yes","No","100%",,"$1,000","$80","$2,480","$60","$110","$940","$30","$60","$1,000","$200","$280","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Signature/2018 OR IND Providence Oregon Standard Gold Plan  Signature Network00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1320001","Providence Oregon Standard Gold Choice Network","56707OR132",,"ORN002","ORS002","ORF003","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99147",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1320001-01","Providence Oregon Standard Gold Choice Network","Standard Gold On Exchange Plan",,"0.805929779898703","No","Yes","No","100%",,"$1,000","$80","$2,480","$60","$110","$940","$30","$60","$1,000","$200","$280","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Signature/2018 OR IND Providence Oregon Standard Gold Plan  Signature Network01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1320001","Providence Oregon Standard Gold Choice Network","56707OR132",,"ORN002","ORS002","ORF003","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99147",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1320001-02","Providence Oregon Standard Gold Choice Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Signature/2018 OR IND Providence Oregon Standard Gold Plan  Signature Network02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1320001","Providence Oregon Standard Gold Choice Network","56707OR132",,"ORN002","ORS002","ORF003","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99147",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1320001-03","Providence Oregon Standard Gold Choice Network","Limited Cost Sharing Plan Variation",,"0.805929779898703","No","Yes","No","100%",,"$1,000","$80","$2,480","$60","$110","$940","$30","$60","$1,000","$200","$280","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Signature/2018 OR IND Providence Oregon Standard Gold Plan  Signature Network03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1330001","Providence Oregon Standard Silver Choice Network","56707OR133",,"ORN002","ORS002","ORF004","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9889",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1330001-00","Providence Oregon Standard Silver Choice Network","Standard Silver Off Exchange Plan",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$140","$3,720","$60","$90","$1,730","$40","$60","$990","$400","$420","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Signature/2018 OR IND Providence Oregon Standard Silver Plan  Signature Network00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1330001","Providence Oregon Standard Silver Choice Network","56707OR133",,"ORN002","ORS002","ORF004","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9889",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1330001-01","Providence Oregon Standard Silver Choice Network","Standard Silver On Exchange Plan",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$140","$3,720","$60","$90","$1,730","$40","$60","$990","$400","$420","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Signature/2018 OR IND Providence Oregon Standard Silver Plan  Signature Network01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1330001","Providence Oregon Standard Silver Choice Network","56707OR133",,"ORN002","ORS002","ORF004","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9889",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1330001-02","Providence Oregon Standard Silver Choice Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Signature/2018 OR IND Providence Oregon Standard Silver Plan  Signature Network02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1330001","Providence Oregon Standard Silver Choice Network","56707OR133",,"ORN002","ORS002","ORF004","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9889",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1330001-03","Providence Oregon Standard Silver Choice Network","Limited Cost Sharing Plan Variation",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$140","$3,720","$60","$90","$1,730","$40","$60","$990","$400","$420","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Signature/2018 OR IND Providence Oregon Standard Silver Plan  Signature Network03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1330001","Providence Oregon Standard Silver Choice Network","56707OR133",,"ORN002","ORS002","ORF004","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9889",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1330001-04","Providence Oregon Standard Silver Choice Network","73% AV Level Silver Plan",,"0.739705728444532","No","Yes","No","100%",,"$2,410","$0","$3,440","$60","$90","$1,580","$40","$60","$990","$370","$420","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Signature/2018 OR IND Providence Oregon Standard Silver Plan  Signature Network04 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1330001","Providence Oregon Standard Silver Choice Network","56707OR133",,"ORN002","ORS002","ORF004","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9889",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1330001-05","Providence Oregon Standard Silver Choice Network","87% AV Level Silver Plan",,"0.879317618154505","No","Yes","No","100%",,"$850","$0","$1,150","$60","$120","$820","$10","$60","$850","$150","$140","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Signature/2018 OR IND Providence Oregon Standard Silver Plan  Signature Network05 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1330001","Providence Oregon Standard Silver Choice Network","56707OR133",,"ORN002","ORS002","ORF004","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9889",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1330001-06","Providence Oregon Standard Silver Choice Network","94% AV Level Silver Plan",,"0.948751888340639","No","Yes","No","100%",,"$100","$0","$700","$60","$100","$410","$10","$60","$100","$100","$140","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Signature/2018 OR IND Providence Oregon Standard Silver Plan  Signature Network06 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1340001","Providence Oregon Standard Bronze HSA Choice Network","56707OR134",,"ORN002","ORS002","ORF005","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9863",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1340001-00","Providence Oregon Standard Bronze HSA Choice Network","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Signature/2018 OR IND Providence Oregon Standard Bronze HSA Plan  Signature Network00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1340001","Providence Oregon Standard Bronze HSA Choice Network","56707OR134",,"ORN002","ORS002","ORF005","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9863",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1340001-01","Providence Oregon Standard Bronze HSA Choice Network","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Signature/2018 OR IND Providence Oregon Standard Bronze HSA Plan  Signature Network01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1340001","Providence Oregon Standard Bronze HSA Choice Network","56707OR134",,"ORN002","ORS002","ORF005","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9863",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1340001-02","Providence Oregon Standard Bronze HSA Choice Network","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Signature/2018 OR IND Providence Oregon Standard Bronze HSA Plan  Signature Network02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1340001","Providence Oregon Standard Bronze HSA Choice Network","56707OR134",,"ORN002","ORS002","ORF005","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9863",,,"2018-01-01","2018-12-31","No",,"Yes","National Network","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1340001-03","Providence Oregon Standard Bronze HSA Choice Network","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/Signature/2018 OR IND Providence Oregon Standard Bronze HSA Plan  Signature Network03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0600004","BridgeSpan Standard Gold Plan EPO OHSU Plus","63474OR060",,"ORN002","ORS002","ORF006","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.99851429002229",,,"2018-01-01",,"No",,"No",,"No",,"https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0600004-03","BridgeSpan Standard Gold Plan EPO OHSU Plus","Limited Cost Sharing Plan Variation",,"0.806652511792053","No","Yes","No","100%",,"$1,000","$33","$2,243","$60","$102","$1,624","$0","$255","$1,000","$200","$127","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/StandardGoldPlanEPO+300Ex","https://www.bridgespanhealth.com/go/policy/2018/OR/StandardGoldPlanEPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0600005","BridgeSpan Standard Silver Plan EPO OHSU Plus","63474OR060",,"ORN002","ORS002","ORF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.998086970645365",,,"2018-01-01",,"No",,"No",,"No",,"https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0600005-00","BridgeSpan Standard Silver Plan EPO OHSU Plus","Standard Silver Off Exchange Plan",,"0.718777138979002","No","Yes","No","100%",,"$2,500","$36","$2,914","$60","$102","$2,695","$0","$255","$1,636","$289","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/StandardSilverPlanEPO","https://www.bridgespanhealth.com/go/policy/2018/OR/StandardSilverPlanEPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0600005","BridgeSpan Standard Silver Plan EPO OHSU Plus","63474OR060",,"ORN002","ORS002","ORF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.998086970645365",,,"2018-01-01",,"No",,"No",,"No",,"https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0600005-01","BridgeSpan Standard Silver Plan EPO OHSU Plus","Standard Silver On Exchange Plan",,"0.718777138979002","No","Yes","No","100%",,"$2,500","$36","$2,914","$60","$102","$2,695","$0","$255","$1,636","$289","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/StandardSilverPlanEPOEx","https://www.bridgespanhealth.com/go/policy/2018/OR/StandardSilverPlanEPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0600005","BridgeSpan Standard Silver Plan EPO OHSU Plus","63474OR060",,"ORN002","ORS002","ORF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.998086970645365",,,"2018-01-01",,"No",,"No",,"No",,"https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0600005-02","BridgeSpan Standard Silver Plan EPO OHSU Plus","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$255","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/StandardSilverPlanEPO-300Ex","https://www.bridgespanhealth.com/go/policy/2018/OR/StandardSilverPlanEPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0600005","BridgeSpan Standard Silver Plan EPO OHSU Plus","63474OR060",,"ORN002","ORS002","ORF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.998086970645365",,,"2018-01-01",,"No",,"No",,"No",,"https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0600005-03","BridgeSpan Standard Silver Plan EPO OHSU Plus","Limited Cost Sharing Plan Variation",,"0.718777138979002","No","Yes","No","100%",,"$2,500","$36","$2,914","$60","$102","$2,695","$0","$255","$1,636","$289","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/StandardSilverPlanEPO+300Ex","https://www.bridgespanhealth.com/go/policy/2018/OR/StandardSilverPlanEPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0600005","BridgeSpan Standard Silver Plan EPO OHSU Plus","63474OR060",,"ORN002","ORS002","ORF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.998086970645365",,,"2018-01-01",,"No",,"No",,"No",,"https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0600005-04","BridgeSpan Standard Silver Plan EPO OHSU Plus","73% AV Level Silver Plan",,"0.739742366431346","No","Yes","No","100%",,"$2,500","$36","$2,914","$60","$102","$2,458","$0","$255","$1,636","$281","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/StandardSilverPlanEPO73Ex","https://www.bridgespanhealth.com/go/policy/2018/OR/StandardSilverPlanEPOEx"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1380001","Connect 2500 Silver","56707OR138",,"ORN003","ORS003","ORF001","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9881",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1380001-00","Connect 2500 Silver","Standard Silver Off Exchange Plan","71.23%","0.733075328218236","Yes","Yes","No","100%",,"$2,500","$130","$3,720","$60","$0","$1,900","$560","$60","$1,140","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/2018 OR IND Connect 2500 Silver00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1380001","Connect 2500 Silver","56707OR138",,"ORN003","ORS003","ORF001","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9881",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1380001-01","Connect 2500 Silver","Standard Silver On Exchange Plan","71.23%","0.733075328218236","Yes","Yes","No","100%",,"$2,500","$130","$3,720","$60","$0","$1,900","$560","$60","$1,140","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/2018 OR IND Connect 2500 Silver01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1380001","Connect 2500 Silver","56707OR138",,"ORN003","ORS003","ORF001","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9881",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1380001-02","Connect 2500 Silver","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/2018 OR IND Connect 2500 Silver02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1380001","Connect 2500 Silver","56707OR138",,"ORN003","ORS003","ORF001","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9881",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1380001-03","Connect 2500 Silver","Limited Cost Sharing Plan Variation","71.23%","0.733075328218236","Yes","Yes","No","100%",,"$2,500","$130","$3,720","$60","$0","$1,900","$560","$60","$1,140","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/2018 OR IND Connect 2500 Silver03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1380001","Connect 2500 Silver","56707OR138",,"ORN003","ORS003","ORF001","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9881",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1380001-04","Connect 2500 Silver","73% AV Level Silver Plan","73.85%","0.757430761199693","Yes","Yes","No","100%",,"$1,790","$0","$3,510","$60","$0","$1,900","$560","$60","$1,140","$150","$490","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/2018 OR IND Connect 2500 Silver04 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1380001","Connect 2500 Silver","56707OR138",,"ORN003","ORS003","ORF001","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9881",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1380001-05","Connect 2500 Silver","87% AV Level Silver Plan","87.55%","0.883704870264349","Yes","Yes","No","100%",,"$750","$10","$1,240","$60","$0","$1,040","$190","$60","$750","$90","$160","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/2018 OR IND Connect 2500 Silver05 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1380001","Connect 2500 Silver","56707OR138",,"ORN003","ORS003","ORF001","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9881",,,"2018-01-01","2018-12-31","No",,"No",,"No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1380001-06","Connect 2500 Silver","94% AV Level Silver Plan","94.62%","0.947569574736775","Yes","Yes","No","100%",,"$100","$30","$620","$60","$0","$680","$70","$60","$100","$60","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/2018 OR IND Connect 2500 Silver06 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1380002","Connect 7350 Bronze","56707OR138",,"ORN003","ORS003","ORF002","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.985",,,"2018-01-01","2018-12-31","No",,"No",,"No",,"https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1380002-00","Connect 7350 Bronze","Standard Bronze Off Exchange Plan",,"0.609709625080478","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$3,990","$1,330","$860","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/2018 OR IND Connect 7350 Bronze00 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1380002","Connect 7350 Bronze","56707OR138",,"ORN003","ORS003","ORF002","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.985",,,"2018-01-01","2018-12-31","No",,"No",,"No",,"https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1380002-01","Connect 7350 Bronze","Standard Bronze On Exchange Plan",,"0.609709625080478","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$3,990","$1,330","$860","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/2018 OR IND Connect 7350 Bronze01 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1380002","Connect 7350 Bronze","56707OR138",,"ORN003","ORS003","ORF002","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.985",,,"2018-01-01","2018-12-31","No",,"No",,"No",,"https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1380002-02","Connect 7350 Bronze","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/2018 OR IND Connect 7350 Bronze02 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","56707","SERFF","2017-11-01 20:15:29","Individual","No","93-0863097","56707OR1380002","Connect 7350 Bronze","56707OR138",,"ORN003","ORS003","ORF002","New","EPO","Bronze","Not Applicable","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.985",,,"2018-01-01","2018-12-31","No",,"No",,"No",,"https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1380002-03","Connect 7350 Bronze","Limited Cost Sharing Plan Variation",,"0.609709625080478","Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$3,990","$1,330","$860","$60","$1,930","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/sbc/2018 OR IND Connect 7350 Bronze03 SBC.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2018/plan overview.pdf"
"2018","OR","60013","SERFF","2017-08-07 20:15:53","Individual","Yes","93-1171647","60013OR0020002","ProCare Oregon Plan 1","60013OR002",,"ORN001","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"Services that are not dentally appropriate are not covered.  Services that are not listed as covered in the policy are not covered.",,"No","Allows Adult and Child-Only",,,,,"0.688","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","The enrollee may seek treatment for a dental emergency from a non-participating provider if the enrollee is 50-miles or more from the nearest participating provider’s office.  The company will reimburse the enrollee up to $100 toward covered services provided for treatment of the dental emergency, minus applicable copayments.","No","http://www.willamettedental.com/pco-member","","60013OR0020002-00","ProCare Oregon Plan 1","Standard Low Off Exchange Plan","68.03%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.willamettedental.com/_literature_239820/2018_ProCare_OR_Ben_Sum_Plan_1","http://www.willamettedental.com/pco-member"
"2018","OR","60013","SERFF","2017-08-07 20:15:53","Individual","Yes","93-1171647","60013OR0020002","ProCare Oregon Plan 1","60013OR002",,"ORN001","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"Services that are not dentally appropriate are not covered.  Services that are not listed as covered in the policy are not covered.",,"No","Allows Adult and Child-Only",,,,,"0.688","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","The enrollee may seek treatment for a dental emergency from a non-participating provider if the enrollee is 50-miles or more from the nearest participating provider’s office.  The company will reimburse the enrollee up to $100 toward covered services provided for treatment of the dental emergency, minus applicable copayments.","No","http://www.willamettedental.com/pco-member","","60013OR0020002-01","ProCare Oregon Plan 1","Standard Low On Exchange Plan","68.03%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.willamettedental.com/_literature_239820/2018_ProCare_OR_Ben_Sum_Plan_1","http://www.willamettedental.com/pco-member"
"2018","OR","60013","SERFF","2017-08-07 20:15:53","Individual","Yes","93-1171647","60013OR0020003","ProCare Oregon Plan 2","60013OR002",,"ORN001","ORS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,"Services that are not dentally appropriate are not covered.  Services that are not listed as covered in the policy are not covered.",,"No","Allows Adult and Child-Only",,,,,"0.719","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","The enrollee may seek treatment for a dental emergency from a non-participating provider if the enrollee is 50-miles or more from the nearest participating provider’s office.  The company will reimburse the enrollee up to $100 toward covered services provided for treatment of the dental emergency, minus applicable copayments.","No","http://www.willamettedental.com/pco-member","","60013OR0020003-00","ProCare Oregon Plan 2","Standard High Off Exchange Plan","86.59%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.willamettedental.com/_literature_239821/2018_ProCare_OR_Ben_Sum_Plan_2","http://www.willamettedental.com/pco-member"
"2018","OR","60013","SERFF","2017-08-07 20:15:53","Individual","Yes","93-1171647","60013OR0020003","ProCare Oregon Plan 2","60013OR002",,"ORN001","ORS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,"Services that are not dentally appropriate are not covered.  Services that are not listed as covered in the policy are not covered.",,"No","Allows Adult and Child-Only",,,,,"0.719","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","The enrollee may seek treatment for a dental emergency from a non-participating provider if the enrollee is 50-miles or more from the nearest participating provider’s office.  The company will reimburse the enrollee up to $100 toward covered services provided for treatment of the dental emergency, minus applicable copayments.","No","http://www.willamettedental.com/pco-member","","60013OR0020003-01","ProCare Oregon Plan 2","Standard High On Exchange Plan","86.59%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.willamettedental.com/_literature_239821/2018_ProCare_OR_Ben_Sum_Plan_2","http://www.willamettedental.com/pco-member"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0590006","Silver HDHP 3000 EPO OHSU Plus","63474OR059",,"ORN002","ORS002","ORF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997922689371769",,,"2018-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0590006-00","Silver HDHP 3000 EPO OHSU Plus","Standard Silver Off Exchange Plan",,"0.684008843591775","Yes","Yes","No","100%",,"$3,000","$0","$925","$60","$3,000","$0","$1,032","$255","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/SilverHDHP3000EPOEx","https://www.bridgespanhealth.com/go/policy/2018/OR/SilverHDHP3000EPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0590006","Silver HDHP 3000 EPO OHSU Plus","63474OR059",,"ORN002","ORS002","ORF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997922689371769",,,"2018-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0590006-01","Silver HDHP 3000 EPO OHSU Plus","Standard Silver On Exchange Plan",,"0.684008843591775","Yes","Yes","No","100%",,"$3,000","$0","$925","$60","$3,000","$0","$1,032","$255","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/SilverHDHP3000EPOEx","https://www.bridgespanhealth.com/go/policy/2018/OR/SilverHDHP3000EPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0590006","Silver HDHP 3000 EPO OHSU Plus","63474OR059",,"ORN002","ORS002","ORF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997922689371769",,,"2018-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0590006-02","Silver HDHP 3000 EPO OHSU Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$255","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/SilverHDHP3000EPO-300Ex","https://www.bridgespanhealth.com/go/policy/2018/OR/SilverHDHP3000EPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0590006","Silver HDHP 3000 EPO OHSU Plus","63474OR059",,"ORN002","ORS002","ORF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997922689371769",,,"2018-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0590006-03","Silver HDHP 3000 EPO OHSU Plus","Limited Cost Sharing Plan Variation",,"0.684008843591775","Yes","Yes","No","100%",,"$3,000","$0","$925","$60","$3,000","$0","$1,032","$255","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/SilverHDHP3000EPO+300Ex","https://www.bridgespanhealth.com/go/policy/2018/OR/SilverHDHP3000EPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0590006","Silver HDHP 3000 EPO OHSU Plus","63474OR059",,"ORN002","ORS002","ORF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997922689371769",,,"2018-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0590006-04","Silver HDHP 3000 EPO OHSU Plus","73% AV Level Silver Plan",,"0.731003179862851","Yes","Yes","No","100%",,"$2,100","$0","$1,015","$60","$2,100","$0","$1,068","$255","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","per person not applicable","$4200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/SilverHDHP3000EPO73Ex","https://www.bridgespanhealth.com/go/policy/2018/OR/SilverHDHP3000EPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0590006","Silver HDHP 3000 EPO OHSU Plus","63474OR059",,"ORN002","ORS002","ORF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997922689371769",,,"2018-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0590006-05","Silver HDHP 3000 EPO OHSU Plus","87% AV Level Silver Plan",,"0.870636026189644","Yes","Yes","No","100%",,"$550","$0","$1,170","$60","$550","$0","$1,375","$255","$550","$0","$138","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","per person not applicable","$1100 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/SilverHDHP3000EPO87Ex","https://www.bridgespanhealth.com/go/policy/2018/OR/SilverHDHP3000EPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0590006","Silver HDHP 3000 EPO OHSU Plus","63474OR059",,"ORN002","ORS002","ORF002","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997922689371769",,,"2018-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0590006-06","Silver HDHP 3000 EPO OHSU Plus","94% AV Level Silver Plan",,"0.939702806686699","Yes","Yes","No","100%",,"$100","$0","$800","$60","$100","$0","$800","$255","$100","$0","$183","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/SilverHDHP3000EPO94Ex","https://www.bridgespanhealth.com/go/policy/2018/OR/SilverHDHP3000EPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0590004","Bronze HDHP 6000 EPO OHSU Plus","63474OR059",,"ORN002","ORS002","ORF004","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997491412329818",,,"2018-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0590004-00","Bronze HDHP 6000 EPO OHSU Plus","Standard Bronze Off Exchange Plan",,"0.604275277665417","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$312","$255","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/BronzeHDHP6000EPOEx","https://www.bridgespanhealth.com/go/policy/2018/OR/BronzeHDHP6000EPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0590004","Bronze HDHP 6000 EPO OHSU Plus","63474OR059",,"ORN002","ORS002","ORF004","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997491412329818",,,"2018-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0590004-01","Bronze HDHP 6000 EPO OHSU Plus","Standard Bronze On Exchange Plan",,"0.604275277665417","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$312","$255","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/BronzeHDHP6000EPOEx","https://www.bridgespanhealth.com/go/policy/2018/OR/BronzeHDHP6000EPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0590004","Bronze HDHP 6000 EPO OHSU Plus","63474OR059",,"ORN002","ORS002","ORF004","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997491412329818",,,"2018-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0590004-02","Bronze HDHP 6000 EPO OHSU Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$255","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/BronzeHDHP6000EPO-300Ex","https://www.bridgespanhealth.com/go/policy/2018/OR/BronzeHDHP6000EPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0590004","Bronze HDHP 6000 EPO OHSU Plus","63474OR059",,"ORN002","ORS002","ORF004","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997491412329818",,,"2018-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0590004-03","Bronze HDHP 6000 EPO OHSU Plus","Limited Cost Sharing Plan Variation",,"0.604275277665417","Yes","Yes","No","100%",,"$6,000","$0","$650","$60","$6,000","$0","$312","$255","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/BronzeHDHP6000EPO+300Ex","https://www.bridgespanhealth.com/go/policy/2018/OR/BronzeHDHP6000EPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0590005","Bronze Essential 7150 EPO OHSU Plus","63474OR059",,"ORN002","ORS002","ORF005","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997641830546018",,,"2018-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0590005-00","Bronze Essential 7150 EPO OHSU Plus","Standard Bronze Off Exchange Plan",,"0.603475531476691","Yes","Yes","No","100%",,"$7,150","$0","$200","$60","$5,412","$749","$0","$255","$1,636","$261","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/BronzeEssential7150EPOEx","https://www.bridgespanhealth.com/go/policy/2018/OR/BronzeEssential7150EPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0590005","Bronze Essential 7150 EPO OHSU Plus","63474OR059",,"ORN002","ORS002","ORF005","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997641830546018",,,"2018-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0590005-01","Bronze Essential 7150 EPO OHSU Plus","Standard Bronze On Exchange Plan",,"0.603475531476691","Yes","Yes","No","100%",,"$7,150","$0","$200","$60","$5,412","$749","$0","$255","$1,636","$261","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/BronzeEssential7150EPOEx","https://www.bridgespanhealth.com/go/policy/2018/OR/BronzeEssential7150EPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0590005","Bronze Essential 7150 EPO OHSU Plus","63474OR059",,"ORN002","ORS002","ORF005","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997641830546018",,,"2018-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0590005-02","Bronze Essential 7150 EPO OHSU Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$255","$0","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/BronzeEssential7150EPO-300Ex","https://www.bridgespanhealth.com/go/policy/2018/OR/BronzeEssential7150EPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0590005","Bronze Essential 7150 EPO OHSU Plus","63474OR059",,"ORN002","ORS002","ORF005","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997641830546018",,,"2018-01-01",,"No",,"No",,"No","https://bridgespanhealth.com","https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0590005-03","Bronze Essential 7150 EPO OHSU Plus","Limited Cost Sharing Plan Variation",,"0.603475531476691","Yes","Yes","No","100%",,"$7,150","$0","$200","$60","$5,412","$749","$0","$255","$1,636","$261","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/BronzeEssential7150EPO+300Ex","https://www.bridgespanhealth.com/go/policy/2018/OR/BronzeEssential7150EPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0600004","BridgeSpan Standard Gold Plan EPO OHSU Plus","63474OR060",,"ORN002","ORS002","ORF006","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.99851429002229",,,"2018-01-01",,"No",,"No",,"No",,"https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0600004-00","BridgeSpan Standard Gold Plan EPO OHSU Plus","Standard Gold Off Exchange Plan",,"0.806652511792053","No","Yes","No","100%",,"$1,000","$33","$2,243","$60","$102","$1,624","$0","$255","$1,000","$200","$127","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/StandardGoldPlanEPO","https://www.bridgespanhealth.com/go/policy/2018/OR/StandardGoldPlanEPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0600004","BridgeSpan Standard Gold Plan EPO OHSU Plus","63474OR060",,"ORN002","ORS002","ORF006","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.99851429002229",,,"2018-01-01",,"No",,"No",,"No",,"https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0600004-01","BridgeSpan Standard Gold Plan EPO OHSU Plus","Standard Gold On Exchange Plan",,"0.806652511792053","No","Yes","No","100%",,"$1,000","$33","$2,243","$60","$102","$1,624","$0","$255","$1,000","$200","$127","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/StandardGoldPlanEPOEX","https://www.bridgespanhealth.com/go/policy/2018/OR/StandardGoldPlanEPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0600004","BridgeSpan Standard Gold Plan EPO OHSU Plus","63474OR060",,"ORN002","ORS002","ORF006","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.99851429002229",,,"2018-01-01",,"No",,"No",,"No",,"https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0600004-02","BridgeSpan Standard Gold Plan EPO OHSU Plus","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$255","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/StandardGoldPlanEPO-300Ex","https://www.bridgespanhealth.com/go/policy/2018/OR/StandardGoldPlanEPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0600005","BridgeSpan Standard Silver Plan EPO OHSU Plus","63474OR060",,"ORN002","ORS002","ORF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.998086970645365",,,"2018-01-01",,"No",,"No",,"No",,"https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0600005-05","BridgeSpan Standard Silver Plan EPO OHSU Plus","87% AV Level Silver Plan",,"0.879329405293239","No","Yes","No","100%",,"$850","$14","$1,136","$60","$102","$1,409","$0","$255","$850","$150","$79","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/StandardSilverPlanEPO87Ex","https://www.bridgespanhealth.com/go/policy/2018/OR/StandardSilverPlanEPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0600005","BridgeSpan Standard Silver Plan EPO OHSU Plus","63474OR060",,"ORN002","ORS002","ORF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.998086970645365",,,"2018-01-01",,"No",,"No",,"No",,"https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0600005-06","BridgeSpan Standard Silver Plan EPO OHSU Plus","94% AV Level Silver Plan",,"0.948751888340639","No","Yes","No","100%",,"$100","$0","$700","$60","$100","$690","$0","$255","$100","$100","$154","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/StandardSilverPlanEPO94Ex","https://www.bridgespanhealth.com/go/policy/2018/OR/StandardSilverPlanEPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0600006","BridgeSpan Standard Bronze HSA Plan EPO OHSU Plus","63474OR060",,"ORN002","ORS002","ORF003","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997633132192373",,,"2018-01-01",,"No",,"No",,"No",,"https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0600006-00","BridgeSpan Standard Bronze HSA Plan EPO OHSU Plus","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$255","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/StandardBronzePlanEPO","https://www.bridgespanhealth.com/go/policy/2018/OR/StandardBronzePlanEPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0600006","BridgeSpan Standard Bronze HSA Plan EPO OHSU Plus","63474OR060",,"ORN002","ORS002","ORF003","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997633132192373",,,"2018-01-01",,"No",,"No",,"No",,"https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0600006-01","BridgeSpan Standard Bronze HSA Plan EPO OHSU Plus","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$255","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/StandardBronzePlanEPOEx","https://www.bridgespanhealth.com/go/policy/2018/OR/StandardBronzePlanEPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0600006","BridgeSpan Standard Bronze HSA Plan EPO OHSU Plus","63474OR060",,"ORN002","ORS002","ORF003","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997633132192373",,,"2018-01-01",,"No",,"No",,"No",,"https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0600006-02","BridgeSpan Standard Bronze HSA Plan EPO OHSU Plus","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$255","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/StandardBronzePlanEPO-300Ex","https://www.bridgespanhealth.com/go/policy/2018/OR/StandardBronzePlanEPOEx"
"2018","OR","63474","SERFF","2017-11-01 20:15:29","Individual","No","87-0388069","63474OR0600006","BridgeSpan Standard Bronze HSA Plan EPO OHSU Plus","63474OR060",,"ORN002","ORS002","ORF003","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.997633132192373",,,"2018-01-01",,"No",,"No",,"No",,"https://www.bridgespanhealth.com/go/formulary/2018/6tierEssential","63474OR0600006-03","BridgeSpan Standard Bronze HSA Plan EPO OHSU Plus","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,550","$0","$0","$255","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.bridgespanhealth.com/go/2018/SBC/OR/StandardBronzePlanEPO+300Ex","https://www.bridgespanhealth.com/go/policy/2018/OR/StandardBronzePlanEPOEx"
"2018","OR","68420","SERFF","2017-08-11 20:15:53","Individual","Yes","75-1233841","68420OR0010007","Dentegra Dental PPO Family Basic Plan","68420OR001",,"ORN001","ORS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","68420OR0010007-00","Dentegra Dental PPO Family Basic Plan","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","$85 per person","per group not applicable",,,,,,"$85","$85 per person","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/or/68420or0010007-18"
"2018","OR","68420","SERFF","2017-08-11 20:15:53","Individual","Yes","75-1233841","68420OR0010007","Dentegra Dental PPO Family Basic Plan","68420OR001",,"ORN001","ORS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","68420OR0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","$85 per person","per group not applicable",,,,,,"$85","$85 per person","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/or/68420or0010007-18"
"2018","OR","68420","SERFF","2017-08-11 20:15:53","Individual","Yes","75-1233841","68420OR0010008","Dentegra Dental PPO Family Preferred Plan","68420OR001",,"ORN001","ORS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","68420OR0010008-00","Dentegra Dental PPO Family Preferred Plan","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/or/68420or0010008-18"
"2018","OR","68420","SERFF","2017-08-11 20:15:53","Individual","Yes","75-1233841","68420OR0010008","Dentegra Dental PPO Family Preferred Plan","68420OR001",,"ORN001","ORS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","68420OR0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/or/68420or0010008-18"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","Yes","93-0798039","71287OR0590001","KP OR Dental 100","71287OR059",,"ORN001","ORS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.024","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","71287OR0590001-00","KP OR Dental 100","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420001","KP OR Gold 0/20","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9778",,,"2018-01-01","2018-12-31","Yes","Yes","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420001-00","KP OR Gold 0/20","Standard Gold Off Exchange Plan",,"0.819830686921185","Yes","Yes","No","100%",,"$0","$100","$2,700","$60","$0","$900","$90","$100","$0","$500","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-OFF-Exchange/KP_OR_Gold_0_20.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420001","KP OR Gold 0/20","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9778",,,"2018-01-01","2018-12-31","Yes","Yes","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420001-01","KP OR Gold 0/20","Standard Gold On Exchange Plan",,"0.819830686921185","Yes","Yes","No","100%",,"$0","$100","$2,700","$60","$0","$900","$90","$100","$0","$500","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Gold_0_20.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","Yes","93-0798039","71287OR0590001","KP OR Dental 100","71287OR059",,"ORN001","ORS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.024","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","71287OR0590001-01","KP OR Dental 100","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420002","Kaiser Permanete Oregon Standard Gold Plan","71287OR042",,"ORN001","ORS001","ORF002","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.998",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420002-03","Kaiser Permanete Oregon Standard Gold Plan","Limited Cost Sharing Plan Variation",,"0.806653050101976","No","Yes","No","100%",,"$1,000","$30","$2,300","$60","$300","$1,100","$100","$60","$1,000","$200","$80","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Standard_Gold_Plan_Ltd_Cost_Sharing_AI_AN_Plan_Var.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420011","KP OR Silver 2500/30","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9774",,,"2018-01-01","2018-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420011-01","KP OR Silver 2500/30","Standard Silver On Exchange Plan",,"0.718726613018583","Yes","Yes","No","100%",,"$2,500","$40","$2,300","$60","$300","$1,900","$0","$60","$1,380","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Silver_2500_30.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420011","KP OR Silver 2500/30","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9774",,,"2018-01-01","2018-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420011-02","KP OR Silver 2500/30","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Silver_2500_30_Zero_Cost_Sharing_AI_AN_Plan_Var.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420011","KP OR Silver 2500/30","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9774",,,"2018-01-01","2018-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420011-03","KP OR Silver 2500/30","Limited Cost Sharing Plan Variation",,"0.718726613018583","Yes","Yes","No","100%",,"$2,500","$40","$2,300","$60","$300","$1,900","$0","$60","$1,380","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Silver_2500_30.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services","No","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420003-00","Kaiser Permanente Oregon Standard Silver Plan","Standard Silver Off Exchange Plan",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$40","$3,000","$60","$300","$1,900","$0","$60","$1,380","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-OFF-Exchange/KP_OR_Standard_Silver_Plan.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","Yes","93-0798039","71287OR0590003","KP OR Dental 80L","71287OR059",,"ORN001","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"No",,"No","Allows Adult and Child-Only",,,,,"0.024","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","71287OR0590003-00","KP OR Dental 80L","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","Yes","93-0798039","71287OR0590003","KP OR Dental 80L","71287OR059",,"ORN001","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"No",,"No","Allows Adult and Child-Only",,,,,"0.024","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","71287OR0590003-01","KP OR Dental 80L","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3500/30","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9962",,,"2018-01-01","2018-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420012-05","KP OR Silver 3500/30","87% AV Level Silver Plan",,"0.867232020981704","Yes","Yes","No","100%",,"$500","$0","$1,500","$60","$130","$1,400","$200","$60","$500","$200","$300","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Silver_3500_30_87_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3500/30","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9962",,,"2018-01-01","2018-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420012-06","KP OR Silver 3500/30","94% AV Level Silver Plan",,"0.93711061667386","Yes","Yes","No","100%",,"$100","$20","$1,000","$60","$100","$400","$100","$60","$100","$60","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Silver_3500_30_94_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0050002","Elite ePPO Premium","15614PA005","7962405180","PAN003","PAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Must receive services from a participating Elite PPO dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes",,"","15614PA0050002-00","Elite ePPO Premium","Standard High Off Exchange Plan","83.6%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18EPHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18EPHINDPEDEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0050002","Elite ePPO Premium","15614PA005","7962405180","PAN003","PAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Must receive services from a participating Elite PPO dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes",,"","15614PA0050002-01","Elite ePPO Premium","Standard High On Exchange Plan","83.6%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18EPHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18EPHINDPEDEHB.PDF"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420001","KP OR Gold 0/20","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9778",,,"2018-01-01","2018-12-31","Yes","Yes","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420001-02","KP OR Gold 0/20","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Gold_0_20_Zero_Cost_Sharing_AI_AN_Plan_Var.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420001","KP OR Gold 0/20","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9778",,,"2018-01-01","2018-12-31","Yes","Yes","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420001-03","KP OR Gold 0/20","Limited Cost Sharing Plan Variation",,"0.819830686921185","Yes","Yes","No","100%",,"$0","$100","$2,700","$60","$0","$900","$90","$100","$0","$500","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Gold_0_20_Ltd_Cost_Sharing_AI_AN_Plan_Var.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420002","Kaiser Permanete Oregon Standard Gold Plan","71287OR042",,"ORN001","ORS001","ORF002","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.998",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420002-00","Kaiser Permanete Oregon Standard Gold Plan","Standard Gold Off Exchange Plan",,"0.806653050101976","No","Yes","No","100%",,"$1,000","$30","$2,300","$60","$300","$1,100","$100","$60","$1,000","$200","$80","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-OFF-Exchange/KP_OR_Standard_Gold_Plan.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","Yes","93-0798039","71287OR0590002","KP OR Dental 80H","71287OR059",,"ORN001","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.024","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","71287OR0590002-00","KP OR Dental 80H","Standard Low Off Exchange Plan","68.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","Yes","93-0798039","71287OR0590002","KP OR Dental 80H","71287OR059",,"ORN001","ORS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.024","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","71287OR0590002-01","KP OR Dental 80H","Standard Low On Exchange Plan","68.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420002","Kaiser Permanete Oregon Standard Gold Plan","71287OR042",,"ORN001","ORS001","ORF002","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.998",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420002-01","Kaiser Permanete Oregon Standard Gold Plan","Standard Gold On Exchange Plan",,"0.806653050101976","No","Yes","No","100%",,"$1,000","$30","$2,300","$60","$300","$1,100","$100","$60","$1,000","$200","$80","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Standard_Gold_Plan.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420002","Kaiser Permanete Oregon Standard Gold Plan","71287OR042",,"ORN001","ORS001","ORF002","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.998",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420002-02","Kaiser Permanete Oregon Standard Gold Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Standard_Gold_Plan_Zero_Cost_Sharing_AI_AN_Plan_Var.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services","No","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420003-01","Kaiser Permanente Oregon Standard Silver Plan","Standard Silver On Exchange Plan",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$40","$3,000","$60","$300","$1,900","$0","$60","$1,380","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Standard_Silver_Plan.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services","No","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420003-02","Kaiser Permanente Oregon Standard Silver Plan","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Standard_Gold_Plan_Zero_Cost_Sharing_AI_AN_Plan_Var.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services","No","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420003-03","Kaiser Permanente Oregon Standard Silver Plan","Limited Cost Sharing Plan Variation",,"0.718719947269482","No","Yes","No","100%",,"$2,500","$40","$3,000","$60","$300","$1,900","$0","$60","$1,380","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Standard_Silver_Plan.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services","No","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420003-04","Kaiser Permanente Oregon Standard Silver Plan","73% AV Level Silver Plan",,"0.739705728444532","No","Yes","No","100%",,"$2,500","$40","$2,300","$60","$300","$1,800","$0","$60","$1,380","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Standard_Silver_Plan_73_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services","No","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420003-05","Kaiser Permanente Oregon Standard Silver Plan","87% AV Level Silver Plan",,"0.879317618154505","No","Yes","No","100%",,"$850","$30","$900","$60","$300","$1,000","$0","$60","$850","$200","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Standard_Silver_Plan_87_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","Yes","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services","No","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420003-06","Kaiser Permanente Oregon Standard Silver Plan","94% AV Level Silver Plan",,"0.948751888340639","No","Yes","No","100%",,"$100","$20","$1,000","$60","$100","$500","$100","$60","$100","$100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Standard_Silver_Plan_94_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420004","KP Oregon Standard Bronze HSA Plan","71287OR042",,"ORN001","ORS001","ORF015","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9969",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420004-00","KP Oregon Standard Bronze HSA Plan","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,540","$0","$100","$60","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-OFF-Exchange/KP_OR_Standard_Bronze_Plan.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420004","KP Oregon Standard Bronze HSA Plan","71287OR042",,"ORN001","ORS001","ORF015","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9969",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420004-01","KP Oregon Standard Bronze HSA Plan","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,540","$0","$100","$60","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Standard_Bronze_Plan.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420004","KP Oregon Standard Bronze HSA Plan","71287OR042",,"ORN001","ORS001","ORF015","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9969",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420004-02","KP Oregon Standard Bronze HSA Plan","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Standard_Bronze_Plan_Zero_Cost_Sharing_AI_AN_Plan_Var.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420004","KP Oregon Standard Bronze HSA Plan","71287OR042",,"ORN001","ORS001","ORF015","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9969",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420004-03","KP Oregon Standard Bronze HSA Plan","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$60","$6,540","$0","$100","$60","$1,920","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Standard_Bronze_Plan_Ltd_Cost_Sharing_AI_AN_Plan_Var.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420005","KP OR Gold 1000/20","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9776",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420005-00","KP OR Gold 1000/20","Standard Gold Off Exchange Plan",,"0.799143990954356","Yes","Yes","No","100%",,"$1,000","$30","$2,500","$60","$960","$1,000","$0","$60","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-OFF-Exchange/KP_OR_Gold_1000_20.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420005","KP OR Gold 1000/20","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9776",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420005-01","KP OR Gold 1000/20","Standard Gold On Exchange Plan",,"0.799143990954356","Yes","Yes","No","100%",,"$1,000","$30","$2,500","$60","$960","$1,000","$0","$60","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Gold_1000_20.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420005","KP OR Gold 1000/20","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9776",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420005-02","KP OR Gold 1000/20","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Gold_1000_20_Zero_Cost_Sharing_AI_AN_Plan_Var.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420005","KP OR Gold 1000/20","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9776",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420005-03","KP OR Gold 1000/20","Limited Cost Sharing Plan Variation",,"0.799143990954356","Yes","Yes","No","100%",,"$1,000","$30","$2,500","$60","$960","$1,000","$0","$60","$1,000","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Gold_1000_20_Ltd_Cost_Sharing_AI_AN_Plan_Var.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420011","KP OR Silver 2500/30","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9774",,,"2018-01-01","2018-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420011-00","KP OR Silver 2500/30","Standard Silver Off Exchange Plan",,"0.718726613018583","Yes","Yes","No","100%",,"$2,500","$40","$2,300","$60","$300","$1,900","$0","$60","$1,380","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-OFF-Exchange/KP_OR_Silver_2500_30.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420011","KP OR Silver 2500/30","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9774",,,"2018-01-01","2018-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420011-04","KP OR Silver 2500/30","73% AV Level Silver Plan",,"0.739073028189406","Yes","Yes","No","100%",,"$2,300","$40","$2,400","$60","$300","$1,900","$0","$60","$1,380","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Silver_2500_30_73_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420011","KP OR Silver 2500/30","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9774",,,"2018-01-01","2018-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420011-05","KP OR Silver 2500/30","87% AV Level Silver Plan",,"0.87891713312054","Yes","Yes","No","100%",,"$0","$0","$2,200","$60","$0","$1,400","$90","$60","$0","$200","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Silver_2500_30_87_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050112","UPMC Advantage Catastrophic $7,350/$0 – Select Network","16322PA005",,"PAN006","PAS005","PAF002","Existing","EPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050112-01","UPMC Advantage Catastrophic $7,350/$0 – Select Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,180","$0","$0","$60","$1,930","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEE3_EPO_RX1D05_DCVC_2018_16322PA005011201.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070034","UPMC Small Business Advantage Silver EPO $3,000 $30/$50  - Premium Network","16322PA007",,"PAN001","PAS001","PAF035","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070034-01","UPMC Small Business Advantage Silver EPO $3,000 $30/$50  - Premium Network","Standard Silver On Exchange Plan","71.37%","0.717150420318188","No","Yes","No","100%",,"$3,000","$2,020","$0","$60","$0","$3,490","$0","$60","$800","$1,650","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP26_EPO_RX1I17_EB02_2018_16322PA007003401.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003401"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060054","UPMC Small Business Advantage Gold PPO $1,000 $25/$50 - Premium Network","16322PA006",,"PAN002","PAS001","PAF027","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060054-00","UPMC Small Business Advantage Gold PPO $1,000 $25/$50 - Premium Network","Standard Gold Off Exchange Plan","81.88%","0.817739940120507","No","Yes","No","100%",,"$1,000","$1,900","$0","$60","$0","$3,210","$0","$60","$980","$900","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPI3_PPO_RX1F12_EB02_2018_16322PA006005400.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006005400"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040024","UPMC Advantage Bronze $6,950/$35 - Premium Network","16322PA004",,"PAN007","PAS010","PAF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040024-00","UPMC Advantage Bronze $6,950/$35 - Premium Network","Standard Bronze Off Exchange Plan","60.97%","0.610646860942347","Yes","Yes","No","100%",,"$6,950","$190","$0","$60","$4,120","$1,210","$1,590","$60","$1,910","$0","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP40_PPO_RX1F33_DOVC_2018_16322PA004002400.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040024","UPMC Advantage Bronze $6,950/$35 - Premium Network","16322PA004",,"PAN007","PAS010","PAF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040024-01","UPMC Advantage Bronze $6,950/$35 - Premium Network","Standard Bronze On Exchange Plan","60.97%","0.610646860942347","Yes","Yes","No","100%",,"$6,950","$190","$0","$60","$4,120","$1,210","$1,590","$60","$1,910","$0","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP76_PPO_RX1F33_DOVC_2018_16322PA004002401.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060054","UPMC Small Business Advantage Gold PPO $1,000 $25/$50 - Premium Network","16322PA006",,"PAN002","PAS001","PAF027","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060054-01","UPMC Small Business Advantage Gold PPO $1,000 $25/$50 - Premium Network","Standard Gold On Exchange Plan","81.88%","0.817739940120507","No","Yes","No","100%",,"$1,000","$1,900","$0","$60","$0","$3,210","$0","$60","$980","$900","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP53_PPO_RX1F12_EB02_2018_16322PA006005401.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006005401"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420011","KP OR Silver 2500/30","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9774",,,"2018-01-01","2018-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420011-06","KP OR Silver 2500/30","94% AV Level Silver Plan",,"0.937241080435502","Yes","Yes","No","100%",,"$0","$20","$1,000","$60","$0","$400","$30","$60","$0","$60","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Silver_2500_30_94_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3500/30","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9962",,,"2018-01-01","2018-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420012-00","KP OR Silver 3500/30","Standard Silver Off Exchange Plan",,"0.703890648798621","Yes","Yes","No","100%",,"$3,500","$40","$2,000","$60","$300","$1,800","$100","$60","$1,380","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-OFF-Exchange/KP_OR_Silver_3500_30.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3500/30","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9962",,,"2018-01-01","2018-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420012-01","KP OR Silver 3500/30","Standard Silver On Exchange Plan",,"0.703890648798621","Yes","Yes","No","100%",,"$3,500","$40","$2,000","$60","$300","$1,800","$100","$60","$1,380","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Silver_3500_30.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3500/30","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9962",,,"2018-01-01","2018-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420012-02","KP OR Silver 3500/30","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Silver_3500_30_Zero_Cost_Sharing_AI_AN_Plan_Var.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3500/30","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9962",,,"2018-01-01","2018-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420012-03","KP OR Silver 3500/30","Limited Cost Sharing Plan Variation",,"0.703890648798621","Yes","Yes","No","100%",,"$3,500","$40","$2,000","$60","$300","$1,800","$100","$60","$1,380","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Silver_3500_30.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3500/30","71287OR042",,"ORN001","ORS001","ORF003","Existing","EPO","Silver","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9962",,,"2018-01-01","2018-12-31","No","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420012-04","KP OR Silver 3500/30","73% AV Level Silver Plan",,"0.734771080176869","Yes","Yes","No","100%",,"$2,550","$40","$2,300","$60","$300","$1,900","$0","$60","$1,380","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,550","$2550 per person","$5100 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Silver_3500_30_73_CSR.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420014","KP OR Bronze 5000/50","71287OR042",,"ORN001","ORS001","ORF014","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9957",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420014-00","KP OR Bronze 5000/50","Standard Bronze Off Exchange Plan",,"0.614919223100384","Yes","Yes","No","100%",,"$5,000","$40","$2,100","$60","$470","$1,400","$1,900","$60","$1,700","$200","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-OFF-Exchange/KP_OR_Bronze_5000_50.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420014","KP OR Bronze 5000/50","71287OR042",,"ORN001","ORS001","ORF014","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9957",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420014-01","KP OR Bronze 5000/50","Standard Bronze On Exchange Plan",,"0.614919223100384","Yes","Yes","No","100%",,"$5,000","$40","$2,100","$60","$470","$1,400","$1,900","$60","$1,700","$200","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Bronze_5000_50.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420014","KP OR Bronze 5000/50","71287OR042",,"ORN001","ORS001","ORF014","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9957",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420014-02","KP OR Bronze 5000/50","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Bronze_5000_50_Zero_Cost_Sharing_AI_AN_Plan_Var.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420014","KP OR Bronze 5000/50","71287OR042",,"ORN001","ORS001","ORF014","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9957",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420014-03","KP OR Bronze 5000/50","Limited Cost Sharing Plan Variation",,"0.614919223100384","Yes","Yes","No","100%",,"$5,000","$40","$2,100","$60","$470","$1,400","$1,900","$60","$1,700","$200","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Bronze_5000_50_Ltd_Cost_Sharing_AI_AN_Plan_Var.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420015","KP OR Bronze 6500/50","71287OR042",,"ORN001","ORS001","ORF016","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9956",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420015-00","KP OR Bronze 6500/50","Standard Bronze Off Exchange Plan",,"0.603176201781406","Yes","Yes","No","100%",,"$6,500","$0","$800","$60","$470","$400","$3,000","$60","$1,925","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-OFF-Exchange/KP_OR_Bronze_6500_50.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420015","KP OR Bronze 6500/50","71287OR042",,"ORN001","ORS001","ORF016","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9956",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420015-01","KP OR Bronze 6500/50","Standard Bronze On Exchange Plan",,"0.603176201781406","Yes","Yes","No","100%",,"$6,500","$0","$800","$60","$470","$400","$3,000","$60","$1,925","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Bronze_6500_50.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420015","KP OR Bronze 6500/50","71287OR042",,"ORN001","ORS001","ORF016","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9956",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420015-02","KP OR Bronze 6500/50","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Bronze_6500_50_Zero_Cost_Sharing_AI_AN_Plan_Var.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420015","KP OR Bronze 6500/50","71287OR042",,"ORN001","ORS001","ORF016","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9956",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420015-03","KP OR Bronze 6500/50","Limited Cost Sharing Plan Variation",,"0.603176201781406","Yes","Yes","No","100%",,"$6,500","$0","$800","$60","$470","$400","$3,000","$60","$1,925","$0","$0","$0",,"0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Bronze_6500_50.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420010","KP OR Catastrophic 7350/0","71287OR042",,"ORN001","ORS001","ORF017","Existing","EPO","Catastrophic","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9955",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420010-00","KP OR Catastrophic 7350/0","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,500","$0","$0","$60","$470","$0","$100","$60","$1,925","$0","$0","$0",,"0","3","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-OFF-Exchange/KP_OR_Catastrophic_7350_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","71287","SERFF","2017-10-31 20:15:29","Individual","No","93-0798039","71287OR0420010","KP OR Catastrophic 7350/0","71287OR042",,"ORN001","ORS001","ORF017","Existing","EPO","Catastrophic","Not Applicable","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9955",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org/orformulary","71287OR0420010-01","KP OR Catastrophic 7350/0","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,500","$0","$0","$60","$470","$0","$100","$60","$1,925","$0","$0","$0",,"0","3","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2018-ON-Exchange/KP_OR_Catastrophic_7350_0.pdf","http://info.kaiserpermanente.org/healthplans/planbrochures/2018/or2018planbrochure.pdf"
"2018","OR","98884","SERFF","2017-08-09 20:15:51","Individual","Yes","54-1808292","98884OR0070003","Choice PPO Basic Kids","98884OR007","7962405180","ORN001","ORS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","98884OR0070003-00","Choice PPO Basic Kids","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNOR17SBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNOR17SBLINDPEDEHB.PDF"
"2018","OR","98884","SERFF","2017-08-09 20:15:51","Individual","Yes","54-1808292","98884OR0070003","Choice PPO Basic Kids","98884OR007","7962405180","ORN001","ORS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","98884OR0070003-01","Choice PPO Basic Kids","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNOR17SBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNOR17SBLINDPEDEHB.PDF"
"2018","OR","98884","SERFF","2017-08-09 20:15:51","Individual","Yes","54-1808292","98884OR0070004","Choice PPO Premium Kids","98884OR007","7962405180","ORN001","ORS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","98884OR0070004-00","Choice PPO Premium Kids","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNOR17SBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNOR17SBHINDPEDEHB.PDF"
"2018","OR","98884","SERFF","2017-08-09 20:15:51","Individual","Yes","54-1808292","98884OR0070004","Choice PPO Premium Kids","98884OR007","7962405180","ORN001","ORS001",,"New","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","98884OR0070004-01","Choice PPO Premium Kids","Standard High On Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNOR17SBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNOR17SBHINDPEDEHB.PDF"
"2018","OR","98884","SERFF","2017-08-09 20:15:51","Individual","Yes","54-1808292","98884OR0070001","Choice PPO Basic","98884OR007","7962405180","ORN001","ORS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","98884OR0070001-00","Choice PPO Basic","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNOR17SBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNOR17SBLINDFAMEHB.PDF"
"2018","OR","98884","SERFF","2017-08-09 20:15:51","Individual","Yes","54-1808292","98884OR0070001","Choice PPO Basic","98884OR007","7962405180","ORN001","ORS001",,"New","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","98884OR0070001-01","Choice PPO Basic","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNOR17SBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNOR17SBLINDFAMEHB.PDF"
"2018","OR","98884","SERFF","2017-08-09 20:15:51","Individual","Yes","54-1808292","98884OR0070002","Choice PPO Premium","98884OR007","7962405180","ORN001","ORS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","98884OR0070002-00","Choice PPO Premium","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNOR17SBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNOR17SBHINDFAMEHB.PDF"
"2018","OR","98884","SERFF","2017-08-09 20:15:51","Individual","Yes","54-1808292","98884OR0070002","Choice PPO Premium","98884OR007","7962405180","ORN001","ORS001",,"New","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","98884OR0070002-01","Choice PPO Premium","Standard High On Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNOR17SBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNOR17SBHINDFAMEHB.PDF"
"2018","OR","98884","SERFF","2017-08-09 20:15:51","Individual","Yes","54-1808292","98884OR0070005","Choice PPO Plus","98884OR007","7962405180","ORN001","ORS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","98884OR0070005-00","Choice PPO Plus","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","OR","98884","SERFF","2017-08-09 20:15:51","Individual","Yes","54-1808292","98884OR0070005","Choice PPO Plus","98884OR007","7962405180","ORN001","ORS001",,"New","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","98884OR0070005-01","Choice PPO Plus","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","PA","15614","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","54-1808292","15614PA0040004","Choice PPO Basic","15614PA004","7962405180","PAN002","PAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","15614PA0040004-00","Choice PPO Basic","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBLSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBLSMGFAMEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0020005","Elite PPO Basic Kids","15614PA002","7962405180","PAN003","PAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020005-00","Elite PPO Basic Kids","Standard Low Off Exchange Plan","70.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBLINDPEDEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0020005","Elite PPO Basic Kids","15614PA002","7962405180","PAN003","PAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020005-01","Elite PPO Basic Kids","Standard Low On Exchange Plan","70.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBLINDPEDEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","54-1808292","15614PA0040004","Choice PPO Basic","15614PA004","7962405180","PAN002","PAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","15614PA0040004-01","Choice PPO Basic","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBLSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBLSMGFAMEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","54-1808292","15614PA0040005","Choice PPO Premium","15614PA004","7962405180","PAN002","PAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","15614PA0040005-00","Choice PPO Premium","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBHSMGFAMEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0020003","Elite PPO Premium Kids","15614PA002","7962405180","PAN003","PAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020003-00","Elite PPO Premium Kids","Standard High Off Exchange Plan","83.6%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBHINDPEDEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0020003","Elite PPO Premium Kids","15614PA002","7962405180","PAN003","PAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020003-01","Elite PPO Premium Kids","Standard High On Exchange Plan","83.6%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBHINDPEDEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","54-1808292","15614PA0040005","Choice PPO Premium","15614PA004","7962405180","PAN002","PAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","15614PA0040005-01","Choice PPO Premium","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBHSMGFAMEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","54-1808292","15614PA0060002","Elite ePPO Premium","15614PA006","7962405180","PAN003","PAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Must receive services from a participating Elite PPO dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0060002-00","Elite ePPO Premium","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18EPHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18EPHSMGFAMEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0010003","Select Plan Basic Kids","15614PA001","7962405180","PAN001","PAS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010003-00","Select Plan Basic Kids","Standard Low Off Exchange Plan","72.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBLINDPEDEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0010003","Select Plan Basic Kids","15614PA001","7962405180","PAN001","PAS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010003-01","Select Plan Basic Kids","Standard Low On Exchange Plan","72.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBLINDPEDEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","54-1808292","15614PA0060002","Elite ePPO Premium","15614PA006","7962405180","PAN003","PAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Must receive services from a participating Elite PPO dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0060002-01","Elite ePPO Premium","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18EPHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18EPHSMGFAMEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0010005","Select Plan Premium Kids","15614PA001","7962405180","PAN001","PAS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010005-00","Select Plan Premium Kids","Standard High Off Exchange Plan","85.4%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBHINDPEDEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0010005","Select Plan Premium Kids","15614PA001","7962405180","PAN001","PAS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010005-01","Select Plan Premium Kids","Standard High On Exchange Plan","85.4%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBHINDPEDEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0020004","Elite PPO Basic","15614PA002","7962405180","PAN003","PAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020004-00","Elite PPO Basic","Standard Low Off Exchange Plan","70.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBLINDFAMEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","54-1808292","15614PA0030004","Select Plan Premium","15614PA003","7962405180","PAN001","PAS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0030004-00","Select Plan Premium","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBHSMGFAMEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","54-1808292","15614PA0030004","Select Plan Premium","15614PA003","7962405180","PAN001","PAS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0030004-01","Select Plan Premium","Standard High On Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBHSMGFAMEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0020004","Elite PPO Basic","15614PA002","7962405180","PAN003","PAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020004-01","Elite PPO Basic","Standard Low On Exchange Plan","70.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBLINDFAMEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0020006","Elite PPO Premium","15614PA002","7962405180","PAN003","PAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020006-00","Elite PPO Premium","Standard High Off Exchange Plan","83.6%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBHINDFAMEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0020006","Elite PPO Premium","15614PA002","7962405180","PAN003","PAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020006-01","Elite PPO Premium","Standard High On Exchange Plan","83.6%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SBHINDFAMEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0050001","Elite ePPO Basic","15614PA005","7962405180","PAN003","PAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Must receive services from a participating Elite PPO dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes",,"","15614PA0050001-00","Elite ePPO Basic","Standard Low Off Exchange Plan","70.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18EPLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18EPLINDPEDEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0050001","Elite ePPO Basic","15614PA005","7962405180","PAN003","PAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Must receive services from a participating Elite PPO dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes",,"","15614PA0050001-01","Elite ePPO Basic","Standard Low On Exchange Plan","70.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18EPLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18EPLINDPEDEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0010004","Select Plan Basic","15614PA001","7962405180","PAN001","PAS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010004-00","Select Plan Basic","Standard Low Off Exchange Plan","72.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBLINDFAMEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","54-1808292","15614PA0040006","Choice PPO Plus","15614PA004","7962405180","PAN002","PAS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0040006-00","Choice PPO Plus","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SB2SMGFAM@@@.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SB2SMGFAM@@@.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0010004","Select Plan Basic","15614PA001","7962405180","PAN001","PAS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010004-01","Select Plan Basic","Standard Low On Exchange Plan","72.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBLINDFAMEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0010006","Select Plan Premium","15614PA001","7962405180","PAN001","PAS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010006-00","Select Plan Premium","Standard High Off Exchange Plan","85.4%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBHINDFAMEHB.PDF"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040024","UPMC Advantage Bronze $6,950/$35 - Premium Network","16322PA004",,"PAN007","PAS010","PAF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040024-02","UPMC Advantage Bronze $0/$0 - Premium Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZS_PPO_RX1D06_DOVC_2018_16322PA004002402.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040024","UPMC Advantage Bronze $6,950/$35 - Premium Network","16322PA004",,"PAN007","PAS010","PAF003","Existing","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040024-03","UPMC Advantage Bronze $6,950/$35 - Premium Network","Limited Cost Sharing Plan Variation","60.97%","0.610646860942347","Yes","Yes","No","100%",,"$6,950","$190","$0","$60","$4,120","$1,210","$1,590","$60","$1,910","$0","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPLX_PPO_RX1F41_DOVC_2018_16322PA004002403.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060075","UPMC Small Business Advantage Gold PPO $1,500 $25/$50 - Premium Network","16322PA006",,"PAN002","PAS001","PAF027","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060075-01","UPMC Small Business Advantage Gold PPO $1,500 $25/$50 - Premium Network","Standard Gold On Exchange Plan","81.82%","0.818194351317122","No","Yes","No","100%",,"$1,500","$990","$0","$60","$0","$3,290","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP55_PPO_RX1F12_EB02_2018_16322PA006007501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006007501"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060083","UPMC Small Business Advantage Gold PPO $1,000 $25/$50 - Premium Network","16322PA006",,"PAN002","PAS001","PAF035","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060083-00","UPMC Small Business Advantage Gold PPO $1,000 $25/$50 - Premium Network","Standard Gold Off Exchange Plan","81.88%","0.815533738920068","No","Yes","No","100%",,"$1,000","$1,920","$0","$60","$0","$3,370","$0","$60","$980","$900","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPI3_PPO_RX1I17_EB02_2018_16322PA006008300.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008300"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050100","UPMC Advantage Bronze $6,950/$35 - Partner Network","16322PA005",,"PAN005","PAS004","PAF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050100-00","UPMC Advantage Bronze $6,950/$35 - Partner Network","Standard Bronze Off Exchange Plan","60.97%","0.610646860942347","Yes","Yes","No","100%",,"$6,950","$190","$0","$60","$4,120","$1,210","$1,590","$60","$1,910","$0","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE50_EPO_RX1F33_DOVC_2018_16322PA005010000.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050100","UPMC Advantage Bronze $6,950/$35 - Partner Network","16322PA005",,"PAN005","PAS004","PAF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050100-01","UPMC Advantage Bronze $6,950/$35 - Partner Network","Standard Bronze On Exchange Plan","60.97%","0.610646860942347","Yes","Yes","No","100%",,"$6,950","$190","$0","$60","$4,120","$1,210","$1,590","$60","$1,910","$0","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEC5_EPO_RX1F33_DOVC_2018_16322PA005010001.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0010006","Select Plan Premium","15614PA001","7962405180","PAN001","PAS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010006-01","Select Plan Premium","Standard High On Exchange Plan","85.4%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18DBHINDFAMEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0020007","Elite PPO Plus","15614PA002","7962405180","PAN003","PAS003",,"New","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020007-00","Elite PPO Plus","Standard Low Off Exchange Plan","70.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SB2SMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SB2SMGFAMEHB.PDF"
"2018","PA","15614","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","15614PA0020007","Elite PPO Plus","15614PA002","7962405180","PAN003","PAS003",,"New","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020007-01","Elite PPO Plus","Standard Low On Exchange Plan","70.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SB2SMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNPA18SB2SMGFAMEHB.PDF"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040026","UPMC Advantage Catastrophic $7,350/$0 - Premium Network","16322PA004",,"PAN007","PAS010","PAF002","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040026-00","UPMC Advantage Catastrophic $7,350/$0 - Premium Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,180","$0","$0","$60","$1,930","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP41_PPO_RX1D05_DCVC_2018_16322PA004002600.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060073","UPMC Small Business Advantage Silver PPO $3,000 $30/$50 - Premium Network","16322PA006",,"PAN002","PAS001","PAF027","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060073-00","UPMC Small Business Advantage Silver PPO $3,000 $30/$50 - Premium Network","Standard Silver Off Exchange Plan","71.43%","0.717835184867964","No","Yes","No","100%",,"$3,000","$2,000","$0","$60","$0","$3,330","$0","$60","$800","$1,650","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPI4_PPO_RX1F12_EB02_2018_16322PA006007300.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006007300"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060073","UPMC Small Business Advantage Silver PPO $3,000 $30/$50 - Premium Network","16322PA006",,"PAN002","PAS001","PAF027","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060073-01","UPMC Small Business Advantage Silver PPO $3,000 $30/$50 - Premium Network","Standard Silver On Exchange Plan","71.43%","0.717835184867964","No","Yes","No","100%",,"$3,000","$2,000","$0","$60","$0","$3,330","$0","$60","$800","$1,650","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP54_PPO_RX1F12_EB02_2018_16322PA006007301.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006007301"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040026","UPMC Advantage Catastrophic $7,350/$0 - Premium Network","16322PA004",,"PAN007","PAS010","PAF002","Existing","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040026-01","UPMC Advantage Catastrophic $7,350/$0 - Premium Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,180","$0","$0","$60","$1,930","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP78_PPO_RX1D05_DCVC_2018_16322PA004002601.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060088","UPMC Small Business Advantage Silver PPO $3,000 $30/$50 - Premium Network","16322PA006",,"PAN002","PAS001","PAF035","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060088-00","UPMC Small Business Advantage Silver PPO $3,000 $30/$50 - Premium Network","Standard Silver Off Exchange Plan","71.37%","0.717150420318188","No","Yes","No","100%",,"$3,000","$2,020","$0","$60","$0","$3,490","$0","$60","$800","$1,650","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPI4_PPO_RX1I17_EB02_2018_16322PA006008800.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008800"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040036","UPMC Advantage Catastrophic $7,350/$0 - Premium Network","16322PA004",,"PAN008","PAS006","PAF002","New","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040036-00","UPMC Advantage Catastrophic $7,350/$0 - Premium Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,180","$0","$0","$60","$1,930","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP41_PPO_RX1D05_DCVC_2018_16322PA004003600.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040036","UPMC Advantage Catastrophic $7,350/$0 - Premium Network","16322PA004",,"PAN008","PAS006","PAF002","New","PPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040036-01","UPMC Advantage Catastrophic $7,350/$0 - Premium Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,180","$0","$0","$60","$1,930","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP78_PPO_RX1D05_DCVC_2018_16322PA004003601.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060088","UPMC Small Business Advantage Silver PPO $3,000 $30/$50 - Premium Network","16322PA006",,"PAN002","PAS001","PAF035","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060088-01","UPMC Small Business Advantage Silver PPO $3,000 $30/$50 - Premium Network","Standard Silver On Exchange Plan","71.37%","0.717150420318188","No","Yes","No","100%",,"$3,000","$2,020","$0","$60","$0","$3,490","$0","$60","$800","$1,650","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP54_PPO_RX1I17_EB02_2018_16322PA006008801.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008801"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070016","UPMC Small Business Advantage Silver EPO $3,000 $30/$50  - Premium Network","16322PA007",,"PAN001","PAS001","PAF027","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070016-00","UPMC Small Business Advantage Silver EPO $3,000 $30/$50  - Premium Network","Standard Silver Off Exchange Plan","71.43%","0.717835184867964","No","Yes","No","100%",,"$3,000","$2,000","$0","$60","$0","$3,330","$0","$60","$800","$1,650","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP72_EPO_RX1F12_EB02_2018_16322PA007001600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007001600"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050111","UPMC Advantage Catastrophic $7,350/$0 - Partner Network","16322PA005",,"PAN005","PAS004","PAF002","Existing","EPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050111-00","UPMC Advantage Catastrophic $7,350/$0 - Partner Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,180","$0","$0","$60","$1,930","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE55_EPO_RX1D05_DCVC_2018_16322PA005011100.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050111","UPMC Advantage Catastrophic $7,350/$0 - Partner Network","16322PA005",,"PAN005","PAS004","PAF002","Existing","EPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050111-01","UPMC Advantage Catastrophic $7,350/$0 - Partner Network","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,180","$0","$0","$60","$1,930","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEE2_EPO_RX1D05_DCVC_2018_16322PA005011101.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070016","UPMC Small Business Advantage Silver EPO $3,000 $30/$50  - Premium Network","16322PA007",,"PAN001","PAS001","PAF027","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070016-01","UPMC Small Business Advantage Silver EPO $3,000 $30/$50  - Premium Network","Standard Silver On Exchange Plan","71.43%","0.717835184867964","No","Yes","No","100%",,"$3,000","$2,000","$0","$60","$0","$3,330","$0","$60","$800","$1,650","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP26_EPO_RX1F12_EB02_2018_16322PA007001601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007001601"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070034","UPMC Small Business Advantage Silver EPO $3,000 $30/$50  - Premium Network","16322PA007",,"PAN001","PAS001","PAF035","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070034-00","UPMC Small Business Advantage Silver EPO $3,000 $30/$50  - Premium Network","Standard Silver Off Exchange Plan","71.37%","0.717150420318188","No","Yes","No","100%",,"$3,000","$2,020","$0","$60","$0","$3,490","$0","$60","$800","$1,650","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP72_EPO_RX1I17_EB02_2018_16322PA007003400.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003400"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050112","UPMC Advantage Catastrophic $7,350/$0 – Select Network","16322PA005",,"PAN006","PAS005","PAF002","Existing","EPO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050112-00","UPMC Advantage Catastrophic $7,350/$0 – Select Network","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$7,180","$0","$0","$60","$1,930","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE56_EPO_RX1D05_DCVC_2018_16322PA005011200.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060075","UPMC Small Business Advantage Gold PPO $1,500 $25/$50 - Premium Network","16322PA006",,"PAN002","PAS001","PAF027","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060075-00","UPMC Small Business Advantage Gold PPO $1,500 $25/$50 - Premium Network","Standard Gold Off Exchange Plan","81.82%","0.818194351317122","No","Yes","No","100%",,"$1,500","$990","$0","$60","$0","$3,290","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPI5_PPO_RX1F12_EB02_2018_16322PA006007500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006007500"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060083","UPMC Small Business Advantage Gold PPO $1,000 $25/$50 - Premium Network","16322PA006",,"PAN002","PAS001","PAF035","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060083-01","UPMC Small Business Advantage Gold PPO $1,000 $25/$50 - Premium Network","Standard Gold On Exchange Plan","81.66%","0.815533738920068","No","Yes","No","100%",,"$1,000","$1,920","$0","$60","$0","$3,370","$0","$60","$980","$900","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP53_PPO_RX1I17_EB02_2018_16322PA006008301.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008301"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060084","UPMC Small Business Advantage Gold PPO $1,500 $25/$50 - Premium Network","16322PA006",,"PAN002","PAS001","PAF035","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060084-00","UPMC Small Business Advantage Gold PPO $1,500 $25/$50 - Premium Network","Standard Gold Off Exchange Plan","81.66%","0.816580930541325","No","Yes","No","100%",,"$1,500","$1,010","$0","$60","$0","$3,450","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPI5_PPO_RX1I17_EB02_2018_16322PA006008400.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008400"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050100","UPMC Advantage Bronze $6,950/$35 - Partner Network","16322PA005",,"PAN005","PAS004","PAF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050100-02","UPMC Advantage Bronze $0/$0 - Partner Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAZE2_EPO_RX1D06_DOVC_2018_16322PA005010002.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050100","UPMC Advantage Bronze $6,950/$35 - Partner Network","16322PA005",,"PAN005","PAS004","PAF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050100-03","UPMC Advantage Bronze $6,950/$35 - Partner Network","Limited Cost Sharing Plan Variation","60.97%","0.610646860942347","Yes","Yes","No","100%",,"$6,950","$190","$0","$60","$4,120","$1,210","$1,590","$60","$1,910","$0","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALE4_EPO_RX1F41_DOVC_2018_16322PA005010003.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060084","UPMC Small Business Advantage Gold PPO $1,500 $25/$50 - Premium Network","16322PA006",,"PAN002","PAS001","PAF035","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060084-01","UPMC Small Business Advantage Gold PPO $1,500 $25/$50 - Premium Network","Standard Gold On Exchange Plan","81.66%","0.816580930541325","No","Yes","No","100%",,"$1,500","$1,010","$0","$60","$0","$3,450","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP55_PPO_RX1I17_EB02_2018_16322PA006008401.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008401"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060085","UPMC Small Business Advantage Gold PPO $1,750 $30/$50 - Premium Network","16322PA006",,"PAN002","PAS001","PAF035","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060085-00","UPMC Small Business Advantage Gold PPO $1,750 $30/$50 - Premium Network","Standard Gold Off Exchange Plan","81.53%","0.816846983798835","No","Yes","No","100%",,"$1,750","$1,020","$0","$60","$0","$3,490","$0","$60","$810","$1,000","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPI9_PPO_RX1I17_EB02_2018_16322PA006008500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008500"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050101","UPMC Advantage Bronze $6,950/$35 - Select Network","16322PA005",,"PAN006","PAS005","PAF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050101-00","UPMC Advantage Bronze $6,950/$35 - Select Network","Standard Bronze Off Exchange Plan","60.97%","0.610646860942347","Yes","Yes","No","100%",,"$6,950","$190","$0","$60","$4,120","$1,210","$1,590","$60","$1,910","$0","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE51_EPO_RX1F33_DOVC_2018_16322PA005010100.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050101","UPMC Advantage Bronze $6,950/$35 - Select Network","16322PA005",,"PAN006","PAS005","PAF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050101-01","UPMC Advantage Bronze $6,950/$35 - Select Network","Standard Bronze On Exchange Plan","60.97%","0.610646860942347","Yes","Yes","No","100%",,"$6,950","$190","$0","$60","$4,120","$1,210","$1,590","$60","$1,910","$0","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEC6_EPO_RX1F33_DOVC_2018_16322PA005010101.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060085","UPMC Small Business Advantage Gold PPO $1,750 $30/$50 - Premium Network","16322PA006",,"PAN002","PAS001","PAF035","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060085-01","UPMC Small Business Advantage Gold PPO $1,750 $30/$50 - Premium Network","Standard Gold On Exchange Plan","81.53%","0.816846983798835","No","Yes","No","100%",,"$1,750","$1,020","$0","$60","$0","$3,490","$0","$60","$810","$1,000","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP59_PPO_RX1I17_EB02_2018_16322PA006008501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008501"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060105","UPMC Small Business Advantage Gold PPO $1,750 $30/$50 - Premium Network","16322PA006",,"PAN002","PAS001","PAF027","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060105-00","UPMC Small Business Advantage Gold PPO $1,750 $30/$50 - Premium Network","Standard Gold Off Exchange Plan","81.67%","0.818867321326563","No","Yes","No","100%",,"$1,750","$1,000","$0","$60","$0","$3,330","$0","$60","$810","$1,000","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPI9_PPO_RX1F12_EB02_2018_16322PA006010500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006010500"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050101","UPMC Advantage Bronze $6,950/$35 - Select Network","16322PA005",,"PAN006","PAS005","PAF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050101-02","UPMC Advantage Bronze $0/$0 - Select Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAZE3_EPO_RX1D06_DOVC_2018_16322PA005010102.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050101","UPMC Advantage Bronze $6,950/$35 - Select Network","16322PA005",,"PAN006","PAS005","PAF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050101-03","UPMC Advantage Bronze $6,950/$35 - Select Network","Limited Cost Sharing Plan Variation","60.97%","0.610646860942347","Yes","Yes","No","100%",,"$6,950","$190","$0","$60","$4,120","$1,210","$1,590","$60","$1,910","$0","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALE5_EPO_RX1F41_DOVC_2018_16322PA005010103.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060105","UPMC Small Business Advantage Gold PPO $1,750 $30/$50 - Premium Network","16322PA006",,"PAN002","PAS001","PAF027","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060105-01","UPMC Small Business Advantage Gold PPO $1,750 $30/$50 - Premium Network","Standard Gold On Exchange Plan","81.67%","0.818867321326563","No","Yes","No","100%",,"$1,750","$1,000","$0","$60","$0","$3,330","$0","$60","$810","$1,000","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP59_PPO_RX1F12_EB02_2018_16322PA006010501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006010501"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070014","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Premium Network","16322PA007",,"PAN001","PAS001","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070014-00","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Premium Network","Standard Gold Off Exchange Plan","81.82%","0.817470418807045","No","Yes","No","100%",,"$1,500","$990","$0","$60","$0","$3,290","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP71_EPO_RX1F12_EB02_2018_16322PA007001400.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007001400"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070014","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Premium Network","16322PA007",,"PAN001","PAS001","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070014-01","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Premium Network","Standard Gold On Exchange Plan","81.82%","0.817470418807045","No","Yes","No","100%",,"$1,500","$990","$0","$60","$0","$3,290","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP25_EPO_RX1F12_EB02_2018_16322PA007001401.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007001401"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070026","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Premium Network","16322PA007",,"PAN001","PAS001","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070026-00","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Premium Network","Standard Gold Off Exchange Plan","81.88%","0.817739940120507","No","Yes","No","100%",,"$1,000","$1,900","$0","$60","$0","$3,210","$0","$60","$980","$900","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP74_EPO_RX1F12_EB02_2018_16322PA007002600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007002600"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070026","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Premium Network","16322PA007",,"PAN001","PAS001","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070026-01","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Premium Network","Standard Gold On Exchange Plan","81.88%","0.817739940120507","No","Yes","No","100%",,"$1,000","$1,900","$0","$60","$0","$3,210","$0","$60","$980","$900","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP28_EPO_RX1F12_EB02_2018_16322PA007002601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007002601"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,700/20% - Select Network","16322PA005",,"PAN006","PAS005","PAF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050108-01","UPMC Advantage Silver HSA $2,700/20% - Select Network","Standard Silver On Exchange Plan","71.43%","0.714205102693663","Yes","Yes","No","100%",,"$2,700","$0","$1,600","$60","$2,700","$1,380","$220","$60","$1,530","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASE8_EPO_RX1F39_DOVC_2018_16322PA005010801.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,700/20% - Select Network","16322PA005",,"PAN006","PAS005","PAF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050108-02","UPMC Advantage Silver $0/$0 - Select Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAZE9_EPO_RX1D06_DOVC_2018_16322PA005010802.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,700/20% - Select Network","16322PA005",,"PAN006","PAS005","PAF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050108-03","UPMC Advantage Silver HSA $2,700/20% - Select Network","Limited Cost Sharing Plan Variation","71.43%","0.714205102693663","Yes","Yes","No","100%",,"$2,700","$0","$1,600","$60","$2,700","$1,380","$220","$60","$1,530","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASEA_EPO_RX1F43_DOVC_2018_16322PA005010803.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,700/20% - Select Network","16322PA005",,"PAN006","PAS005","PAF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050108-04","UPMC Advantage Silver HSA $2,700/20% - Select Network","73% AV Level Silver Plan","73.46%","0.734590666432124","Yes","Yes","No","100%",,"$2,700","$0","$700","$60","$2,300","$950","$150","$60","$1,530","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASEC_EPO_RX1F39_DOVC_2018_16322PA005010804.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,700/20% - Select Network","16322PA005",,"PAN006","PAS005","PAF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050108-05","UPMC Advantage Silver $650/20% - Select Network","87% AV Level Silver Plan","87.59%","0.875702578744096","Yes","Yes","No","100%",,"$650","$0","$1,800","$60","$220","$830","$240","$60","$650","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEE1_EPO_RX1F36_DOVC_2018_16322PA005010805.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,700/20% - Select Network","16322PA005",,"PAN006","PAS005","PAF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050108-06","UPMC Advantage Silver $100/20% - Select Network","94% AV Level Silver Plan","94.67%","0.946648302907483","Yes","Yes","No","100%",,"$100","$0","$650","$60","$0","$530","$220","$60","$100","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEA1_EPO_RX1F37_DOVC_2018_16322PA005010806.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070063","UPMC Small Business Advantage Gold EPO $1,750 $30/$50  - Premium Network","16322PA007",,"PAN001","PAS001","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070063-01","UPMC Small Business Advantage Gold EPO $1,750 $30/$50  - Premium Network","Standard Gold On Exchange Plan","81.67%","0.818187702154404","No","Yes","No","100%",,"$1,750","$1,000","$0","$60","$0","$3,330","$0","$60","$810","$1,000","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP29_EPO_RX1F12_EB02_2018_16322PA007006301.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007006301"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060076","UPMC Small Business Advantage Bronze PPO $6,850 - Premium Network","16322PA006",,"PAN002","PAS001","PAF029","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060076-00","UPMC Small Business Advantage Bronze PPO $6,850 - Premium Network","Standard Bronze Off Exchange Plan","61.25%","0.591514537961228","Yes","Yes","No","100%",,"$6,850","$40","$0","$60","$5,140","$2,010","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPC1_PPO_RX1F47_EB02_2018_16322PA006007600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006007600"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,700/20% - Premium Network","16322PA004",,"PAN007","PAS010","PAF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040025-00","UPMC Advantage Silver HSA $2,700/20% - Premium Network","Standard Silver Off Exchange Plan","71.43%","0.714205102693663","Yes","Yes","No","100%",,"$2,700","$0","$1,600","$60","$2,700","$1,380","$220","$60","$1,530","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NASP2_PPO_RX1F39_DOVC_2018_16322PA004002500.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,700/20% - Premium Network","16322PA004",,"PAN007","PAS010","PAF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040025-01","UPMC Advantage Silver HSA $2,700/20% - Premium Network","Standard Silver On Exchange Plan","71.43%","0.714205102693663","Yes","Yes","No","100%",,"$2,700","$0","$1,600","$60","$2,700","$1,380","$220","$60","$1,530","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASP4_PPO_RX1F39_DOVC_2018_16322PA004002501.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060076","UPMC Small Business Advantage Bronze PPO $6,850 - Premium Network","16322PA006",,"PAN002","PAS001","PAF029","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060076-01","UPMC Small Business Advantage Bronze PPO $6,850 - Premium Network","Standard Bronze On Exchange Plan","61.25%","0.591514537961228","Yes","Yes","No","100%",,"$6,850","$40","$0","$60","$5,140","$2,010","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP47_PPO_RX1F47_EB02_2018_16322PA006007601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006007601"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060089","UPMC Small Business Advantage Bronze PPO $6,850 - Premium Network","16322PA006",,"PAN002","PAS001","PAF037","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060089-00","UPMC Small Business Advantage Bronze PPO $6,850 - Premium Network","Standard Bronze Off Exchange Plan","61.25%","0.591471679656028","Yes","Yes","No","100%",,"$6,850","$60","$0","$60","$4,990","$2,160","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPC1_PPO_RX1I19_EB02_2018_16322PA006008900.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008900"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,700/20% - Premium Network","16322PA004",,"PAN007","PAS010","PAF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040025-02","UPMC Advantage Silver $0/$0 - Premium Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZT_PPO_RX1D06_DOVC_2018_16322PA004002502.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070029","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Premium Network","16322PA007",,"PAN001","PAS001","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070029-00","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Premium Network","Standard Gold Off Exchange Plan","81.66%","0.815533738920068","No","Yes","No","100%",,"$1,000","$1,920","$0","$60","$0","$3,370","$0","$60","$980","$900","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP74_EPO_RX1I17_EB02_2018_16322PA007002900.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007002900"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070029","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Premium Network","16322PA007",,"PAN001","PAS001","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070029-01","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Premium Network","Standard Gold On Exchange Plan","81.66%","0.815533738920068","No","Yes","No","100%",,"$1,000","$1,920","$0","$60","$0","$3,370","$0","$60","$980","$900","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP28_EPO_RX1I17_EB02_2018_16322PA007002901.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007002901"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070030","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Premium Network","16322PA007",,"PAN001","PAS001","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070030-00","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Premium Network","Standard Gold Off Exchange Plan","81.66%","0.816580930541325","No","Yes","No","100%",,"$1,500","$1,010","$0","$60","$0","$3,450","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP71_EPO_RX1I17_EB02_2018_16322PA007003000.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003000"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070030","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Premium Network","16322PA007",,"PAN001","PAS001","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070030-01","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Premium Network","Standard Gold On Exchange Plan","81.66%","0.816580930541325","No","Yes","No","100%",,"$1,500","$1,010","$0","$60","$0","$3,450","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP25_EPO_RX1I17_EB02_2018_16322PA007003001.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003001"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070031","UPMC Small Business Advantage Gold EPO $1,750 $30/$50  - Premium Network","16322PA007",,"PAN001","PAS001","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070031-00","UPMC Small Business Advantage Gold EPO $1,750 $30/$50  - Premium Network","Standard Gold Off Exchange Plan","81.53%","0.816846983798835","No","Yes","No","100%",,"$1,750","$1,020","$0","$60","$0","$3,490","$0","$60","$810","$1,000","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP75_EPO_RX1I17_EB02_2018_16322PA007003100.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003100"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070031","UPMC Small Business Advantage Gold EPO $1,750 $30/$50  - Premium Network","16322PA007",,"PAN001","PAS001","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070031-01","UPMC Small Business Advantage Gold EPO $1,750 $30/$50  - Premium Network","Standard Gold On Exchange Plan","81.53%","0.816846983798835","No","Yes","No","100%",,"$1,750","$1,020","$0","$60","$0","$3,490","$0","$60","$810","$1,000","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP29_EPO_RX1I17_EB02_2018_16322PA007003101.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003101"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070063","UPMC Small Business Advantage Gold EPO $1,750 $30/$50  - Premium Network","16322PA007",,"PAN001","PAS001","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070063-00","UPMC Small Business Advantage Gold EPO $1,750 $30/$50  - Premium Network","Standard Gold Off Exchange Plan","81.67%","0.818187702154404","No","Yes","No","100%",,"$1,750","$1,000","$0","$60","$0","$3,330","$0","$60","$810","$1,000","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP75_EPO_RX1F12_EB02_2018_16322PA007006300.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007006300"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,700/20% - Premium Network","16322PA004",,"PAN007","PAS010","PAF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040025-03","UPMC Advantage Silver HSA $2,700/20% - Premium Network","Limited Cost Sharing Plan Variation","71.43%","0.714205102693663","Yes","Yes","No","100%",,"$2,700","$0","$1,600","$60","$2,700","$1,380","$220","$60","$1,530","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASP7_PPO_RX1F43_DOVC_2018_16322PA004002503.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060089","UPMC Small Business Advantage Bronze PPO $6,850 - Premium Network","16322PA006",,"PAN002","PAS001","PAF037","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060089-01","UPMC Small Business Advantage Bronze PPO $6,850 - Premium Network","Standard Bronze On Exchange Plan","61.25%","0.591471679656028","Yes","Yes","No","100%",,"$6,850","$60","$0","$60","$4,990","$2,160","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP47_PPO_RX1I19_EB02_2018_16322PA006008901.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008901"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070027","UPMC Small Business Advantage Bronze EPO $6,850 - Premium Network","16322PA007",,"PAN001","PAS001","PAF029","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070027-00","UPMC Small Business Advantage Bronze EPO $6,850 - Premium Network","Standard Bronze Off Exchange Plan","61.25%","0.591514537961228","Yes","Yes","No","100%",,"$6,850","$40","$0","$60","$5,140","$2,010","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP47_EPO_RX1F47_EB02_2018_16322PA007002700.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007002700"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,700/20% - Premium Network","16322PA004",,"PAN007","PAS010","PAF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040025-04","UPMC Advantage Silver HSA $2,700/20% - Premium Network","73% AV Level Silver Plan","73.46%","0.734590666432124","Yes","Yes","No","100%",,"$2,700","$0","$700","$60","$2,300","$950","$150","$60","$1,530","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASP9_PPO_RX1F39_DOVC_2018_16322PA004002504.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,700/20% - Premium Network","16322PA004",,"PAN007","PAS010","PAF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040025-05","UPMC Advantage Silver $650/20% - Premium Network","87% AV Level Silver Plan","87.59%","0.875702578744096","Yes","Yes","No","100%",,"$650","$0","$1,800","$60","$220","$830","$240","$60","$650","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","20.00%",,,,,"$1,300","$1300 per person","$2600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP77_PPO_RX1F36_DOVC_2018_16322PA004002505.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070027","UPMC Small Business Advantage Bronze EPO $6,850 - Premium Network","16322PA007",,"PAN001","PAS001","PAF029","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070027-01","UPMC Small Business Advantage Bronze EPO $6,850 - Premium Network","Standard Bronze On Exchange Plan","61.25%","0.591514537961228","Yes","Yes","No","100%",,"$6,850","$40","$0","$60","$5,140","$2,010","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP23_EPO_RX1F47_EB02_2018_16322PA007002701.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007002701"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070035","UPMC Small Business Advantage Bronze EPO $6,850 - Premium Network","16322PA007",,"PAN001","PAS001","PAF037","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070035-00","UPMC Small Business Advantage Bronze EPO $6,850 - Premium Network","Standard Bronze Off Exchange Plan","61.25%","0.591471679656028","Yes","Yes","No","100%",,"$6,850","$60","$0","$60","$4,990","$2,160","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP47_EPO_RX1I19_EB02_2018_16322PA007003500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003500"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,700/20% - Premium Network","16322PA004",,"PAN007","PAS010","PAF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040025-06","UPMC Advantage Silver $100/20% - Premium Network","94% AV Level Silver Plan","94.67%","0.946648302907483","Yes","Yes","No","100%",,"$100","$0","$650","$60","$0","$530","$220","$60","$100","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%",,,,,"$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP59_PPO_RX1F37_DOVC_2018_16322PA004002506.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,700/20% - Partner Network","16322PA005",,"PAN005","PAS004","PAF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050105-00","UPMC Advantage Silver HSA $2,700/20% - Partner Network","Standard Silver Off Exchange Plan","71.43%","0.714205102693663","Yes","Yes","No","100%",,"$2,700","$0","$1,600","$60","$2,700","$1,380","$220","$60","$1,530","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NASE3_EPO_RX1F39_DOVC_2018_16322PA005010500.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070035","UPMC Small Business Advantage Bronze EPO $6,850 - Premium Network","16322PA007",,"PAN001","PAS001","PAF037","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070035-01","UPMC Small Business Advantage Bronze EPO $6,850 - Premium Network","Standard Bronze On Exchange Plan","61.25%","0.591471679656028","Yes","Yes","No","100%",,"$6,850","$60","$0","$60","$4,990","$2,160","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP23_EPO_RX1I19_EB02_2018_16322PA007003501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003501"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,700/20% - Partner Network","16322PA005",,"PAN005","PAS004","PAF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050105-01","UPMC Advantage Silver HSA $2,700/20% - Partner Network","Standard Silver On Exchange Plan","71.43%","0.714205102693663","Yes","Yes","No","100%",,"$2,700","$0","$1,600","$60","$2,700","$1,380","$220","$60","$1,530","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASE7_EPO_RX1F39_DOVC_2018_16322PA005010501.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,700/20% - Partner Network","16322PA005",,"PAN005","PAS004","PAF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050105-02","UPMC Advantage Silver $0/$0 - Partner Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAZE7_EPO_RX1D06_DOVC_2018_16322PA005010502.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,700/20% - Partner Network","16322PA005",,"PAN005","PAS004","PAF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050105-03","UPMC Advantage Silver HSA $2,700/20% - Partner Network","Limited Cost Sharing Plan Variation","71.43%","0.714205102693663","Yes","Yes","No","100%",,"$2,700","$0","$1,600","$60","$2,700","$1,380","$220","$60","$1,530","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASE9_EPO_RX1F43_DOVC_2018_16322PA005010503.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,700/20% - Partner Network","16322PA005",,"PAN005","PAS004","PAF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050105-04","UPMC Advantage Silver HSA $2,700/20% - Partner Network","73% AV Level Silver Plan","73.46%","0.734590666432124","Yes","Yes","No","100%",,"$2,700","$0","$700","$60","$2,300","$950","$150","$60","$1,530","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASEB_EPO_RX1F39_DOVC_2018_16322PA005010504.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,700/20% - Partner Network","16322PA005",,"PAN005","PAS004","PAF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050105-05","UPMC Advantage Silver $650/20% - Partner Network","87% AV Level Silver Plan","87.59%","0.875702578744096","Yes","Yes","No","100%",,"$650","$0","$1,800","$60","$220","$830","$240","$60","$650","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAED8_EPO_RX1F36_DOVC_2018_16322PA005010505.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,700/20% - Partner Network","16322PA005",,"PAN005","PAS004","PAF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050105-06","UPMC Advantage Silver $100/20% - Partner Network","94% AV Level Silver Plan","94.67%","0.946648302907483","Yes","Yes","No","100%",,"$100","$0","$650","$60","$0","$530","$220","$60","$100","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE96_EPO_RX1F37_DOVC_2018_16322PA005010506.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,700/20% - Select Network","16322PA005",,"PAN006","PAS005","PAF004","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050108-00","UPMC Advantage Silver HSA $2,700/20% - Select Network","Standard Silver Off Exchange Plan","71.43%","0.714205102693663","Yes","Yes","No","100%",,"$2,700","$0","$1,600","$60","$2,700","$1,380","$220","$60","$1,530","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NASE4_EPO_RX1F39_DOVC_2018_16322PA005010800.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1,750/$50 - Premium Network","16322PA004",,"PAN007","PAS010","PAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040007-00","UPMC Advantage Silver $1,750/$50 - Premium Network","Standard Silver Off Exchange Plan","71.94%","0.719356193449583","No","Yes","No","100%",,"$1,750","$1,480","$2,300","$60","$200","$4,890","$0","$60","$1,120","$440","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP37_PPO_RX1I05_DOVC_2018_16322PA004000700.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060053","UPMC Small Business Advantage Platinum PPO $10/$25 - Premium Network","16322PA006",,"PAN002","PAS001","PAF027","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060053-00","UPMC Small Business Advantage Platinum PPO $10/$25 - Premium Network","Standard Platinum Off Exchange Plan","91.90%","0.919458997259503","No","Yes","No","100%",,"$0","$510","$0","$60","$0","$1,300","$0","$60","$0","$730","$0","$40",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$1,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPI2_PPO_RX1F12_EB02_2018_16322PA006005300.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006005300"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060053","UPMC Small Business Advantage Platinum PPO $10/$25 - Premium Network","16322PA006",,"PAN002","PAS001","PAF027","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060053-01","UPMC Small Business Advantage Platinum PPO $10/$25 - Premium Network","Standard Platinum On Exchange Plan","91.90%","0.919458997259503","No","Yes","No","100%",,"$0","$510","$0","$60","$0","$1,300","$0","$60","$0","$730","$20","$40",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$1,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP52_PPO_RX1F12_EB02_2018_16322PA006005301.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006005301"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1,750/$50 - Premium Network","16322PA004",,"PAN007","PAS010","PAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040007-01","UPMC Advantage Silver $1,750/$50 - Premium Network","Standard Silver On Exchange Plan","71.94%","0.719356193449583","No","Yes","No","100%",,"$1,750","$1,480","$2,300","$60","$200","$4,890","$0","$60","$1,120","$440","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP68_PPO_RX1I05_DOVC_2018_16322PA004000701.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1,750/$50 - Premium Network","16322PA004",,"PAN007","PAS010","PAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040007-02","UPMC Advantage Silver $0/$0 - Premium Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZP_PPO_RX1D06_DOVC_2018_16322PA004000702.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060074","UPMC Small Business Advantage Platinum PPO $500 $20/$40 - Premium Network","16322PA006",,"PAN002","PAS001","PAF027","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060074-00","UPMC Small Business Advantage Platinum PPO $500 $20/$40 - Premium Network","Standard Platinum Off Exchange Plan","91.72%","0.915606601127699","No","Yes","No","100%",,"$500","$440","$0","$60","$0","$1,000","$0","$60","$500","$480","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$1,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPB8_PPO_RX1F12_EB02_2018_16322PA006007400.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006007400"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060074","UPMC Small Business Advantage Platinum PPO $500 $20/$40 - Premium Network","16322PA006",,"PAN002","PAS001","PAF027","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060074-01","UPMC Small Business Advantage Platinum PPO $500 $20/$40 - Premium Network","Standard Platinum On Exchange Plan","91.72%","0.915606601127699","No","Yes","No","100%",,"$500","$440","$0","$60","$0","$1,000","$0","$60","$500","$480","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$1,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP45_PPO_RX1F12_EB02_2018_16322PA006007401.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006007401"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1,750/$50 - Premium Network","16322PA004",,"PAN007","PAS010","PAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040007-03","UPMC Advantage Silver $1,750/$50 - Premium Network","Limited Cost Sharing Plan Variation","71.94%","0.719356193449583","No","Yes","No","100%",,"$1,750","$1,480","$2,300","$60","$200","$4,890","$0","$60","$1,120","$440","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPLU_PPO_RX1I13_DOVC_2018_16322PA004000703.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1,750/$50 - Premium Network","16322PA004",,"PAN007","PAS010","PAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040007-04","UPMC Advantage Silver $1,425/$50 - Premium Network","73% AV Level Silver Plan","73.97%","0.739662882567168","No","Yes","No","100%",,"$1,430","$1,480","$2,300","$60","$200","$4,890","$0","$60","$1,120","$440","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,425","$1425 per person","$2850 per group","20.00%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP69_PPO_RX1I05_DOVC_2018_16322PA004000704.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060081","UPMC Small Business Advantage Platinum PPO $10/$25 - Premium Network","16322PA006",,"PAN002","PAS001","PAF035","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060081-00","UPMC Small Business Advantage Platinum PPO $10/$25 - Premium Network","Standard Platinum Off Exchange Plan","91.51%","0.915430102618737","No","Yes","No","100%",,"$0","$510","$0","$60","$0","$1,300","$0","$60","$0","$730","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$1,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPI2_PPO_RX1I17_EB02_2018_16322PA006008100.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008100"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060081","UPMC Small Business Advantage Platinum PPO $10/$25 - Premium Network","16322PA006",,"PAN002","PAS001","PAF035","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060081-01","UPMC Small Business Advantage Platinum PPO $10/$25 - Premium Network","Standard Platinum On Exchange Plan","91.51%","0.915430102618737","No","Yes","No","100%",,"$0","$510","$0","$60","$0","$1,300","$0","$60","$0","$730","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$1,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP52_PPO_RX1I17_EB02_2018_16322PA006008101.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008101"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1,750/$50 - Premium Network","16322PA004",,"PAN007","PAS010","PAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040007-05","UPMC Advantage Silver $600/$15 - Premium Network","87% AV Level Silver Plan","87.84%","0.878424117055512","No","Yes","No","100%",,"$600","$260","$1,600","$60","$0","$1,250","$0","$60","$600","$150","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20.00%",,,,,"$1,200","$1200 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP70_PPO_RX1F36_DOVC_2018_16322PA004000705.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1,750/$50 - Premium Network","16322PA004",,"PAN007","PAS010","PAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040007-06","UPMC Advantage Silver $75/$5 - Premium Network","94% AV Level Silver Plan","94.17%","0.941714325060377","No","Yes","No","100%",,"$80","$170","$760","$60","$0","$990","$0","$60","$80","$50","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","20.00%",,,,,"$150","$150 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPA2_PPO_RX1F37_DOVC_2018_16322PA004000706.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060082","UPMC Small Business Advantage Platinum PPO $500 $20/$40 - Premium Network","16322PA006",,"PAN002","PAS001","PAF035","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060082-00","UPMC Small Business Advantage Platinum PPO $500 $20/$40 - Premium Network","Standard Platinum Off Exchange Plan","91.66%","0.915013924350334","No","Yes","No","100%",,"$500","$460","$0","$60","$0","$1,000","$0","$60","$500","$480","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$1,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPB8_PPO_RX1I17_EB02_2018_16322PA006008200.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008200"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,500/$25 - Premium Network","16322PA004",,"PAN007","PAS010","PAF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040008-00","UPMC Advantage Silver $3,500/$25 - Premium Network","Standard Silver Off Exchange Plan","71.91%","0.719138401221728","No","Yes","No","100%",,"$3,500","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP38_PPO_RX1I04_DOVC_2018_16322PA004000800.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060045","UPMC HealthyU Platinum HIA PPO $1,350/10% - Premium Network","16322PA006",,"PAN002","PAS001","PAF030","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060045-00","UPMC HealthyU Platinum HIA PPO $1,350/10% - Premium Network","Standard Platinum Off Exchange Plan","89.29%","0.830990454520775","Yes","Yes","No","100%",,"$1,350","$0","$650","$60","$1,350","$590","$60","$60","$1,350","$0","$210","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","10.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NIP44_PPO_RX1G69_EB02_2018_16322PA006004500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006004500"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060045","UPMC HealthyU Platinum HIA PPO $1,350/10% - Premium Network","16322PA006",,"PAN002","PAS001","PAF030","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060045-01","UPMC HealthyU Platinum HIA PPO $1,350/10% - Premium Network","Standard Platinum On Exchange Plan","89.29%","0.830990454520775","Yes","Yes","No","100%",,"$1,350","$0","$650","$60","$1,350","$590","$60","$60","$1,350","$0","$210","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","10.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XIP11_PPO_RX1G69_EB02_2018_16322PA006004501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006004501"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,500/$25 - Premium Network","16322PA004",,"PAN007","PAS010","PAF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040008-05","UPMC Advantage Silver $1,250/$5 - Premium Network","87% AV Level Silver Plan","87.99%","0.882747350224618","No","Yes","No","100%",,"$1,250","$310","$0","$60","$0","$1,160","$0","$60","$820","$610","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP73_PPO_RX1F36_DOVC_2018_16322PA004000805.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,500/$25 - Premium Network","16322PA004",,"PAN007","PAS010","PAF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040008-06","UPMC Advantage Silver $150/$5 - Premium Network","94% AV Level Silver Plan","94.96%","0.952682995207241","No","Yes","No","100%",,"$150","$210","$0","$60","$0","$1,000","$0","$60","$150","$310","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP74_PPO_RX1F37_DOVC_2018_16322PA004000806.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060096","UPMC HealthyU Gold HIA PPO $2,500/10% - Premium Network","16322PA006",,"PAN002","PAS001","PAF038","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060096-00","UPMC HealthyU Gold HIA PPO $2,500/10% - Premium Network","Standard Gold Off Exchange Plan","81.19%","0.746304020842747","Yes","Yes","No","100%",,"$2,500","$0","$930","$60","$2,400","$950","$80","$60","$1,720","$0","$210","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NIP45_PPO_RX1I20_EB02_2018_16322PA006009600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009600"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060096","UPMC HealthyU Gold HIA PPO $2,500/10% - Premium Network","16322PA006",,"PAN002","PAS001","PAF038","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060096-01","UPMC HealthyU Gold HIA PPO $2,500/10% - Premium Network","Standard Gold On Exchange Plan","81.19%","0.746304020842747","Yes","Yes","No","100%",,"$2,500","$0","$930","$60","$2,400","$950","$80","$60","$1,720","$0","$210","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XIP12_PPO_RX1I20_EB02_2018_16322PA006009601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009601"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,500/$25 - Select Network","16322PA005",,"PAN006","PAS005","PAF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050031-00","UPMC Advantage Silver $3,500/$25 - Select Network","Standard Silver Off Exchange Plan","71.91%","0.719138401221728","No","Yes","No","100%",,"$3,500","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE48_EPO_RX1I04_DOVC_2018_16322PA005003100.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,500/$25 - Select Network","16322PA005",,"PAN006","PAS005","PAF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050031-01","UPMC Advantage Silver $3,500/$25 - Select Network","Standard Silver On Exchange Plan","71.91%","0.719138401221728","No","Yes","No","100%",,"$3,500","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEB9_EPO_RX1I04_DOVC_2018_16322PA005003101.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,500/$25 - Select Network","16322PA005",,"PAN006","PAS005","PAF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050031-02","UPMC Advantage Silver $0/$0 - Select Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZZ_EPO_RX1D06_DOVC_2018_16322PA005003102.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060082","UPMC Small Business Advantage Platinum PPO $500 $20/$40 - Premium Network","16322PA006",,"PAN002","PAS001","PAF035","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060082-01","UPMC Small Business Advantage Platinum PPO $500 $20/$40 - Premium Network","Standard Platinum On Exchange Plan","91.66%","0.915013924350334","No","Yes","No","100%",,"$500","$460","$0","$60","$0","$1,000","$0","$60","$500","$480","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$1,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP45_PPO_RX1I17_EB02_2018_16322PA006008201.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008201"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$50 - Select Network","16322PA005",,"PAN006","PAS005","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050030-00","UPMC Advantage Silver $1,750/$50 - Select Network","Standard Silver Off Exchange Plan","71.94%","0.719356193449583","No","Yes","No","100%",,"$1,750","$1,480","$2,300","$60","$200","$4,890","$0","$60","$1,120","$440","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE47_EPO_RX1I05_DOVC_2018_16322PA005003000.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$50 - Select Network","16322PA005",,"PAN006","PAS005","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050030-01","UPMC Advantage Silver $1,750/$50 - Select Network","Standard Silver On Exchange Plan","71.94%","0.719356193449583","No","Yes","No","100%",,"$1,750","$1,480","$2,300","$60","$200","$4,890","$0","$60","$1,120","$440","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEB6_EPO_RX1I05_DOVC_2018_16322PA005003001.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070012","UPMC Small Business Advantage Platinum EPO $10/$25 - Premium Network","16322PA007",,"PAN001","PAS001","PAF027","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070012-00","UPMC Small Business Advantage Platinum EPO $10/$25 - Premium Network","Standard Platinum Off Exchange Plan","91.90%","0.919458997259503","No","Yes","No","100%",,"$0","$510","$0","$60","$0","$1,300","$0","$60","$0","$730","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP70_EPO_RX1F12_EB02_2018_16322PA007001200.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007001200"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070012","UPMC Small Business Advantage Platinum EPO $10/$25 - Premium Network","16322PA007",,"PAN001","PAS001","PAF027","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070012-01","UPMC Small Business Advantage Platinum EPO $10/$25 - Premium Network","Standard Platinum On Exchange Plan","91.90%","0.919458997259503","No","Yes","No","100%",,"$0","$510","$0","$60","$0","$1,300","$0","$60","$0","$730","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP24_EPO_RX1F12_EB02_2018_16322PA007001201.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007001201"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$50 - Select Network","16322PA005",,"PAN006","PAS005","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050030-02","UPMC Advantage Silver $0/$0 - Select Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZY_EPO_RX1D06_DOVC_2018_16322PA005003002.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$50 - Select Network","16322PA005",,"PAN006","PAS005","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050030-03","UPMC Advantage Silver $1,750/$50 - Select Network","Limited Cost Sharing Plan Variation","71.94%","0.719356193449583","No","Yes","No","100%",,"$1,750","$1,480","$2,300","$60","$200","$4,890","$0","$60","$1,120","$440","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALE1_EPO_RX1I13_DOVC_2018_16322PA005003003.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070013","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Premium Network","16322PA007",,"PAN001","PAS001","PAF027","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070013-00","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Premium Network","Standard Platinum Off Exchange Plan","91.72%","0.915606601127699","No","Yes","No","100%",,"$500","$440","$0","$60","$0","$1,000","$0","$60","$500","$480","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP42_EPO_RX1F12_EB02_2018_16322PA007001300.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007001300"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070013","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Premium Network","16322PA007",,"PAN001","PAS001","PAF027","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070013-01","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Premium Network","Standard Platinum On Exchange Plan","91.72%","0.915606601127699","No","Yes","No","100%",,"$500","$440","$0","$60","$0","$1,000","$0","$60","$500","$480","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP18_EPO_RX1F12_EB02_2018_16322PA007001301.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007001301"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$50 - Select Network","16322PA005",,"PAN006","PAS005","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050030-04","UPMC Advantage Silver $1,425/$50 - Select Network","73% AV Level Silver Plan","73.97%","0.739662882567168","No","Yes","No","100%",,"$1,430","$1,480","$2,300","$60","$200","$4,890","$0","$60","$1,120","$440","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,425","$1425 per person","$2850 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEB7_EPO_RX1I05_DOVC_2018_16322PA005003004.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$50 - Select Network","16322PA005",,"PAN006","PAS005","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050030-05","UPMC Advantage Silver $600/$15 - Select Network","87% AV Level Silver Plan","87.84%","0.878424117055512","No","Yes","No","100%",,"$600","$260","$1,600","$60","$0","$1,250","$0","$60","$600","$150","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEB8_EPO_RX1F36_DOVC_2018_16322PA005003005.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070028","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Premium Network","16322PA007",,"PAN001","PAS001","PAF035","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070028-00","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Premium Network","Standard Platinum Off Exchange Plan","91.66%","0.915013924350334","No","Yes","No","100%",,"$500","$460","$0","$60","$0","$1,000","$0","$60","$500","$480","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP42_EPO_RX1I17_EB02_2018_16322PA007002800.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007002800"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070028","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Premium Network","16322PA007",,"PAN001","PAS001","PAF035","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070028-01","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Premium Network","Standard Platinum On Exchange Plan","91.66%","0.915013924350334","No","Yes","No","100%",,"$500","$460","$0","$60","$0","$1,000","$0","$60","$500","$480","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP18_EPO_RX1I17_EB02_2018_16322PA007002801.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007002801"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$50 - Select Network","16322PA005",,"PAN006","PAS005","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050030-06","UPMC Advantage Silver $75/$5 - Select Network","94% AV Level Silver Plan","94.17%","0.941714325060377","No","Yes","No","100%",,"$80","$170","$760","$60","$0","$990","$0","$60","$80","$50","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEH1_EPO_RX1F37_DOVC_2018_16322PA005003006.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$50 - Partner Network","16322PA005",,"PAN005","PAS004","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050103-00","UPMC Advantage Silver $1,750/$50 - Partner Network","Standard Silver Off Exchange Plan","71.94%","0.719356193449583","No","Yes","No","100%",,"$1,750","$1,480","$2,300","$60","$200","$4,890","$0","$60","$1,120","$440","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE53_EPO_RX1I05_DOVC_2018_16322PA005010300.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070062","UPMC Small Business Advantage Platinum EPO $10/$25 - Premium Network","16322PA007",,"PAN001","PAS001","PAF035","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070062-00","UPMC Small Business Advantage Platinum EPO $10/$25 - Premium Network","Standard Platinum Off Exchange Plan","91.51%","0.915430102618737","No","Yes","No","100%",,"$0","$530","$0","$60","$0","$1,300","$0","$60","$0","$730","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP70_EPO_RX1I17_EB02_2018_16322PA007006200.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007006200"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070062","UPMC Small Business Advantage Platinum EPO $10/$25 - Premium Network","16322PA007",,"PAN001","PAS001","PAF035","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070062-01","UPMC Small Business Advantage Platinum EPO $10/$25 - Premium Network","Standard Platinum On Exchange Plan","91.51%","0.915430102618737","No","Yes","No","100%",,"$0","$530","$0","$60","$0","$1,300","$0","$60","$0","$730","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP24_EPO_RX1I17_EB02_2018_16322PA007006201.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007006201"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$50 - Partner Network","16322PA005",,"PAN005","PAS004","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050103-01","UPMC Advantage Silver $1,750/$50 - Partner Network","Standard Silver On Exchange Plan","71.94%","0.719356193449583","No","Yes","No","100%",,"$1,750","$1,480","$2,300","$60","$200","$4,890","$0","$60","$1,120","$440","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAED1_EPO_RX1I05_DOVC_2018_16322PA005010301.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$50 - Partner Network","16322PA005",,"PAN005","PAS004","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050103-02","UPMC Advantage Silver $0/$0 - Partner Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAZE5_EPO_RX1D06_DOVC_2018_16322PA005010302.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$50 - Partner Network","16322PA005",,"PAN005","PAS004","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050103-03","UPMC Advantage Silver $1,750/$50 - Partner Network","Limited Cost Sharing Plan Variation","71.94%","0.719356193449583","No","Yes","No","100%",,"$1,750","$1,480","$2,300","$60","$200","$4,890","$0","$60","$1,120","$440","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALE7_EPO_RX1I13_DOVC_2018_16322PA005010303.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$50 - Partner Network","16322PA005",,"PAN005","PAS004","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050103-04","UPMC Advantage Silver $1,425/$50 - Partner Network","73% AV Level Silver Plan","73.97%","0.739662882567168","No","Yes","No","100%",,"$1,430","$1,480","$2,300","$60","$200","$4,890","$0","$60","$1,120","$440","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,425","$1425 per person","$2850 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAED2_EPO_RX1I05_DOVC_2018_16322PA005010304.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$50 - Partner Network","16322PA005",,"PAN005","PAS004","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050103-05","UPMC Advantage Silver $600/$15 - Partner Network","87% AV Level Silver Plan","87.84%","0.878424117055512","No","Yes","No","100%",,"$600","$260","$1,600","$60","$0","$1,250","$0","$60","$600","$150","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAED3_EPO_RX1F36_DOVC_2018_16322PA005010305.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$50 - Partner Network","16322PA005",,"PAN005","PAS004","PAF009","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050103-06","UPMC Advantage Silver $75/$5 - Partner Network","94% AV Level Silver Plan","94.17%","0.941714325060377","No","Yes","No","100%",,"$80","$170","$760","$60","$0","$990","$0","$60","$80","$50","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEH2_EPO_RX1F37_DOVC_2018_16322PA005010306.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,500/$25 - Premium Network","16322PA004",,"PAN007","PAS010","PAF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040008-01","UPMC Advantage Silver $3,500/$25 - Premium Network","Standard Silver On Exchange Plan","71.91%","0.719138401221728","No","Yes","No","100%",,"$3,500","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP71_PPO_RX1I04_DOVC_2018_16322PA004000801.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,500/$25 - Premium Network","16322PA004",,"PAN007","PAS010","PAF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040008-02","UPMC Advantage Silver $0/$0 - Premium Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZQ_PPO_RX1D06_DOVC_2018_16322PA004000802.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060046","UPMC HealthyU Gold HIA PPO $2,500/10% - Premium Network","16322PA006",,"PAN002","PAS001","PAF030","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060046-00","UPMC HealthyU Gold HIA PPO $2,500/10% - Premium Network","Standard Gold Off Exchange Plan","81.23%","0.746764536569126","Yes","Yes","No","100%",,"$2,500","$0","$930","$60","$2,440","$910","$80","$60","$1,720","$0","$210","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NIP45_PPO_RX1G69_EB02_2018_16322PA006004600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006004600"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060046","UPMC HealthyU Gold HIA PPO $2,500/10% - Premium Network","16322PA006",,"PAN002","PAS001","PAF030","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060046-01","UPMC HealthyU Gold HIA PPO $2,500/10% - Premium Network","Standard Gold On Exchange Plan","81.23%","0.746764536569126","Yes","Yes","No","100%",,"$2,500","$0","$930","$60","$2,440","$910","$80","$60","$1,720","$0","$210","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XIP12_PPO_RX1G69_EB02_2018_16322PA006004601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006004601"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,500/$25 - Premium Network","16322PA004",,"PAN007","PAS010","PAF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040008-03","UPMC Advantage Silver $3,500/$25 - Premium Network","Limited Cost Sharing Plan Variation","71.91%","0.719138401221728","No","Yes","No","100%",,"$3,500","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPLV_PPO_RX1I14_DOVC_2018_16322PA004000803.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,500/$25 - Premium Network","16322PA004",,"PAN007","PAS010","PAF007","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040008-04","UPMC Advantage Silver $2,650/$25 - Premium Network","73% AV Level Silver Plan","73.94%","0.739376308730272","No","Yes","No","100%",,"$2,650","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","0.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP72_PPO_RX1I04_DOVC_2018_16322PA004000804.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060095","UPMC HealthyU Platinum HIA PPO $1,350/10% - Premium Network","16322PA006",,"PAN002","PAS001","PAF038","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060095-00","UPMC HealthyU Platinum HIA PPO $1,350/10% - Premium Network","Standard Platinum Off Exchange Plan","89.21%","0.830143701850187","Yes","Yes","No","100%",,"$1,350","$0","$650","$60","$1,350","$590","$60","$60","$1,350","$0","$210","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","10.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NIP44_PPO_RX1I20_EB02_2018_16322PA006009500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009500"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060095","UPMC HealthyU Platinum HIA PPO $1,350/10% - Premium Network","16322PA006",,"PAN002","PAS001","PAF038","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060095-01","UPMC HealthyU Platinum HIA PPO $1,350/10% - Premium Network","Standard Platinum On Exchange Plan","89.21%","0.830143701850187","Yes","Yes","No","100%",,"$1,350","$0","$650","$60","$1,350","$590","$60","$60","$1,350","$0","$210","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","10.00%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XIP11_PPO_RX1I20_EB02_2018_16322PA006009501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009501"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,500/$25 - Select Network","16322PA005",,"PAN006","PAS005","PAF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050031-03","UPMC Advantage Silver $3,500/$25 - Select Network","Limited Cost Sharing Plan Variation","71.91%","0.719138401221728","No","Yes","No","100%",,"$3,500","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALE2_EPO_RX1I14_DOVC_2018_16322PA005003103.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,500/$25 - Select Network","16322PA005",,"PAN006","PAS005","PAF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050031-04","UPMC Advantage Silver $2,650/$25 - Select Network","73% AV Level Silver Plan","73.94%","0.739376308730272","No","Yes","No","100%",,"$2,650","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEC1_EPO_RX1I04_DOVC_2018_16322PA005003104.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,500/$25 - Select Network","16322PA005",,"PAN006","PAS005","PAF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050031-05","UPMC Advantage Silver $1,250/$5 - Select Network","87% AV Level Silver Plan","87.99%","0.882747350224618","No","Yes","No","100%",,"$1,250","$310","$0","$60","$0","$1,160","$0","$60","$820","$610","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEC2_EPO_RX1F36_DOVC_2018_16322PA005003105.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,500/$25 - Select Network","16322PA005",,"PAN006","PAS005","PAF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050031-06","UPMC Advantage Silver $150/$5 - Select Network","94% AV Level Silver Plan","94.96%","0.952682995207241","No","Yes","No","100%",,"$150","$210","$0","$60","$0","$1,000","$0","$60","$150","$310","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEC3_EPO_RX1F37_DOVC_2018_16322PA005003106.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,500/$25 - Partner Network","16322PA005",,"PAN005","PAS004","PAF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050104-00","UPMC Advantage Silver $3,500/$25 - Partner Network","Standard Silver Off Exchange Plan","71.91%","0.719138401221728","No","Yes","No","100%",,"$3,500","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE54_EPO_RX1I04_DOVC_2018_16322PA005010400.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060041","UPMC Consumer Advantage Silver HSA PPO $3,250 - Premium Network","16322PA006",,"PAN003","PAS002","PAF029","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060041-00","UPMC Consumer Advantage Silver HSA PPO $3,250 - Premium Network","Standard Silver Off Exchange Plan","71.38%","0.713788741700987","Yes","Yes","No","100%",,"$3,250","$40","$0","$60","$3,250","$2,190","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0.00%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NSP66_PPO_RX1F47_EB02_2018_16322PA006004100.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006004100"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060041","UPMC Consumer Advantage Silver HSA PPO $3,250 - Premium Network","16322PA006",,"PAN003","PAS002","PAF029","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060041-01","UPMC Consumer Advantage Silver HSA PPO $3,250 - Premium Network","Standard Silver On Exchange Plan","71.38%","0.713788741700987","Yes","Yes","No","100%",,"$3,250","$40","$0","$60","$3,250","$2,190","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0.00%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XSP16_PPO_RX1F47_EB02_2018_16322PA006004101.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006004101"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN007","PAS010","PAF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040006-01","UPMC Advantage Silver $0/$50 - Premium Network","Standard Silver On Exchange Plan","70.55%","0.705463685866637","No","Yes","No","100%",,"$0","$7,350","$0","$60","$80","$4,690","$0","$60","$0","$5,590","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP65_PPO_RX1I06_DOVC_2018_16322PA004000601.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN007","PAS010","PAF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040006-02","UPMC Advantage Silver $0/$0 - Premium Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZO_PPO_RX1D06_DOVC_2018_16322PA004000602.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN005","PAS004","PAF011","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050102-03","UPMC Advantage Silver $0/$50 - Partner Network","Limited Cost Sharing Plan Variation","70.55%","0.705463685866637","No","Yes","No","100%",,"$0","$7,350","$0","$60","$80","$4,690","$0","$60","$0","$5,590","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALE6_EPO_RX1I12_DOVC_2018_16322PA005010203.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN005","PAS004","PAF011","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050102-04","UPMC Advantage Silver $0/$50 - Partner Network","73% AV Level Silver Plan","73.02%","0.730159096513538","No","Yes","No","100%",,"$0","$5,850","$0","$60","$80","$4,690","$0","$60","$0","$5,590","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEC8_EPO_RX1I06_DOVC_2018_16322PA005010204.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN005","PAS004","PAF011","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050102-05","UPMC Advantage Silver $0/$30 - Partner Network","87% AV Level Silver Plan","87.30%","0.871049381227757","No","Yes","No","100%",,"$0","$1,150","$0","$60","$0","$1,680","$0","$60","$0","$2,430","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEC9_EPO_RX1F36_DOVC_2018_16322PA005010205.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN005","PAS004","PAF011","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050102-06","UPMC Advantage Silver $0/$10 - Partner Network","94% AV Level Silver Plan","93.85%","0.938501401786344","No","Yes","No","100%",,"$0","$560","$0","$60","$0","$1,000","$0","$60","$0","$1,000","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE86_EPO_RX1F37_DOVC_2018_16322PA005010206.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040010","UPMC Advantage Gold $800/$20 - Premium Network","16322PA004",,"PAN007","PAS010","PAF013","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040010-00","UPMC Advantage Gold $800/$20 - Premium Network","Standard Gold Off Exchange Plan","81.95%","0.819473325418308","No","Yes","No","100%",,"$800","$760","$1,150","$60","$0","$3,330","$0","$60","$800","$310","$160","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP39_PPO_RX1F38_DOVC_2018_16322PA004001000.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060047","UPMC Inside Advantage Platinum PPO $250 $20/$40 - Premium Network","16322PA006",,"PAN003","PAS002","PAF027","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060047-00","UPMC Inside Advantage Platinum PPO $250 $20/$40 - Premium Network","Standard Platinum Off Exchange Plan","91.83%","0.918320313670647","No","Yes","Yes","90%","10%","$250","$620","$0","$60","$0","$1,000","$0","$60","$250","$730","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%","$500","$500 per person","$1000 per group","35.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPA5_PPO_RX1F12_EB02_2018_16322PA006004700.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006004700"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060047","UPMC Inside Advantage Platinum PPO $250 $20/$40 - Premium Network","16322PA006",,"PAN003","PAS002","PAF027","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060047-01","UPMC Inside Advantage Platinum PPO $250 $20/$40 - Premium Network","Standard Platinum On Exchange Plan","91.83%","0.918320313670647","No","Yes","Yes","90%","10%","$250","$620","$0","$60","$0","$1,000","$0","$60","$250","$730","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%","$500","$500 per person","$1000 per group","35.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP33_PPO_RX1F12_EB02_2018_16322PA006004701.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006004701"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,500/$25 - Partner Network","16322PA005",,"PAN005","PAS004","PAF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050104-01","UPMC Advantage Silver $3,500/$25 - Partner Network","Standard Silver On Exchange Plan","71.91%","0.719138401221728","No","Yes","No","100%",,"$3,500","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAED4_EPO_RX1I04_DOVC_2018_16322PA005010401.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,500/$25 - Partner Network","16322PA005",,"PAN005","PAS004","PAF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050104-02","UPMC Advantage Silver $0/$0 - Partner Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAZE6_EPO_RX1D06_DOVC_2018_16322PA005010402.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,500/$25 - Partner Network","16322PA005",,"PAN005","PAS004","PAF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050104-03","UPMC Advantage Silver $3,500/$25 - Partner Network","Limited Cost Sharing Plan Variation","71.91%","0.719138401221728","No","Yes","No","100%",,"$3,500","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALE8_EPO_RX1I14_DOVC_2018_16322PA005010403.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,500/$25 - Partner Network","16322PA005",,"PAN005","PAS004","PAF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050104-04","UPMC Advantage Silver $2,650/$25 - Partner Network","73% AV Level Silver Plan","73.94%","0.739376308730272","No","Yes","No","100%",,"$2,650","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAED5_EPO_RX1I04_DOVC_2018_16322PA005010404.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,500/$25 - Partner Network","16322PA005",,"PAN005","PAS004","PAF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050104-05","UPMC Advantage Silver $1,250/$5 - Partner Network","87% AV Level Silver Plan","87.99%","0.882747350224618","No","Yes","No","100%",,"$1,250","$310","$0","$60","$0","$1,160","$0","$60","$820","$610","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAED6_EPO_RX1F36_DOVC_2018_16322PA005010405.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,500/$25 - Partner Network","16322PA005",,"PAN005","PAS004","PAF007","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050104-06","UPMC Advantage Silver $150/$5 - Partner Network","94% AV Level Silver Plan","94.96%","0.952682995207241","No","Yes","No","100%",,"$150","$210","$0","$60","$0","$1,000","$0","$60","$150","$310","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAED7_EPO_RX1F37_DOVC_2018_16322PA005010406.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN007","PAS010","PAF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040006-00","UPMC Advantage Silver $0/$50 - Premium Network","Standard Silver Off Exchange Plan","70.55%","0.705463685866637","No","Yes","No","100%",,"$0","$7,350","$0","$60","$80","$4,690","$0","$60","$0","$5,590","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP36_PPO_RX1I06_DOVC_2018_16322PA004000600.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060042","UPMC Consumer Advantage Gold HSA PPO $2,000 - Premium Network","16322PA006",,"PAN002","PAS001","PAF028","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060042-00","UPMC Consumer Advantage Gold HSA PPO $2,000 - Premium Network","Standard Gold Off Exchange Plan","78.24%","0.782397460007059","Yes","Yes","No","100%",,"$2,000","$40","$0","$60","$2,000","$1,430","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$6850 per person","$6850 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NSP67_PPO_RX1F13_EB02_2018_16322PA006004200.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006004200"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060042","UPMC Consumer Advantage Gold HSA PPO $2,000 - Premium Network","16322PA006",,"PAN002","PAS001","PAF028","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060042-01","UPMC Consumer Advantage Gold HSA PPO $2,000 - Premium Network","Standard Gold On Exchange Plan","78.24%","0.782397460007059","Yes","Yes","No","100%",,"$2,000","$40","$0","$60","$2,000","$1,430","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$6850 per person","$6850 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XSP17_PPO_RX1F13_EB02_2018_16322PA006004201.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006004201"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN007","PAS010","PAF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040006-03","UPMC Advantage Silver $0/$50 - Premium Network","Limited Cost Sharing Plan Variation","70.55%","0.705463685866637","No","Yes","No","100%",,"$0","$7,350","$0","$60","$80","$4,690","$0","$60","$0","$5,590","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPLT_PPO_RX1I12_DOVC_2018_16322PA004000603.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN007","PAS010","PAF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040006-04","UPMC Advantage Silver $0/$50 - Premium Network","73% AV Level Silver Plan","73.02%","0.730159096513538","No","Yes","No","100%",,"$0","$5,850","$0","$60","$80","$4,690","$0","$60","$0","$5,590","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP66_PPO_RX1I06_DOVC_2018_16322PA004000604.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060043","UPMC Consumer Advantage Gold HSA PPO $1,350/10% - Premium Network","16322PA006",,"PAN002","PAS001","PAF028","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060043-00","UPMC Consumer Advantage Gold HSA PPO $1,350/10% - Premium Network","Standard Gold Off Exchange Plan","79.88%","0.79883674361599","Yes","Yes","No","100%",,"$1,350","$40","$1,260","$60","$1,350","$1,960","$120","$60","$1,350","$0","$210","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","10.00%",,,,,"$2,700","$5400 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NSP48_PPO_RX1F13_EB02_2018_16322PA006004300.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006004300"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060043","UPMC Consumer Advantage Gold HSA PPO $1,350/10% - Premium Network","16322PA006",,"PAN002","PAS001","PAF028","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060043-01","UPMC Consumer Advantage Gold HSA PPO $1,350/10% - Premium Network","Standard Gold On Exchange Plan","79.88%","0.79883674361599","Yes","Yes","No","100%",,"$1,350","$40","$1,260","$60","$1,350","$1,960","$120","$60","$1,350","$0","$210","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","10.00%",,,,,"$2,700","$5400 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XSP18_PPO_RX1F13_EB02_2018_16322PA006004301.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006004301"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN007","PAS010","PAF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040006-05","UPMC Advantage Silver $0/$30 - Premium Network","87% AV Level Silver Plan","87.30%","0.871049381227757","No","Yes","No","100%",,"$0","$1,150","$0","$60","$0","$1,680","$0","$60","$0","$2,430","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP67_PPO_RX1F36_DOVC_2018_16322PA004000605.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN007","PAS010","PAF011","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040006-06","UPMC Advantage Silver $0/$10 - Premium Network","94% AV Level Silver Plan","93.85%","0.938501401786344","No","Yes","No","100%",,"$0","$560","$0","$60","$0","$1,000","$0","$60","$0","$1,000","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP46_PPO_RX1F37_DOVC_2018_16322PA004000606.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060097","UPMC Consumer Advantage Gold HSA PPO $1,350/10% - Premium Network","16322PA006",,"PAN002","PAS001","PAF036","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060097-00","UPMC Consumer Advantage Gold HSA PPO $1,350/10% - Premium Network","Standard Gold Off Exchange Plan","79.70%","0.79883674361599","Yes","Yes","No","100%",,"$1,350","$60","$1,260","$60","$1,350","$1,960","$120","$60","$1,350","$0","$210","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","10.00%",,,,,"$2,700","$5400 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NSP68_PPO_RX1I18_EB02_2018_16322PA006009700.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009700"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060097","UPMC Consumer Advantage Gold HSA PPO $1,350/10% - Premium Network","16322PA006",,"PAN002","PAS001","PAF036","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060097-01","UPMC Consumer Advantage Gold HSA PPO $1,350/10% - Premium Network","Standard Gold On Exchange Plan","79.70%","0.79883674361599","Yes","Yes","No","100%",,"$1,350","$60","$1,260","$60","$1,350","$1,960","$120","$60","$1,350","$0","$210","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","10.00%",,,,,"$2,700","$5400 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XSP18_PPO_RX1I18_EB02_2018_16322PA006009701.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009701"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN006","PAS005","PAF011","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050029-00","UPMC Advantage Silver $0/$50 - Select Network","Standard Silver Off Exchange Plan","70.55%","0.705463685866637","No","Yes","No","100%",,"$0","$7,350","$0","$60","$80","$4,690","$0","$60","$0","$5,590","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE46_EPO_RX1I06_DOVC_2018_16322PA005002900.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN006","PAS005","PAF011","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050029-01","UPMC Advantage Silver $0/$50 - Select Network","Standard Silver On Exchange Plan","70.55%","0.705463685866637","No","Yes","No","100%",,"$0","$7,350","$0","$60","$80","$4,690","$0","$60","$0","$5,590","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEB3_EPO_RX1I06_DOVC_2018_16322PA005002901.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060098","UPMC Consumer Advantage Gold HSA PPO $2,000 - Premium Network","16322PA006",,"PAN002","PAS001","PAF036","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060098-00","UPMC Consumer Advantage Gold HSA PPO $2,000 - Premium Network","Standard Gold Off Exchange Plan","78.06%","0.782397460007059","Yes","Yes","No","100%",,"$2,000","$60","$0","$60","$2,000","$1,430","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$6850 per person","$6850 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NSP67_PPO_RX1I18_EB02_2018_16322PA006009800.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009800"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060098","UPMC Consumer Advantage Gold HSA PPO $2,000 - Premium Network","16322PA006",,"PAN002","PAS001","PAF036","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060098-01","UPMC Consumer Advantage Gold HSA PPO $2,000 - Premium Network","Standard Gold On Exchange Plan","78.06%","0.782397460007059","Yes","Yes","No","100%",,"$2,000","$60","$0","$60","$2,000","$1,430","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$6850 per person","$6850 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XSP17_PPO_RX1I18_EB02_2018_16322PA006009801.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009801"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN006","PAS005","PAF011","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050029-02","UPMC Advantage Silver $0/$0 - Select Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZX_EPO_RX1D06_DOVC_2018_16322PA005002902.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN006","PAS005","PAF011","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050029-03","UPMC Advantage Silver $0/$50 - Select Network","Limited Cost Sharing Plan Variation","70.55%","0.705463685866637","No","Yes","No","100%",,"$0","$7,350","$0","$60","$80","$4,690","$0","$60","$0","$5,590","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAELZ_EPO_RX1I12_DOVC_2018_16322PA005002903.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060099","UPMC Consumer Advantage Silver HSA PPO $3,250 - Premium Network","16322PA006",,"PAN003","PAS002","PAF037","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060099-00","UPMC Consumer Advantage Silver HSA PPO $3,250 - Premium Network","Standard Silver Off Exchange Plan","71.25%","0.713788741700987","Yes","Yes","No","100%",,"$3,250","$60","$0","$60","$3,250","$2,350","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0.00%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NSP66_PPO_RX1I19_EB02_2018_16322PA006009900.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009900"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060099","UPMC Consumer Advantage Silver HSA PPO $3,250 - Premium Network","16322PA006",,"PAN003","PAS002","PAF037","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060099-01","UPMC Consumer Advantage Silver HSA PPO $3,250 - Premium Network","Standard Silver On Exchange Plan","71.25%","0.713788741700987","Yes","Yes","No","100%",,"$3,250","$60","$0","$60","$3,250","$2,350","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0.00%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XSP16_PPO_RX1I19_EB02_2018_16322PA006009901.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009901"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN006","PAS005","PAF011","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050029-04","UPMC Advantage Silver $0/$50 - Select Network","73% AV Level Silver Plan","73.02%","0.730159096513538","No","Yes","No","100%",,"$0","$5,850","$0","$60","$80","$4,690","$0","$60","$0","$5,590","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEB4_EPO_RX1I06_DOVC_2018_16322PA005002904.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN006","PAS005","PAF011","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050029-05","UPMC Advantage Silver $0/$30 - Select Network","87% AV Level Silver Plan","87.30%","0.871049381227757","No","Yes","No","100%",,"$0","$1,150","$0","$60","$0","$1,680","$0","$60","$0","$2,430","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEB5_EPO_RX1F36_DOVC_2018_16322PA005002905.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN006","PAS005","PAF011","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050029-06","UPMC Advantage Silver $0/$10 - Select Network","94% AV Level Silver Plan","93.85%","0.938501401786344","No","Yes","No","100%",,"$0","$560","$0","$60","$0","$1,000","$0","$60","$0","$1,000","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE70_EPO_RX1F37_DOVC_2018_16322PA005002906.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN005","PAS004","PAF011","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050102-00","UPMC Advantage Silver $0/$50 - Partner Network","Standard Silver Off Exchange Plan","70.55%","0.705463685866637","No","Yes","No","100%",,"$0","$7,350","$0","$60","$80","$4,690","$0","$60","$0","$5,590","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE52_EPO_RX1I06_DOVC_2018_16322PA005010200.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN005","PAS004","PAF011","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050102-01","UPMC Advantage Silver $0/$50 - Partner Network","Standard Silver On Exchange Plan","70.55%","0.705463685866637","No","Yes","No","100%",,"$0","$7,350","$0","$60","$80","$4,690","$0","$60","$0","$5,590","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEC7_EPO_RX1I06_DOVC_2018_16322PA005010201.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN005","PAS004","PAF011","Existing","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050102-02","UPMC Advantage Silver $0/$0 - Partner Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAZE4_EPO_RX1D06_DOVC_2018_16322PA005010202.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040010","UPMC Advantage Gold $800/$20 - Premium Network","16322PA004",,"PAN007","PAS010","PAF013","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040010-01","UPMC Advantage Gold $800/$20 - Premium Network","Standard Gold On Exchange Plan","81.95%","0.819473325418308","No","Yes","No","100%",,"$800","$760","$1,150","$60","$0","$3,330","$0","$60","$800","$310","$160","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP75_PPO_RX1F38_DOVC_2018_16322PA004001001.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040010","UPMC Advantage Gold $800/$20 - Premium Network","16322PA004",,"PAN007","PAS010","PAF013","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040010-02","UPMC Advantage Gold $0/$0 - Premium Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZR_PPO_RX1D06_DOVC_2018_16322PA004001002.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060048","UPMC Inside Advantage Gold PPO $1,250 $25/$50 - Premium Network","16322PA006",,"PAN003","PAS002","PAF027","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060048-00","UPMC Inside Advantage Gold PPO $1,250 $25/$50 - Premium Network","Standard Gold Off Exchange Plan","81.96%","0.819565069545065","No","Yes","Yes","90%","10%","$1,250","$990","$0","$60","$0","$3,290","$0","$60","$980","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0.00%","$2,500","$2500 per person","$5000 per group","35.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPH7_PPO_RX1F12_EB02_2018_16322PA006004800.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006004800"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060048","UPMC Inside Advantage Gold PPO $1,250 $25/$50 - Premium Network","16322PA006",,"PAN003","PAS002","PAF027","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060048-01","UPMC Inside Advantage Gold PPO $1,250 $25/$50 - Premium Network","Standard Gold On Exchange Plan","81.96%","0.819565069545065","No","Yes","Yes","90%","10%","$1,250","$990","$0","$60","$0","$3,290","$0","$60","$980","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0.00%","$2,500","$2500 per person","$5000 per group","35.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP48_PPO_RX1F12_EB02_2018_16322PA006004801.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006004801"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040010","UPMC Advantage Gold $800/$20 - Premium Network","16322PA004",,"PAN007","PAS010","PAF013","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040010-03","UPMC Advantage Gold $800/$20 - Premium Network","Limited Cost Sharing Plan Variation","81.95%","0.819473325418308","No","Yes","No","100%",,"$800","$760","$1,150","$60","$0","$3,330","$0","$60","$800","$310","$160","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPLW_PPO_RX1F44_DOVC_2018_16322PA004001003.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050033","UPMC Advantage Gold $800/$20 - Select Network","16322PA005",,"PAN006","PAS005","PAF013","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050033-00","UPMC Advantage Gold $800/$20 - Select Network","Standard Gold Off Exchange Plan","81.95%","0.819473325418308","No","Yes","No","100%",,"$800","$760","$1,150","$60","$0","$3,330","$0","$60","$800","$310","$160","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE49_EPO_RX1F38_DOVC_2018_16322PA005003300.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060049","UPMC Inside Advantage Silver PPO $3,000 $30/$60 - Premium Network","16322PA006",,"PAN003","PAS002","PAF027","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060049-00","UPMC Inside Advantage Silver PPO $3,000 $30/$60 - Premium Network","Standard Silver Off Exchange Plan","71.64%","0.718969815772747","No","Yes","Yes","90%","10%","$2,390","$2,380","$0","$60","$0","$3,510","$0","$60","$900","$1,580","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%","$6,600","$6600 per person","$13200 per group","35.00%","$13,200","$13200 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPH8_PPO_RX1F12_EB02_2018_16322PA006004900.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006004900"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060049","UPMC Inside Advantage Silver PPO $3,000 $30/$60 - Premium Network","16322PA006",,"PAN003","PAS002","PAF027","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060049-01","UPMC Inside Advantage Silver PPO $3,000 $30/$60 - Premium Network","Standard Silver On Exchange Plan","71.64%","0.718969815772747","No","Yes","Yes","90%","10%","$2,390","$2,380","$0","$60","$0","$3,510","$0","$60","$900","$1,580","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%","$6,600","$6600 per person","$13200 per group","35.00%","$13,200","$13200 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP49_PPO_RX1F12_EB02_2018_16322PA006004901.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006004901"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050033","UPMC Advantage Gold $800/$20 - Select Network","16322PA005",,"PAN006","PAS005","PAF013","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050033-01","UPMC Advantage Gold $800/$20 - Select Network","Standard Gold On Exchange Plan","81.95%","0.819473325418308","No","Yes","No","100%",,"$800","$760","$1,150","$60","$0","$3,330","$0","$60","$800","$310","$160","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEC4_EPO_RX1F38_DOVC_2018_16322PA005003301.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050033","UPMC Advantage Gold $800/$20 - Select Network","16322PA005",,"PAN006","PAS005","PAF013","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050033-02","UPMC Advantage Gold $0/$0 - Select Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAZE1_EPO_RX1D06_DOVC_2018_16322PA005003302.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060050","UPMC Inside Advantage Silver PPO $5,000 $30/$60 - Premium Network","16322PA006",,"PAN003","PAS002","PAF027","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060050-00","UPMC Inside Advantage Silver PPO $5,000 $30/$60 - Premium Network","Standard Silver Off Exchange Plan","71.34%","0.719152504404904","No","Yes","Yes","90%","10%","$2,390","$2,380","$0","$60","$0","$3,510","$0","$60","$770","$2,330","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%","$6,350","$6350 per person","$12700 per group","35.00%","$12,700","$12700 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPH9_PPO_RX1F12_EB02_2018_16322PA006005000.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006005000"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060050","UPMC Inside Advantage Silver PPO $5,000 $30/$60 - Premium Network","16322PA006",,"PAN003","PAS002","PAF027","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060050-01","UPMC Inside Advantage Silver PPO $5,000 $30/$60 - Premium Network","Standard Silver On Exchange Plan","71.34%","0.719152504404904","No","Yes","Yes","90%","10%","$2,390","$2,380","$0","$60","$0","$3,510","$0","$60","$770","$2,330","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%","$6,350","$6350 per person","$12700 per group","35.00%","$12,700","$12700 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP50_PPO_RX1F12_EB02_2018_16322PA006005001.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006005001"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050033","UPMC Advantage Gold $800/$20 - Select Network","16322PA005",,"PAN006","PAS005","PAF013","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050033-03","UPMC Advantage Gold $800/$20 - Select Network","Limited Cost Sharing Plan Variation","81.95%","0.819473325418308","No","Yes","No","100%",,"$800","$760","$1,150","$60","$0","$3,330","$0","$60","$800","$310","$160","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALE3_EPO_RX1F44_DOVC_2018_16322PA005003303.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050106","UPMC Advantage Gold $800/$20 - Partner Network","16322PA005",,"PAN005","PAS004","PAF013","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050106-00","UPMC Advantage Gold $800/$20 - Partner Network","Standard Gold Off Exchange Plan","81.95%","0.819473325418308","No","Yes","No","100%",,"$800","$760","$1,150","$60","$0","$3,330","$0","$60","$800","$310","$160","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE64_EPO_RX1F38_DOVC_2018_16322PA005010600.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060090","UPMC Inside Advantage Platinum PPO $250 $20/$40 - Premium Network","16322PA006",,"PAN003","PAS002","PAF035","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060090-00","UPMC Inside Advantage Platinum PPO $250 $20/$40 - Premium Network","Standard Platinum Off Exchange Plan","91.69%","0.916949964749937","No","Yes","Yes","90%","10%","$250","$640","$0","$60","$0","$1,000","$0","$60","$250","$730","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%","$500","$500 per person","$1000 per group","35.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPA5_PPO_RX1I17_EB02_2018_16322PA006009000.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009000"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060090","UPMC Inside Advantage Platinum PPO $250 $20/$40 - Premium Network","16322PA006",,"PAN003","PAS002","PAF035","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060090-01","UPMC Inside Advantage Platinum PPO $250 $20/$40 - Premium Network","Standard Platinum On Exchange Plan","91.69%","0.916949964749937","No","Yes","Yes","90%","10%","$250","$640","$0","$60","$0","$1,000","$0","$60","$250","$730","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%","$500","$500 per person","$1000 per group","35.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP33_PPO_RX1I17_EB02_2018_16322PA006009001.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009001"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050106","UPMC Advantage Gold $800/$20 - Partner Network","16322PA005",,"PAN005","PAS004","PAF013","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050106-01","UPMC Advantage Gold $800/$20 - Partner Network","Standard Gold On Exchange Plan","81.95%","0.819473325418308","No","Yes","No","100%",,"$800","$760","$1,150","$60","$0","$3,330","$0","$60","$800","$310","$160","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAED9_EPO_RX1F38_DOVC_2018_16322PA005010601.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050106","UPMC Advantage Gold $800/$20 - Partner Network","16322PA005",,"PAN005","PAS004","PAF013","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050106-02","UPMC Advantage Gold $0/$0 - Partner Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAZE8_EPO_RX1D06_DOVC_2018_16322PA005010602.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060091","UPMC Inside Advantage Gold PPO $1,000 $25/$50 - Premium Network","16322PA006",,"PAN003","PAS002","PAF035","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060091-00","UPMC Inside Advantage Gold PPO $1,000 $25/$50 - Premium Network","Standard Gold Off Exchange Plan","81.70%","0.816324442599126","No","Yes","Yes","90%","10%","$1,000","$1,810","$0","$60","$0","$3,450","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%","$2,000","$2000 per person","$4000 per group","35.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPJ2_PPO_RX1I17_EB02_2018_16322PA006009100.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009100"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060091","UPMC Inside Advantage Gold PPO $1,000 $25/$50 - Premium Network","16322PA006",,"PAN003","PAS002","PAF035","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060091-01","UPMC Inside Advantage Gold PPO $1,000 $25/$50 - Premium Network","Standard Gold On Exchange Plan","81.70%","0.816324442599126","No","Yes","Yes","90%","10%","$1,000","$1,810","$0","$60","$0","$3,450","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%","$2,000","$2000 per person","$4000 per group","35.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP61_PPO_RX1I17_EB02_2018_16322PA006009101.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009101"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050106","UPMC Advantage Gold $800/$20 - Partner Network","16322PA005",,"PAN005","PAS004","PAF013","Existing","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050106-03","UPMC Advantage Gold $800/$20 - Partner Network","Limited Cost Sharing Plan Variation","81.95%","0.819473325418308","No","Yes","No","100%",,"$800","$760","$1,150","$60","$0","$3,330","$0","$60","$800","$310","$160","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALE9_EPO_RX1F44_DOVC_2018_16322PA005010603.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060092","UPMC Inside Advantage Gold PPO $1,250 $25/$50 - Premium Network","16322PA006",,"PAN003","PAS002","PAF035","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060092-00","UPMC Inside Advantage Gold PPO $1,250 $25/$50 - Premium Network","Standard Gold Off Exchange Plan","81.78%","0.817778272479738","No","Yes","Yes","90%","10%","$1,250","$1,010","$0","$60","$0","$3,450","$0","$60","$980","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0.00%","$2,500","$2500 per person","$5000 per group","35.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPH7_PPO_RX1I17_EB02_2018_16322PA006009200.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009200"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060092","UPMC Inside Advantage Gold PPO $1,250 $25/$50 - Premium Network","16322PA006",,"PAN003","PAS002","PAF035","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060092-01","UPMC Inside Advantage Gold PPO $1,250 $25/$50 - Premium Network","Standard Gold On Exchange Plan","81.78%","0.817778272479738","No","Yes","Yes","90%","10%","$1,250","$1,010","$0","$60","$0","$3,450","$0","$60","$980","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0.00%","$2,500","$2500 per person","$5000 per group","35.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP48_PPO_RX1I17_EB02_2018_16322PA006009201.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009201"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060093","UPMC Inside Advantage Silver PPO $3,000 $30/$60 - Premium Network","16322PA006",,"PAN003","PAS002","PAF035","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060093-00","UPMC Inside Advantage Silver PPO $3,000 $30/$60 - Premium Network","Standard Silver Off Exchange Plan","71.57%","0.718346533271594","No","Yes","Yes","90%","10%","$2,390","$2,400","$0","$60","$0","$3,670","$0","$60","$900","$1,580","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%","$6,600","$6600 per person","$13200 per group","35.00%","$13,200","$13200 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPH8_PPO_RX1I17_EB02_2018_16322PA006009300.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009300"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060093","UPMC Inside Advantage Silver PPO $3,000 $30/$60 - Premium Network","16322PA006",,"PAN003","PAS002","PAF035","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060093-01","UPMC Inside Advantage Silver PPO $3,000 $30/$60 - Premium Network","Standard Silver On Exchange Plan","71.57%","0.718346533271594","No","Yes","Yes","90%","10%","$2,390","$2,400","$0","$60","$0","$3,670","$0","$60","$900","$1,580","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%","$6,600","$6600 per person","$13200 per group","35.00%","$13,200","$13200 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP49_PPO_RX1I17_EB02_2018_16322PA006009301.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009301"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060094","UPMC Inside Advantage Silver PPO $5,000 $30/$60 - Premium Network","16322PA006",,"PAN003","PAS002","PAF035","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060094-00","UPMC Inside Advantage Silver PPO $5,000 $30/$60 - Premium Network","Standard Silver Off Exchange Plan","71.31%","0.718822765402735","No","Yes","Yes","90%","10%","$2,390","$2,400","$0","$60","$0","$3,670","$0","$60","$770","$2,330","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%","$6,350","$6350 per person","$12700 per group","35.00%","$12,700","$12700 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPH9_PPO_RX1I17_EB02_2018_16322PA006009400.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009400"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060094","UPMC Inside Advantage Silver PPO $5,000 $30/$60 - Premium Network","16322PA006",,"PAN003","PAS002","PAF035","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060094-01","UPMC Inside Advantage Silver PPO $5,000 $30/$60 - Premium Network","Standard Silver On Exchange Plan","71.31%","0.718822765402735","No","Yes","Yes","90%","10%","$2,390","$2,400","$0","$60","$0","$3,670","$0","$60","$770","$2,330","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0.00%","$6,350","$6350 per person","$12700 per group","35.00%","$12,700","$12700 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP50_PPO_RX1I17_EB02_2018_16322PA006009401.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006009401"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060107","UPMC Inside Advantage Gold PPO $1,000 $25/$50 - Premium Network","16322PA006",,"PAN003","PAS002","PAF027","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060107-00","UPMC Inside Advantage Gold PPO $1,000 $25/$50 - Premium Network","Standard Gold Off Exchange Plan","81.93%","0.818476190417069","No","Yes","Yes","90%","10%","$1,000","$1,790","$0","$60","$0","$3,290","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%","$2,000","$2000 per person","$4000 per group","35.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPJ2_PPO_RX1F12_EB02_2018_16322PA006010700.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006010700"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060107","UPMC Inside Advantage Gold PPO $1,000 $25/$50 - Premium Network","16322PA006",,"PAN003","PAS002","PAF027","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060107-01","UPMC Inside Advantage Gold PPO $1,000 $25/$50 - Premium Network","Standard Gold On Exchange Plan","81.93%","0.818476190417069","No","Yes","Yes","90%","10%","$1,000","$1,790","$0","$60","$0","$3,290","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%","$2,000","$2000 per person","$4000 per group","35.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP61_PPO_RX1F12_EB02_2018_16322PA006010701.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006010701"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060077","UPMC MyCare Advantage Platinum PPO $250 $20/$40 - Premium Network","16322PA006",,"PAN004","PAS003","PAF027","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060077-00","UPMC MyCare Advantage Platinum PPO $250 $20/$40 - Premium Network","Standard Platinum Off Exchange Plan","91.74%","0.917371063041483","No","Yes","Yes","90%","10%","$250","$620","$0","$60","$0","$1,000","$0","$60","$250","$730","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%","$500","$500 per person","$1000 per group","35.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPA9_PPO_RX1F12_EB02_2018_16322PA006007700.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006007700"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040012","UPMC Advantage Platinum $250/$20 - Premium Network","16322PA004",,"PAN007","PAS010","PAF014","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040012-00","UPMC Advantage Platinum $250/$20 - Premium Network","Standard Platinum Off Exchange Plan","91.17%","0.910030444219447","Yes","Yes","No","100%",,"$250","$10","$1,240","$60","$250","$1,210","$40","$60","$250","$0","$210","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP32_PPO_RX1F40_DOVC_2018_16322PA004001200.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040012","UPMC Advantage Platinum $250/$20 - Premium Network","16322PA004",,"PAN007","PAS010","PAF014","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040012-01","UPMC Advantage Platinum $250/$20 - Premium Network","Standard Platinum On Exchange Plan","91.17%","0.910030444219447","Yes","Yes","No","100%",,"$250","$10","$1,240","$60","$250","$1,210","$40","$60","$250","$0","$210","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP56_PPO_RX1F40_DOVC_2018_16322PA004001201.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060077","UPMC MyCare Advantage Platinum PPO $250 $20/$40 - Premium Network","16322PA006",,"PAN004","PAS003","PAF027","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060077-01","UPMC MyCare Advantage Platinum PPO $250 $20/$40 - Premium Network","Standard Platinum On Exchange Plan","91.74%","0.917371063041483","No","Yes","Yes","90%","10%","$250","$620","$0","$60","$0","$1,000","$0","$60","$250","$730","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%","$500","$500 per person","$1000 per group","35.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP37_PPO_RX1F12_EB02_2018_16322PA006007701.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006007701"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060078","UPMC MyCare Advantage Gold PPO $1,500 $25/$50  - Premium Network","16322PA006",,"PAN004","PAS003","PAF027","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060078-00","UPMC MyCare Advantage Gold PPO $1,500 $25/$50  - Premium Network","Standard Gold Off Exchange Plan","81.67%","0.816210869011357","No","Yes","Yes","90%","10%","$1,500","$720","$0","$60","$0","$3,050","$0","$60","$980","$910","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","$3,750","$3750 per person","$7500 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%","$3,000","$3000 per person","$6000 per group","35.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPI6_PPO_RX1F12_EB02_2018_16322PA006007800.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006007800"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040012","UPMC Advantage Platinum $250/$20 - Premium Network","16322PA004",,"PAN007","PAS010","PAF014","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040012-02","UPMC Advantage Platinum $0/$0 - Premium Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZK_PPO_RX1D06_DOVC_2018_16322PA004001202.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040012","UPMC Advantage Platinum $250/$20 - Premium Network","16322PA004",,"PAN007","PAS010","PAF014","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040012-03","UPMC Advantage Platinum $250/$20 - Premium Network","Limited Cost Sharing Plan Variation","91.17%","0.910030444219447","Yes","Yes","No","100%",,"$250","$10","$1,240","$60","$250","$1,210","$40","$60","$250","$0","$210","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPLQ_PPO_RX1F45_DOVC_2018_16322PA004001203.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060078","UPMC MyCare Advantage Gold PPO $1,500 $25/$50  - Premium Network","16322PA006",,"PAN004","PAS003","PAF027","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060078-01","UPMC MyCare Advantage Gold PPO $1,500 $25/$50  - Premium Network","Standard Gold On Exchange Plan","81.67%","0.816210869011357","No","Yes","Yes","90%","10%","$1,500","$720","$0","$60","$0","$3,050","$0","$60","$980","$910","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","$3,750","$3750 per person","$7500 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%","$3,000","$3000 per person","$6000 per group","35.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP56_PPO_RX1F12_EB02_2018_16322PA006007801.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006007801"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060079","UPMC MyCare Advantage Silver PPO $4,500 $40/$65 - Premium Network","16322PA006",,"PAN004","PAS003","PAF027","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060079-00","UPMC MyCare Advantage Silver PPO $4,500 $40/$65 - Premium Network","Standard Silver Off Exchange Plan","71.96%","0.719678136227761","No","Yes","Yes","90%","10%","$4,500","$120","$0","$60","$0","$2,640","$0","$60","$1,520","$420","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$7000 per group","0.00%","$7,000","$7000 per person","$14000 per group","35.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPI7_PPO_RX1F12_EB02_2018_16322PA006007900.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006007900"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050035","UPMC Advantage Platinum $250/$20 - Select Network","16322PA005",,"PAN006","PAS005","PAF014","Existing","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050035-00","UPMC Advantage Platinum $250/$20 - Select Network","Standard Platinum Off Exchange Plan","91.17%","0.910030444219447","Yes","Yes","No","100%",,"$250","$10","$1,240","$60","$250","$1,210","$40","$60","$250","$0","$210","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE34_EPO_RX1F40_DOVC_2018_16322PA005003500.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040027","UPMC Advantage Silver $3,500/$30 - Premium Network","16322PA004",,"PAN007","PAS010","PAF019","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040027-00","UPMC Advantage Silver $3,500/$30 - Premium Network","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$110","$3,190","$30","$60","$1,290","$200","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP42_PPO_RX1I07_DOVC_2018_16322PA004002700.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040027","UPMC Advantage Silver $3,500/$30 - Premium Network","16322PA004",,"PAN007","PAS010","PAF019","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040027-01","UPMC Advantage Silver $3,500/$30 - Premium Network","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$110","$3,190","$30","$60","$1,290","$200","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP79_PPO_RX1I07_DOVC_2018_16322PA004002701.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070038","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Partner Network","16322PA007",,"PAN011","PAS009","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070038-01","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Partner Network","Standard Gold On Exchange Plan","81.66%","0.815533738920068","No","Yes","No","100%",,"$1,000","$1,920","$0","$60","$0","$3,370","$0","$60","$980","$900","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP33_EPO_RX1I17_EB02_2018_16322PA007003801.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003801"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070039","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Partner Network","16322PA007",,"PAN011","PAS009","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070039-00","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Partner Network","Standard Gold Off Exchange Plan","81.66%","0.816580930541325","No","Yes","No","100%",,"$1,500","$1,010","$0","$60","$0","$3,450","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP80_EPO_RX1I17_EB02_2018_16322PA007003900.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003900"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040027","UPMC Advantage Silver $3,500/$30 - Premium Network","16322PA004",,"PAN007","PAS010","PAF019","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040027-06","UPMC Advantage Silver $250/$5 - Premium Network","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$20","$620","$60","$130","$390","$10","$60","$250","$30","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP82_PPO_RX1I10_DOVC_2018_16322PA004002706.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040028","UPMC Advantage Gold $1,400/$20 - Premium Network","16322PA004",,"PAN007","PAS010","PAF024","New","PPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040028-00","UPMC Advantage Gold $1,400/$20 - Premium Network","Standard Gold Off Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$80","$2,480","$60","$110","$2,450","$30","$60","$1,290","$150","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP43_PPO_RX1I11_DOVC_2018_16322PA004002800.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070039","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Partner Network","16322PA007",,"PAN011","PAS009","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070039-01","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Partner Network","Standard Gold On Exchange Plan","81.66%","0.816580930541325","No","Yes","No","100%",,"$1,500","$1,010","$0","$60","$0","$3,450","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP34_EPO_RX1I17_EB02_2018_16322PA007003901.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003901"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070040","UPMC Small Business Advantage Gold EPO $1,750 $30/$50  - Partner Network","16322PA007",,"PAN011","PAS009","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070040-00","UPMC Small Business Advantage Gold EPO $1,750 $30/$50  - Partner Network","Standard Gold Off Exchange Plan","81.53%","0.815334843524248","No","Yes","No","100%",,"$1,750","$1,020","$0","$60","$0","$3,490","$0","$60","$810","$1,000","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP81_EPO_RX1I17_EB02_2018_16322PA007004000.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004000"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040028","UPMC Advantage Gold $1,400/$20 - Premium Network","16322PA004",,"PAN007","PAS010","PAF024","New","PPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040028-01","UPMC Advantage Gold $1,400/$20 - Premium Network","Standard Gold On Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$80","$2,480","$60","$110","$2,450","$30","$60","$1,290","$150","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP83_PPO_RX1I11_DOVC_2018_16322PA004002801.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050035","UPMC Advantage Platinum $250/$20 - Select Network","16322PA005",,"PAN006","PAS005","PAF014","Existing","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050035-01","UPMC Advantage Platinum $250/$20 - Select Network","Standard Platinum On Exchange Plan","91.17%","0.910030444219447","Yes","Yes","No","100%",,"$250","$10","$1,240","$60","$250","$1,210","$40","$60","$250","$0","$210","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE80_EPO_RX1F40_DOVC_2018_16322PA005003501.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060079","UPMC MyCare Advantage Silver PPO $4,500 $40/$65 - Premium Network","16322PA006",,"PAN004","PAS003","PAF027","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060079-01","UPMC MyCare Advantage Silver PPO $4,500 $40/$65 - Premium Network","Standard Silver On Exchange Plan","71.96%","0.719678136227761","No","Yes","Yes","90%","10%","$4,500","$120","$0","$60","$0","$2,640","$0","$60","$1,520","$420","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$7000 per group","0.00%","$7,000","$7000 per person","$14000 per group","35.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP57_PPO_RX1F12_EB02_2018_16322PA006007901.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006007901"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060080","UPMC MyCare Advantage Silver PPO $6,500 $25/$50 - Premium Network","16322PA006",,"PAN004","PAS003","PAF027","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060080-00","UPMC MyCare Advantage Silver PPO $6,500 $25/$50 - Premium Network","Standard Silver Off Exchange Plan","71.45%","0.714507122141864","No","Yes","Yes","90%","10%","$6,500","$630","$0","$60","$0","$2,970","$0","$60","$830","$1,130","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$7000 per group","0.00%","$7,000","$7000 per person","$14000 per group","35.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPI8_PPO_RX1F12_EB02_2018_16322PA006008000.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008000"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050035","UPMC Advantage Platinum $250/$20 - Select Network","16322PA005",,"PAN006","PAS005","PAF014","Existing","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050035-02","UPMC Advantage Platinum $0/$0 - Select Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZL_EPO_RX1D06_DOVC_2018_16322PA005003502.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050035","UPMC Advantage Platinum $250/$20 - Select Network","16322PA005",,"PAN006","PAS005","PAF014","Existing","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050035-03","UPMC Advantage Platinum $250/$20 - Select Network","Limited Cost Sharing Plan Variation","91.17%","0.910030444219447","Yes","Yes","No","100%",,"$250","$10","$1,240","$60","$250","$1,210","$40","$60","$250","$0","$210","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAELP_EPO_RX1F45_DOVC_2018_16322PA005003503.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060080","UPMC MyCare Advantage Silver PPO $6,500 $25/$50 - Premium Network","16322PA006",,"PAN004","PAS003","PAF027","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060080-01","UPMC MyCare Advantage Silver PPO $6,500 $25/$50 - Premium Network","Standard Silver On Exchange Plan","71.45%","0.714507122141864","No","Yes","Yes","90%","10%","$6,500","$630","$0","$60","$0","$2,970","$0","$60","$830","$1,130","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$7000 per group","0.00%","$7,000","$7000 per person","$14000 per group","35.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP58_PPO_RX1F12_EB02_2018_16322PA006008001.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008001"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060100","UPMC MyCare Advantage Platinum PPO $250 $20/$40 - Premium Network","16322PA006",,"PAN004","PAS003","PAF035","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060100-00","UPMC MyCare Advantage Platinum PPO $250 $20/$40 - Premium Network","Standard Platinum Off Exchange Plan","91.60%","0.916029368165208","No","Yes","Yes","90%","10%","$250","$640","$0","$60","$0","$1,000","$0","$60","$250","$730","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%","$500","$500 per person","$1000 per group","35.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPA9_PPO_RX1I17_EB02_2018_16322PA006010000.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006010000"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050107","UPMC Advantage Platinum $250/$20 - Partner Network","16322PA005",,"PAN005","PAS004","PAF014","Existing","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050107-00","UPMC Advantage Platinum $250/$20 - Partner Network","Standard Platinum Off Exchange Plan","91.17%","0.910030444219447","Yes","Yes","No","100%",,"$250","$10","$1,240","$60","$250","$1,210","$40","$60","$250","$0","$210","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE41_EPO_RX1F40_DOVC_2018_16322PA005010700.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050107","UPMC Advantage Platinum $250/$20 - Partner Network","16322PA005",,"PAN005","PAS004","PAF014","Existing","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050107-01","UPMC Advantage Platinum $250/$20 - Partner Network","Standard Platinum On Exchange Plan","91.17%","0.910030444219447","Yes","Yes","No","100%",,"$250","$10","$1,240","$60","$250","$1,210","$40","$60","$250","$0","$210","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAE98_EPO_RX1F40_DOVC_2018_16322PA005010701.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060100","UPMC MyCare Advantage Platinum PPO $250 $20/$40 - Premium Network","16322PA006",,"PAN004","PAS003","PAF035","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060100-01","UPMC MyCare Advantage Platinum PPO $250 $20/$40 - Premium Network","Standard Platinum On Exchange Plan","91.60%","0.916029368165208","No","Yes","Yes","90%","10%","$250","$640","$0","$60","$0","$1,000","$0","$60","$250","$730","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0.00%","$500","$500 per person","$1000 per group","35.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP37_PPO_RX1I17_EB02_2018_16322PA006010001.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006010001"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060101","UPMC MyCare Advantage Gold PPO $1,000 $25/$50 - Premium Network","16322PA006",,"PAN004","PAS003","PAF035","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060101-00","UPMC MyCare Advantage Gold PPO $1,000 $25/$50 - Premium Network","Standard Gold Off Exchange Plan","81.77%","0.817650027084325","No","Yes","Yes","90%","10%","$1,000","$1,010","$0","$60","$0","$3,450","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%","$2,000","$2000 per person","$4000 per group","35.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPJ3_PPO_RX1I17_EB02_2018_16322PA006010100.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006010100"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050107","UPMC Advantage Platinum $250/$20 - Partner Network","16322PA005",,"PAN005","PAS004","PAF014","Existing","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050107-02","UPMC Advantage Platinum $0/$0 - Partner Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEZT_EPO_RX1D06_DOVC_2018_16322PA005010702.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050107","UPMC Advantage Platinum $250/$20 - Partner Network","16322PA005",,"PAN005","PAS004","PAF014","Existing","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050107-03","UPMC Advantage Platinum $250/$20 - Partner Network","Limited Cost Sharing Plan Variation","91.17%","0.910030444219447","Yes","Yes","No","100%",,"$250","$10","$1,240","$60","$250","$1,210","$40","$60","$250","$0","$210","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAELW_EPO_RX1F45_DOVC_2018_16322PA005010703.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060101","UPMC MyCare Advantage Gold PPO $1,000 $25/$50 - Premium Network","16322PA006",,"PAN004","PAS003","PAF035","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060101-01","UPMC MyCare Advantage Gold PPO $1,000 $25/$50 - Premium Network","Standard Gold On Exchange Plan","81.77%","0.817650027084325","No","Yes","Yes","90%","10%","$1,000","$1,010","$0","$60","$0","$3,450","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%","$2,000","$2000 per person","$4000 per group","35.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP62_PPO_RX1I17_EB02_2018_16322PA006010101.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006010101"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060102","UPMC MyCare Advantage Gold PPO $1,500 $25/$50  - Premium Network","16322PA006",,"PAN004","PAS003","PAF035","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060102-00","UPMC MyCare Advantage Gold PPO $1,500 $25/$50  - Premium Network","Standard Gold Off Exchange Plan","81.52%","0.814655528141957","No","Yes","Yes","90%","10%","$1,500","$740","$0","$60","$0","$3,210","$0","$60","$980","$910","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","$3,750","$3750 per person","$7500 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%","$3,000","$3000 per person","$6000 per group","35.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPI6_PPO_RX1I17_EB02_2018_16322PA006010200.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006010200"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060102","UPMC MyCare Advantage Gold PPO $1,500 $25/$50  - Premium Network","16322PA006",,"PAN004","PAS003","PAF035","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060102-01","UPMC MyCare Advantage Gold PPO $1,500 $25/$50  - Premium Network","Standard Gold On Exchange Plan","81.52%","0.814655528141957","No","Yes","Yes","90%","10%","$1,500","$740","$0","$60","$0","$3,210","$0","$60","$980","$910","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","$3,750","$3750 per person","$7500 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%","$3,000","$3000 per person","$6000 per group","35.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP56_PPO_RX1I17_EB02_2018_16322PA006010201.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006010201"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060103","UPMC MyCare Advantage Silver PPO $4,500 $40/$65 - Premium Network","16322PA006",,"PAN004","PAS003","PAF035","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060103-00","UPMC MyCare Advantage Silver PPO $4,500 $40/$65 - Premium Network","Standard Silver Off Exchange Plan","71.84%","0.718469642932761","No","Yes","Yes","90%","10%","$4,500","$140","$0","$60","$280","$2,800","$0","$60","$1,520","$420","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$7000 per group","0.00%","$7,000","$7000 per person","$14000 per group","35.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPI7_PPO_RX1I17_EB02_2018_16322PA006010300.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006010300"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060103","UPMC MyCare Advantage Silver PPO $4,500 $40/$65 - Premium Network","16322PA006",,"PAN004","PAS003","PAF035","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060103-01","UPMC MyCare Advantage Silver PPO $4,500 $40/$65 - Premium Network","Standard Silver On Exchange Plan","71.84%","0.718469642932761","No","Yes","Yes","90%","10%","$4,500","$140","$0","$60","$280","$2,800","$0","$60","$1,520","$420","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$7000 per group","0.00%","$7,000","$7000 per person","$14000 per group","35.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP57_PPO_RX1I17_EB02_2018_16322PA006010301.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006010301"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060104","UPMC MyCare Advantage Silver PPO $6,500 $25/$50 - Premium Network","16322PA006",,"PAN004","PAS003","PAF035","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060104-00","UPMC MyCare Advantage Silver PPO $6,500 $25/$50 - Premium Network","Standard Silver Off Exchange Plan","71.39%","0.71394605359832","No","Yes","Yes","90%","10%","$6,500","$650","$0","$60","$0","$3,130","$0","$60","$830","$1,130","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$7000 per group","0.00%","$7,000","$7000 per person","$14000 per group","35.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPI8_PPO_RX1I17_EB02_2018_16322PA006010400.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006010400"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060104","UPMC MyCare Advantage Silver PPO $6,500 $25/$50 - Premium Network","16322PA006",,"PAN004","PAS003","PAF035","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060104-01","UPMC MyCare Advantage Silver PPO $6,500 $25/$50 - Premium Network","Standard Silver On Exchange Plan","71.39%","0.71394605359832","No","Yes","Yes","90%","10%","$6,500","$650","$0","$60","$0","$3,130","$0","$60","$830","$1,130","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$7000 per group","0.00%","$7,000","$7000 per person","$14000 per group","35.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP58_PPO_RX1I17_EB02_2018_16322PA006010401.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006010401"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060108","UPMC MyCare Advantage Gold PPO $1,000 $25/$50 - Premium Network","16322PA006",,"PAN004","PAS003","PAF027","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060108-00","UPMC MyCare Advantage Gold PPO $1,000 $25/$50 - Premium Network","Standard Gold Off Exchange Plan","82.00%","0.819983087369007","No","Yes","Yes","90%","10%","$1,000","$990","$0","$60","$0","$3,290","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%","$2,000","$2000 per person","$4000 per group","35.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPJ3_PPO_RX1F12_EB02_2018_16322PA006010800.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006010800"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060108","UPMC MyCare Advantage Gold PPO $1,000 $25/$50 - Premium Network","16322PA006",,"PAN004","PAS003","PAF027","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060108-01","UPMC MyCare Advantage Gold PPO $1,000 $25/$50 - Premium Network","Standard Gold On Exchange Plan","82.00%","0.819983087369007","No","Yes","Yes","90%","10%","$1,000","$990","$0","$60","$0","$3,290","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%","$2,000","$2000 per person","$4000 per group","35.00%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP62_PPO_RX1F12_EB02_2018_16322PA006010801.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006010801"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070036","UPMC Small Business Advantage Platinum EPO $10/$25 - Partner Network","16322PA007",,"PAN011","PAS009","PAF035","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070036-00","UPMC Small Business Advantage Platinum EPO $10/$25 - Partner Network","Standard Platinum Off Exchange Plan","91.51%","0.915052240195496","No","Yes","No","100%",,"$0","$530","$0","$60","$0","$1,300","$0","$60","$0","$730","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP77_EPO_RX1I17_EB02_2018_16322PA007003600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003600"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070036","UPMC Small Business Advantage Platinum EPO $10/$25 - Partner Network","16322PA007",,"PAN011","PAS009","PAF035","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070036-01","UPMC Small Business Advantage Platinum EPO $10/$25 - Partner Network","Standard Platinum On Exchange Plan","91.51%","0.915052240195496","No","Yes","No","100%",,"$0","$530","$0","$60","$0","$1,300","$0","$60","$0","$730","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP31_EPO_RX1I17_EB02_2018_16322PA007003601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003601"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070037","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Partner Network","16322PA007",,"PAN011","PAS009","PAF035","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070037-00","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Partner Network","Standard Platinum Off Exchange Plan","91.66%","0.916587676811767","No","Yes","No","100%",,"$500","$460","$0","$60","$0","$1,000","$0","$60","$500","$480","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP78_EPO_RX1I17_EB02_2018_16322PA007003700.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003700"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040027","UPMC Advantage Silver $3,500/$30 - Premium Network","16322PA004",,"PAN007","PAS010","PAF019","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040027-02","UPMC Advantage Silver $0/$0 - Premium Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZU_PPO_RX1D06_DOVC_2018_16322PA004002702.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040027","UPMC Advantage Silver $3,500/$30 - Premium Network","16322PA004",,"PAN007","PAS010","PAF019","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040027-03","UPMC Advantage Silver $3,500/$30 - Premium Network","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$110","$3,190","$30","$60","$1,290","$200","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPLY_PPO_RX1I15_DOVC_2018_16322PA004002703.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070037","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Partner Network","16322PA007",,"PAN011","PAS009","PAF035","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070037-01","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Partner Network","Standard Platinum On Exchange Plan","91.66%","0.916587676811767","No","Yes","No","100%",,"$500","$460","$0","$60","$0","$1,000","$0","$60","$500","$480","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP32_EPO_RX1I17_EB02_2018_16322PA007003701.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003701"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070038","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Partner Network","16322PA007",,"PAN011","PAS009","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070038-00","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Partner Network","Standard Gold Off Exchange Plan","81.66%","0.815533738920068","No","Yes","No","100%",,"$1,000","$1,920","$0","$60","$0","$3,370","$0","$60","$980","$900","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP79_EPO_RX1I17_EB02_2018_16322PA007003800.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003800"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040027","UPMC Advantage Silver $3,500/$30 - Premium Network","16322PA004",,"PAN007","PAS010","PAF019","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040027-04","UPMC Advantage Silver $3,000/$30 - Premium Network","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$120","$2,480","$60","$110","$3,190","$30","$60","$1,290","$200","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP80_PPO_RX1I08_DOVC_2018_16322PA004002704.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040027","UPMC Advantage Silver $3,500/$30 - Premium Network","16322PA004",,"PAN007","PAS010","PAF019","Existing","PPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040027-05","UPMC Advantage Silver $700/$10 - Premium Network","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$110","$1,460","$30","$60","$700","$80","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"$1,400","$1400 per person","$2800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP81_PPO_RX1I09_DOVC_2018_16322PA004002705.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040028","UPMC Advantage Gold $1,400/$20 - Premium Network","16322PA004",,"PAN007","PAS010","PAF024","New","PPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040028-02","UPMC Advantage Gold $0/$0 - Premium Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZV_PPO_RX1D06_DOVC_2018_16322PA004002802.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070040","UPMC Small Business Advantage Gold EPO $1,750 $30/$50  - Partner Network","16322PA007",,"PAN011","PAS009","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070040-01","UPMC Small Business Advantage Gold EPO $1,750 $30/$50  - Partner Network","Standard Gold On Exchange Plan","81.53%","0.815334843524248","No","Yes","No","100%",,"$1,750","$1,020","$0","$60","$0","$3,490","$0","$60","$810","$1,000","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP35_EPO_RX1I17_EB02_2018_16322PA007004001.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004001"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070041","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Partner Network","16322PA007",,"PAN011","PAS009","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070041-00","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Partner Network","Standard Gold Off Exchange Plan","81.82%","0.818238726687189","No","Yes","No","100%",,"$2,000","$820","$0","$60","$0","$3,230","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP82_EPO_RX1I17_EB02_2018_16322PA007004100.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004100"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040028","UPMC Advantage Gold $1,400/$20 - Premium Network","16322PA004",,"PAN007","PAS010","PAF024","New","PPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040028-03","UPMC Advantage Gold $1,400/$20 - Premium Network","Limited Cost Sharing Plan Variation",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$80","$2,480","$60","$110","$2,450","$30","$60","$1,290","$150","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPLZ_PPO_RX1I16_DOVC_2018_16322PA004002803.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070041","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Partner Network","16322PA007",,"PAN011","PAS009","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070041-01","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Partner Network","Standard Gold On Exchange Plan","81.82%","0.818238726687189","No","Yes","No","100%",,"$2,000","$820","$0","$60","$0","$3,230","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP36_EPO_RX1I17_EB02_2018_16322PA007004101.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004101"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070042","UPMC Small Business Advantage Gold EPO $2,500 $20/$40 - Partner Network","16322PA007",,"PAN011","PAS009","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070042-00","UPMC Small Business Advantage Gold EPO $2,500 $20/$40 - Partner Network","Standard Gold Off Exchange Plan","81.59%","0.815902152250536","No","Yes","No","100%",,"$2,500","$820","$0","$60","$0","$3,230","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP83_EPO_RX1I17_EB02_2018_16322PA007004200.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004200"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070042","UPMC Small Business Advantage Gold EPO $2,500 $20/$40 - Partner Network","16322PA007",,"PAN011","PAS009","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070042-01","UPMC Small Business Advantage Gold EPO $2,500 $20/$40 - Partner Network","Standard Gold On Exchange Plan","81.59%","0.815902152250536","No","Yes","No","100%",,"$2,500","$820","$0","$60","$0","$3,230","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP37_EPO_RX1I17_EB02_2018_16322PA007004201.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004201"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070043","UPMC Small Business Advantage Silver EPO $3,000 $30/$50 - Partner Network","16322PA007",,"PAN011","PAS009","PAF035","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070043-00","UPMC Small Business Advantage Silver EPO $3,000 $30/$50 - Partner Network","Standard Silver Off Exchange Plan","71.37%","0.717150420318188","No","Yes","No","100%",,"$3,000","$2,020","$0","$60","$0","$3,490","$0","$60","$800","$1,650","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP84_EPO_RX1I17_EB02_2018_16322PA007004300.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004300"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070043","UPMC Small Business Advantage Silver EPO $3,000 $30/$50 - Partner Network","16322PA007",,"PAN011","PAS009","PAF035","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070043-01","UPMC Small Business Advantage Silver EPO $3,000 $30/$50 - Partner Network","Standard Silver On Exchange Plan","71.37%","0.717150420318188","No","Yes","No","100%",,"$3,000","$2,020","$0","$60","$0","$3,490","$0","$60","$800","$1,650","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP38_EPO_RX1I17_EB02_2018_16322PA007004301.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004301"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070044","UPMC Small Business Advantage Bronze EPO $6,850 - Partner Network","16322PA007",,"PAN011","PAS009","PAF037","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070044-00","UPMC Small Business Advantage Bronze EPO $6,850 - Partner Network","Standard Bronze Off Exchange Plan","61.25%","0.591471679656028","Yes","Yes","No","100%",,"$6,850","$60","$0","$60","$4,990","$2,160","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP85_EPO_RX1I19_EB02_2018_16322PA007004400.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004400"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070044","UPMC Small Business Advantage Bronze EPO $6,850 - Partner Network","16322PA007",,"PAN011","PAS009","PAF037","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070044-01","UPMC Small Business Advantage Bronze EPO $6,850 - Partner Network","Standard Bronze On Exchange Plan","61.25%","0.591471679656028","Yes","Yes","No","100%",,"$6,850","$60","$0","$60","$4,990","$2,160","$0","$60","$1,190","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP39_EPO_RX1I19_EB02_2018_16322PA007004401.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004401"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070045","UPMC Small Business Advantage Platinum EPO $10/$25 - Partner Network","16322PA007",,"PAN011","PAS009","PAF027","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070045-00","UPMC Small Business Advantage Platinum EPO $10/$25 - Partner Network","Standard Platinum Off Exchange Plan","91.90%","0.919026150204349","No","Yes","No","100%",,"$0","$510","$0","$60","$0","$1,300","$0","$60","$0","$730","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP77_EPO_RX1F12_EB02_2018_16322PA007004500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004500"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070045","UPMC Small Business Advantage Platinum EPO $10/$25 - Partner Network","16322PA007",,"PAN011","PAS009","PAF027","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070045-01","UPMC Small Business Advantage Platinum EPO $10/$25 - Partner Network","Standard Platinum On Exchange Plan","91.90%","0.919026150204349","No","Yes","No","100%",,"$0","$510","$0","$60","$0","$1,300","$0","$60","$0","$730","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP31_EPO_RX1F12_EB02_2018_16322PA007004501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004501"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070046","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Partner Network","16322PA007",,"PAN011","PAS009","PAF027","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070046-00","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Partner Network","Standard Platinum Off Exchange Plan","91.72%","0.917181168150152","No","Yes","No","100%",,"$500","$440","$0","$60","$0","$1,000","$0","$60","$500","$480","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP78_EPO_RX1F12_EB02_2018_16322PA007004600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004600"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070046","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Partner Network","16322PA007",,"PAN011","PAS009","PAF027","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070046-01","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Partner Network","Standard Platinum On Exchange Plan","91.72%","0.917181168150152","No","Yes","No","100%",,"$500","$440","$0","$60","$0","$1,000","$0","$60","$500","$480","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP32_EPO_RX1F12_EB02_2018_16322PA007004601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004601"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070055","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Partner Network","16322PA007",,"PAN011","PAS009","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070055-00","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Partner Network","Standard Gold Off Exchange Plan","81.88%","0.817739940120507","No","Yes","No","100%",,"$1,000","$1,900","$0","$60","$0","$3,210","$0","$60","$980","$900","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP79_EPO_RX1F12_EB02_2018_16322PA007005500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005500"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070055","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Partner Network","16322PA007",,"PAN011","PAS009","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070055-01","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Partner Network","Standard Gold On Exchange Plan","81.88%","0.817739940120507","No","Yes","No","100%",,"$1,000","$1,900","$0","$60","$0","$3,210","$0","$60","$980","$900","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP33_EPO_RX1F12_EB02_2018_16322PA007005501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005501"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070056","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Partner Network","16322PA007",,"PAN011","PAS009","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070056-00","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Partner Network","Standard Gold Off Exchange Plan","81.82%","0.818194351317122","No","Yes","No","100%",,"$1,500","$990","$0","$60","$0","$3,290","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP80_EPO_RX1F12_EB02_2018_16322PA007005600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005600"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070056","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Partner Network","16322PA007",,"PAN011","PAS009","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070056-01","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Partner Network","Standard Gold On Exchange Plan","81.82%","0.818194351317122","No","Yes","No","100%",,"$1,500","$990","$0","$60","$0","$3,290","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP34_EPO_RX1F12_EB02_2018_16322PA007005601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005601"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070057","UPMC Small Business Advantage Gold EPO $1,750 $30/$50 - Partner Network","16322PA007",,"PAN011","PAS009","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070057-00","UPMC Small Business Advantage Gold EPO $1,750 $30/$50 - Partner Network","Standard Gold Off Exchange Plan","81.67%","0.816702588644044","No","Yes","No","100%",,"$1,750","$1,000","$0","$60","$0","$3,330","$0","$60","$810","$1,000","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP81_EPO_RX1F12_EB02_2018_16322PA007005700.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005700"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070057","UPMC Small Business Advantage Gold EPO $1,750 $30/$50 - Partner Network","16322PA007",,"PAN011","PAS009","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070057-01","UPMC Small Business Advantage Gold EPO $1,750 $30/$50 - Partner Network","Standard Gold On Exchange Plan","81.67%","0.816702588644044","No","Yes","No","100%",,"$1,750","$1,000","$0","$60","$0","$3,330","$0","$60","$810","$1,000","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP35_EPO_RX1F12_EB02_2018_16322PA007005701.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005701"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070058","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Partner Network","16322PA007",,"PAN011","PAS009","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070058-00","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Partner Network","Standard Gold Off Exchange Plan","81.96%","0.819556953183541","No","Yes","No","100%",,"$2,000","$800","$0","$60","$0","$3,070","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP82_EPO_RX1F12_EB02_2018_16322PA007005800.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005800"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070058","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Partner Network","16322PA007",,"PAN011","PAS009","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070058-01","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Partner Network","Standard Gold On Exchange Plan","81.96%","0.819556953183541","No","Yes","No","100%",,"$2,000","$800","$0","$60","$0","$3,070","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP36_EPO_RX1F12_EB02_2018_16322PA007005801.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005801"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050114","UPMC Advantage Silver $3,500/$30 - Partner Network","16322PA005",,"PAN005","PAS004","PAF019","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050114-02","UPMC Advantage Silver $0/$0 - Partner Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAZEB_EPO_RX1D06_DOVC_2018_16322PA005011402.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070053","UPMC Small Business Advantage Silver EPO $3,000 $30/$50  - Tower Network","16322PA007",,"PAN010","PAS008","PAF035","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070053-00","UPMC Small Business Advantage Silver EPO $3,000 $30/$50  - Tower Network","Standard Silver Off Exchange Plan","71.37%",,"No","Yes","No","100%",,"$3,000","$2,020","$0","$60","$0","$3,490","$0","$60","$800","$1,650","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"7350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","3000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP92_EPO_RX1I38_EB02_2018_16322PA007005300.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005300"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070053","UPMC Small Business Advantage Silver EPO $3,000 $30/$50  - Tower Network","16322PA007",,"PAN010","PAS008","PAF035","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070053-01","UPMC Small Business Advantage Silver EPO $3,000 $30/$50  - Tower Network","Standard Silver On Exchange Plan","71.37%",,"No","Yes","No","100%",,"$3,000","$2,020","$0","$60","$0","$3,490","$0","$60","$800","$1,650","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"7350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","3000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP46_EPO_RX1I38_EB02_2018_16322PA007005301.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005301"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070047","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Tower Network","16322PA007",,"PAN010","PAS008","PAF035","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070047-00","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Tower Network","Standard Platinum Off Exchange Plan","91.66%",,"No","Yes","No","100%",,"$500","$460","$0","$60","$0","$1,000","$0","$60","$500","$480","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"1000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP86_EPO_RX1I38_EB02_2018_16322PA007004700.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004700"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050113","UPMC Advantage Silver $3,500/$30 - Select Network","16322PA005",,"PAN006","PAS005","PAF019","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050113-00","UPMC Advantage Silver $3,500/$30 - Select Network","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$110","$3,190","$30","$60","$1,290","$200","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE57_EPO_RX1I07_DOVC_2018_16322PA005011300.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050113","UPMC Advantage Silver $3,500/$30 - Select Network","16322PA005",,"PAN006","PAS005","PAF019","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050113-01","UPMC Advantage Silver $3,500/$30 - Select Network","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$110","$3,190","$30","$60","$1,290","$200","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEE4_EPO_RX1I07_DOVC_2018_16322PA005011301.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070047","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Tower Network","16322PA007",,"PAN010","PAS008","PAF035","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070047-01","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Tower Network","Standard Platinum On Exchange Plan","91.66%",,"No","Yes","No","100%",,"$500","$460","$0","$60","$0","$1,000","$0","$60","$500","$480","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"1000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP40_EPO_RX1I38_EB02_2018_16322PA007004701.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004701"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070048","UPMC Small Business Advantage Platinum EPO $10/$25 - Tower Network","16322PA007",,"PAN010","PAS008","PAF035","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070048-00","UPMC Small Business Advantage Platinum EPO $10/$25 - Tower Network","Standard Platinum Off Exchange Plan","91.51%",,"No","Yes","No","100%",,"$0","$530","$0","$60","$0","$1,300","$0","$60","$0","$730","$0","$40",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"1300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP87_EPO_RX1I38_EB02_2018_16322PA007004800.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004800"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050113","UPMC Advantage Silver $3,500/$30 - Select Network","16322PA005",,"PAN006","PAS005","PAF019","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050113-02","UPMC Advantage Silver $0/$0 - Select Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAZEA_EPO_RX1D06_DOVC_2018_16322PA005011302.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050113","UPMC Advantage Silver $3,500/$30 - Select Network","16322PA005",,"PAN006","PAS005","PAF019","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050113-03","UPMC Advantage Silver $3,500/$30 - Select Network","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$110","$3,190","$30","$60","$1,290","$200","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALEA_EPO_RX1I15_DOVC_2018_16322PA005011303.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070048","UPMC Small Business Advantage Platinum EPO $10/$25 - Tower Network","16322PA007",,"PAN010","PAS008","PAF035","New","EPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070048-01","UPMC Small Business Advantage Platinum EPO $10/$25 - Tower Network","Standard Platinum On Exchange Plan","91.51%",,"No","Yes","No","100%",,"$0","$530","$0","$60","$0","$1,330","$0","$60","$0","$730","$0","$40",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"1300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP41_EPO_RX1I38_EB02_2018_16322PA007004801.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004801"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070049","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Tower Network","16322PA007",,"PAN010","PAS008","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070049-00","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Tower Network","Standard Gold Off Exchange Plan","81.66%",,"No","Yes","No","100%",,"$1,000","$1,920","$0","$60","$0","$3,370","$0","$60","$980","$900","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"5000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","1000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP88_EPO_RX1I38_EB02_2018_16322PA007004900.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004900"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050113","UPMC Advantage Silver $3,500/$30 - Select Network","16322PA005",,"PAN006","PAS005","PAF019","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050113-04","UPMC Advantage Silver $3,000/$30 - Select Network","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$120","$2,480","$60","$110","$3,190","$30","$60","$1,290","$200","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEE5_EPO_RX1I08_DOVC_2018_16322PA005011304.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050113","UPMC Advantage Silver $3,500/$30 - Select Network","16322PA005",,"PAN006","PAS005","PAF019","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050113-05","UPMC Advantage Silver $700/$10 - Select Network","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$110","$1,460","$30","$60","$700","$80","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEE6_EPO_RX1I09_DOVC_2018_16322PA005011305.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070049","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Tower Network","16322PA007",,"PAN010","PAS008","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070049-01","UPMC Small Business Advantage Gold EPO $1,000 $25/$50 - Tower Network","Standard Gold On Exchange Plan","81.66%",,"No","Yes","No","100%",,"$1,000","$1,920","$0","$60","$0","$3,370","$0","$60","$980","$900","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"5000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","1000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP42_EPO_RX1I38_EB02_2018_16322PA007004901.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007004901"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070050","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Tower Network","16322PA007",,"PAN010","PAS008","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070050-00","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Tower Network","Standard Gold Off Exchange Plan","81.82%",,"No","Yes","No","100%",,"$1,500","$1,010","$0","$60","$0","$3,450","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"5000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","1500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP89_EPO_RX1I38_EB02_2018_16322PA007005000.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005000"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050113","UPMC Advantage Silver $3,500/$30 - Select Network","16322PA005",,"PAN006","PAS005","PAF019","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050113-06","UPMC Advantage Silver $250/$5 - Select Network","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$20","$620","$60","$130","$390","$10","$60","$250","$30","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEE7_EPO_RX1I10_DOVC_2018_16322PA005011306.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070050","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Tower Network","16322PA007",,"PAN010","PAS008","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070050-01","UPMC Small Business Advantage Gold EPO $1,500 $25/$50 - Tower Network","Standard Gold On Exchange Plan","81.66%",,"No","Yes","No","100%",,"$1,500","$1,010","$0","$60","$0","$3,450","$0","$60","$810","$930","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"5000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","1500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP43_EPO_RX1I38_EB02_2018_16322PA007005001.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005001"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050115","UPMC Advantage Gold $1,400/$20 - Select Network","16322PA005",,"PAN006","PAS005","PAF024","New","EPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050115-00","UPMC Advantage Gold $1,400/$20 - Select Network","Standard Gold Off Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$80","$2,480","$60","$110","$2,450","$30","$60","$1,290","$150","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE59_EPO_RX1I11_DOVC_2018_16322PA005011500.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050115","UPMC Advantage Gold $1,400/$20 - Select Network","16322PA005",,"PAN006","PAS005","PAF024","New","EPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050115-01","UPMC Advantage Gold $1,400/$20 - Select Network","Standard Gold On Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$80","$2,480","$60","$110","$2,450","$30","$60","$1,290","$150","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEF3_EPO_RX1I11_DOVC_2018_16322PA005011501.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070051","UPMC Small Business Advantage Gold EPO $1,750 $30/$50 - Tower Network","16322PA007",,"PAN010","PAS008","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070051-00","UPMC Small Business Advantage Gold EPO $1,750 $30/$50 - Tower Network","Standard Gold Off Exchange Plan","81.53%",,"No","Yes","No","100%",,"$1,750","$1,020","$0","$60","$0","$3,490","$0","$60","$810","$1,000","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"4000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","1750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP90_EPO_RX1I38_EB02_2018_16322PA007005100.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005100"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070051","UPMC Small Business Advantage Gold EPO $1,750 $30/$50 - Tower Network","16322PA007",,"PAN010","PAS008","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070051-01","UPMC Small Business Advantage Gold EPO $1,750 $30/$50 - Tower Network","Standard Gold On Exchange Plan","81.53%",,"No","Yes","No","100%",,"$1,750","$1,020","$0","$60","$0","$3,490","$0","$60","$810","$1,000","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"4000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","1750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP44_EPO_RX1I38_EB02_2018_16322PA007005101.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005101"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050115","UPMC Advantage Gold $1,400/$20 - Select Network","16322PA005",,"PAN006","PAS005","PAF024","New","EPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050115-02","UPMC Advantage Gold $0/$0 - Select Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAZEC_EPO_RX1D06_DOVC_2018_16322PA005011502.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050115","UPMC Advantage Gold $1,400/$20 - Select Network","16322PA005",,"PAN006","PAS005","PAF024","New","EPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050115-03","UPMC Advantage Gold $1,400/$20 - Select Network","Limited Cost Sharing Plan Variation",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$80","$2,480","$60","$110","$2,450","$30","$60","$1,290","$150","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALEC_EPO_RX1I16_DOVC_2018_16322PA005011503.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070052","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Tower Network","16322PA007",,"PAN010","PAS008","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070052-00","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Tower Network","Standard Gold Off Exchange Plan","81.82%",,"No","Yes","No","100%",,"$2,000","$820","$0","$60","$0","$3,230","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"5000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","2000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP91_EPO_RX1I38_EB02_2018_16322PA007005200.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005200"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070052","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Tower Network","16322PA007",,"PAN010","PAS008","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070052-01","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Tower Network","Standard Gold On Exchange Plan","81.82%",,"No","Yes","No","100%",,"$2,000","$820","$0","$60","$0","$3,230","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"5000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","2000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP45_EPO_RX1I38_EB02_2018_16322PA007005201.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005201"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070054","UPMC Small Business Advantage Bronze EPO $6,850 - Tower Network","16322PA007",,"PAN010","PAS008","PAF037","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070054-00","UPMC Small Business Advantage Bronze EPO $6,850 - Tower Network","Standard Bronze Off Exchange Plan","61.25%",,"Yes","Yes","No","100%",,"$6,850","$60","$0","$60","$1,200","$2,350","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"7150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP93_EPO_RX1I38_EB02_2018_16322PA007005400.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005400"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070054","UPMC Small Business Advantage Bronze EPO $6,850 - Tower Network","16322PA007",,"PAN010","PAS008","PAF037","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070054-01","UPMC Small Business Advantage Bronze EPO $6,850 - Tower Network","Standard Bronze On Exchange Plan","61.25%",,"Yes","Yes","No","100%",,"$6,850","$60","$0","$60","$1,200","$2,350","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"7150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP47_EPO_RX1I38_EB02_2018_16322PA007005401.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005401"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050114","UPMC Advantage Silver $3,500/$30 - Partner Network","16322PA005",,"PAN005","PAS004","PAF019","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050114-00","UPMC Advantage Silver $3,500/$30 - Partner Network","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$110","$3,190","$30","$60","$1,290","$200","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE58_EPO_RX1I07_DOVC_2018_16322PA005011400.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060051","UPMC Small Business Advantage Gold PPO $2,000 $20/$40 - Premium Network","16322PA006",,"PAN002","PAS001","PAF027","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060051-00","UPMC Small Business Advantage Gold PPO $2,000 $20/$40 - Premium Network","Standard Gold Off Exchange Plan","81.96%",,"No","Yes","No","100%",,"$2,000","$800","$0","$60","$0","$3,070","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"5000","$5000 per person","$10000 per group",,,,"10000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","2000","$2000 per person","$4000 per group","0%",,,,,"4000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPI1_PPO_RX1F12_EB02_2018_16322PA006005100.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006005100"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060051","UPMC Small Business Advantage Gold PPO $2,000 $20/$40 - Premium Network","16322PA006",,"PAN002","PAS001","PAF027","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060051-01","UPMC Small Business Advantage Gold PPO $2,000 $20/$40 - Premium Network","Standard Gold On Exchange Plan","81.96%",,"No","Yes","No","100%",,"$2,000","$800","$0","$60","$0","$3,070","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"5000","$5000 per person","$10000 per group",,,,"10000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","2000","$2000 per person","$4000 per group","0%",,,,,"4000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP51_PPO_RX1F12_EB02_2018_16322PA006005101.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006005101"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050114","UPMC Advantage Silver $3,500/$30 - Partner Network","16322PA005",,"PAN005","PAS004","PAF019","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050114-01","UPMC Advantage Silver $3,500/$30 - Partner Network","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$110","$3,190","$30","$60","$1,290","$200","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEE8_EPO_RX1I07_DOVC_2018_16322PA005011401.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060086","UPMC Small Business Advantage Gold PPO $2,000 $20/$40 - Premium Network","16322PA006",,"PAN002","PAS001","PAF035","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060086-00","UPMC Small Business Advantage Gold PPO $2,000 $20/$40 - Premium Network","Standard Gold Off Exchange Plan","81.82%",,"No","Yes","No","100%",,"$2,000","$820","$0","$60","$0","$3,230","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"5000","$5000 per person","$10000 per group",,,,"10000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","2000","$2000 per person","$4000 per group","0%",,,,,"4000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPI1_PPO_RX1I17_EB02_2018_16322PA006008600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008600"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060086","UPMC Small Business Advantage Gold PPO $2,000 $20/$40 - Premium Network","16322PA006",,"PAN002","PAS001","PAF035","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060086-01","UPMC Small Business Advantage Gold PPO $2,000 $20/$40 - Premium Network","Standard Gold On Exchange Plan","81.82%",,"No","Yes","No","100%",,"$2,000","$820","$0","$60","$0","$3,230","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"5000","$5000 per person","$10000 per group",,,,"10000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","2000","$2000 per person","$4000 per group","0%",,,,,"4000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP51_PPO_RX1I17_EB02_2018_16322PA006008601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008601"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050114","UPMC Advantage Silver $3,500/$30 - Partner Network","16322PA005",,"PAN005","PAS004","PAF019","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050114-03","UPMC Advantage Silver $3,500/$30 - Partner Network","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$110","$3,190","$30","$60","$1,290","$200","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALEB_EPO_RX1I15_DOVC_2018_16322PA005011403.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050114","UPMC Advantage Silver $3,500/$30 - Partner Network","16322PA005",,"PAN005","PAS004","PAF019","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050114-04","UPMC Advantage Silver $3,000/$30 - Partner Network","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$120","$2,480","$60","$110","$3,190","$30","$60","$1,290","$200","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEE9_EPO_RX1I08_DOVC_2018_16322PA005011404.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060087","UPMC Small Business Advantage Gold PPO $2,500 $20/$40 - Premium Network","16322PA006",,"PAN002","PAS001","PAF035","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060087-00","UPMC Small Business Advantage Gold PPO $2,500 $20/$40 - Premium Network","Standard Gold Off Exchange Plan","81.59%",,"No","Yes","No","100%",,"$2,500","$820","$0","$60","$0","$3,230","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"4000","$4000 per person","$8000 per group",,,,"10000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","2500","$2500 per person","$5000 per group","0%",,,,,"5000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPJ1_PPO_RX1I17_EB02_2018_16322PA006008700.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008700"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040030","UPMC Advantage Inside Advantage for Individuals Silver HSA $2,700/20% - Premium Network","16322PA004",,"PAN008","PAS006","PAF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040030-04","UPMC Advantage Inside Advantage for Individuals Silver HSA $2,700/20% - Premium Network","73% AV Level Silver Plan","73.41%","0.734076335100533","Yes","Yes","Yes","90%","10%","$2,700","$0","$700","$60","$2,300","$950","$150","$60","$1,530","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","$3,400","$3400 per person","$6800 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%","$3,000","$3000 per person","$6000 per group","30.00%","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASP6_PPO_RX1F39_DOVC_2018_16322PA004003004.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040030","UPMC Advantage Inside Advantage for Individuals Silver HSA $2,700/20% - Premium Network","16322PA004",,"PAN008","PAS006","PAF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040030-05","UPMC Advantage Inside Advantage for Individuals Silver $650/20% - Premium Network","87% AV Level Silver Plan","87.44%","0.87440548296282","Yes","Yes","Yes","90%","10%","$650","$0","$1,800","$60","$220","$830","$240","$60","$650","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","20.00%","$800","$800 per person","$1600 per group","30.00%","$1,300","$1300 per person","$2600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP85_PPO_RX1F36_DOVC_2018_16322PA004003005.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040030","UPMC Advantage Inside Advantage for Individuals Silver HSA $2,700/20% - Premium Network","16322PA004",,"PAN008","PAS006","PAF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040030-06","UPMC Advantage Inside Advantage for Individuals Silver $100/20% - Premium Network","94% AV Level Silver Plan","94.62%","0.946201353138253","Yes","Yes","Yes","90%","10%","$100","$0","$650","$60","$0","$530","$220","$60","$100","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20.00%","$200","$200 per person","$400 per group","30.00%","$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP86_PPO_RX1F37_DOVC_2018_16322PA004003006.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070064","UPMC Small Business Advantage Gold EPO $2,500 $20/$40  - Premium Network","16322PA007",,"PAN001","PAS001","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070064-00","UPMC Small Business Advantage Gold EPO $2,500 $20/$40  - Premium Network","Standard Gold Off Exchange Plan","81.68%",,"No","Yes","No","100%",,"$2,500","$820","$0","$60","$0","$3,070","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"4000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","2500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP76_EPO_RX1F12_EB02_2018_16322PA007006400.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007006400"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070064","UPMC Small Business Advantage Gold EPO $2,500 $20/$40  - Premium Network","16322PA007",,"PAN001","PAS001","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070064-01","UPMC Small Business Advantage Gold EPO $2,500 $20/$40  - Premium Network","Standard Gold On Exchange Plan","81.68%",,"No","Yes","No","100%",,"$2,500","$800","$0","$60","$0","$3,070","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"4000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","2500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP30_EPO_RX1F12_EB02_2018_16322PA007006401.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007006401"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070059","UPMC Small Business Advantage Gold EPO $2,500 $20/$40  - Partner Network","16322PA007",,"PAN011","PAS009","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070059-00","UPMC Small Business Advantage Gold EPO $2,500 $20/$40  - Partner Network","Standard Gold Off Exchange Plan","81.68%","0.816761686137813","No","Yes","No","100%",,"$2,500","$800","$0","$60","$0","$3,070","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP83_EPO_RX1F12_EB02_2018_16322PA007005900.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005900"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040029","UPMC Advantage Inside Advantage for Individuals Bronze $6,950/$35 - Premium Network","16322PA004",,"PAN008","PAS006","PAF003","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040029-00","UPMC Advantage Inside Advantage for Individuals Bronze $6,950/$35 - Premium Network","Standard Bronze Off Exchange Plan","60.90%","0.609810328763542","Yes","Yes","Yes","90%","10%","$6,950","$190","$0","$60","$4,120","$1,210","$1,590","$60","$1,910","$0","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%","$6,950","$6950 per person","$13900 per group","30.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP44_PPO_RX1F33_DOVC_2018_16322PA004002900.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060087","UPMC Small Business Advantage Gold PPO $2,500 $20/$40 - Premium Network","16322PA006",,"PAN002","PAS001","PAF035","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060087-01","UPMC Small Business Advantage Gold PPO $2,500 $20/$40 - Premium Network","Standard Gold On Exchange Plan","81.59%",,"No","Yes","No","100%",,"$2,500","$820","$0","$60","$0","$3,230","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"4000","$4000 per person","$8000 per group",,,,"10000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","2500","$2500 per person","$5000 per group","0%",,,,,"5000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP60_PPO_RX1I17_EB02_2018_16322PA006008701.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006008701"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050114","UPMC Advantage Silver $3,500/$30 - Partner Network","16322PA005",,"PAN005","PAS004","PAF019","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050114-05","UPMC Advantage Silver $700/$10 - Partner Network","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$110","$1,460","$30","$60","$700","$80","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEF1_EPO_RX1I09_DOVC_2018_16322PA005011405.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050114","UPMC Advantage Silver $3,500/$30 - Partner Network","16322PA005",,"PAN005","PAS004","PAF019","Existing","EPO","Silver","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050114-06","UPMC Advantage Silver $250/$5 - Partner Network","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$20","$620","$60","$130","$390","$10","$60","$250","$30","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEF2_EPO_RX1I10_DOVC_2018_16322PA005011406.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060106","UPMC Small Business Advantage Gold PPO $2,500 $20/$40 - Premium Network","16322PA006",,"PAN002","PAS001","PAF027","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060106-00","UPMC Small Business Advantage Gold PPO $2,500 $20/$40 - Premium Network","Standard Gold Off Exchange Plan","81.68%",,"No","Yes","No","100%",,"$2,500","$800","$0","$60","$0","$3,070","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"4000","$4000 per person","$8000 per group",,,,"10000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","2500","$2500 per person","$5000 per group","0%",,,,,"5000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NPPJ1_PPO_RX1F12_EB02_2018_16322PA006010600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006010600"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0060106","UPMC Small Business Advantage Gold PPO $2,500 $20/$40 - Premium Network","16322PA006",,"PAN002","PAS001","PAF027","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0060106-01","UPMC Small Business Advantage Gold PPO $2,500 $20/$40 - Premium Network","Standard Gold On Exchange Plan","81.68%",,"No","Yes","No","100%",,"$2,500","$800","$0","$60","$0","$3,070","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"4000","$4000 per person","$8000 per group",,,,"10000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","2500","$2500 per person","$5000 per group","0%",,,,,"5000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XPP60_PPO_RX1F12_EB02_2018_16322PA006010601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA006010601"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050116","UPMC Advantage Gold $1,400$20 - Partner Network","16322PA005",,"PAN005","PAS004","PAF024","New","EPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050116-00","UPMC Advantage Gold $1,400$20 - Partner Network","Standard Gold Off Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$80","$2,480","$60","$110","$2,450","$30","$60","$1,290","$150","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE60_EPO_RX1I11_DOVC_2018_16322PA005011600.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050116","UPMC Advantage Gold $1,400$20 - Partner Network","16322PA005",,"PAN005","PAS004","PAF024","New","EPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050116-01","UPMC Advantage Gold $1,400$20 - Partner Network","Standard Gold On Exchange Plan",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$80","$2,480","$60","$110","$2,450","$30","$60","$1,290","$150","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEF4_EPO_RX1I11_DOVC_2018_16322PA005011601.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070025","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Premium Network","16322PA007",,"PAN001","PAS001","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070025-00","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Premium Network","Standard Gold Off Exchange Plan","81.96%",,"No","Yes","No","100%",,"$2,000","$800","$0","$60","$0","$3,070","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"5000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","2000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP73_EPO_RX1F12_EB02_2018_16322PA007002500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007002500"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070025","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Premium Network","16322PA007",,"PAN001","PAS001","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070025-01","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Premium Network","Standard Gold On Exchange Plan","81.96%",,"No","Yes","No","100%",,"$2,000","$800","$0","$60","$0","$3,070","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"5000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","2000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP27_EPO_RX1F12_EB02_2018_16322PA007002501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007002501"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050116","UPMC Advantage Gold $1,400$20 - Partner Network","16322PA005",,"PAN005","PAS004","PAF024","New","EPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050116-02","UPMC Advantage Gold $0$0 - Partner Network","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAZED_EPO_RX1D06_DOVC_2018_16322PA005011602.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050116","UPMC Advantage Gold $1,400$20 - Partner Network","16322PA005",,"PAN005","PAS004","PAF024","New","EPO","Gold","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050116-03","UPMC Advantage Gold $1,400$20 - Partner Network","Limited Cost Sharing Plan Variation",,"0.806461580880611","No","Yes","No","100%",,"$1,400","$80","$2,480","$60","$110","$2,450","$30","$60","$1,290","$150","$340","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALED_EPO_RX1I16_DOVC_2018_16322PA005011603.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070032","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Premium Network","16322PA007",,"PAN001","PAS001","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070032-00","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Premium Network","Standard Gold Off Exchange Plan","81.82%",,"No","Yes","No","100%",,"$2,000","$820","$0","$60","$0","$3,230","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"5000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","2000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP73_EPO_RX1I17_EB02_2018_16322PA007003200.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003200"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070032","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Premium Network","16322PA007",,"PAN001","PAS001","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070032-01","UPMC Small Business Advantage Gold EPO $2,000 $20/$40 - Premium Network","Standard Gold On Exchange Plan","81.82%",,"No","Yes","No","100%",,"$2,000","$820","$0","$60","$0","$3,230","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"5000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","2000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP27_EPO_RX1I17_EB02_2018_16322PA007003201.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003201"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070033","UPMC Small Business Advantage Gold EPO $2,500 $20/$40 - Premium Network","16322PA007",,"PAN001","PAS001","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070033-00","UPMC Small Business Advantage Gold EPO $2,500 $20/$40 - Premium Network","Standard Gold Off Exchange Plan","81.59%",,"No","Yes","No","100%",,"$2,000","$820","$0","$60","$0","$3,230","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"4000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","2500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP76_EPO_RX1I17_EB02_2018_16322PA007003300.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003300"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070033","UPMC Small Business Advantage Gold EPO $2,500 $20/$40 - Premium Network","16322PA007",,"PAN001","PAS001","PAF035","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070033-01","UPMC Small Business Advantage Gold EPO $2,500 $20/$40 - Premium Network","Standard Gold On Exchange Plan","81.59%",,"No","Yes","No","100%",,"$2,500","$820","$0","$60","$0","$3,230","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"4000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","2500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP30_EPO_RX1I17_EB02_2018_16322PA007003301.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007003301"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040029","UPMC Advantage Inside Advantage for Individuals Bronze $6,950/$35 - Premium Network","16322PA004",,"PAN008","PAS006","PAF003","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040029-01","UPMC Advantage Inside Advantage for Individuals Bronze $6,950/$35 - Premium Network","Standard Bronze On Exchange Plan","60.90%","0.609810328763542","Yes","Yes","Yes","90%","10%","$6,950","$190","$0","$60","$4,120","$1,210","$1,590","$60","$1,910","$0","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%","$6,950","$6950 per person","$13900 per group","30.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP84_PPO_RX1F33_DOVC_2018_16322PA004002901.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070059","UPMC Small Business Advantage Gold EPO $2,500 $20/$40  - Partner Network","16322PA007",,"PAN011","PAS009","PAF027","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070059-01","UPMC Small Business Advantage Gold EPO $2,500 $20/$40  - Partner Network","Standard Gold On Exchange Plan","81.68%","0.816761686137813","No","Yes","No","100%",,"$2,500","$800","$0","$60","$0","$3,070","$0","$60","$810","$620","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP37_EPO_RX1F12_EB02_2018_16322PA007005901.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007005901"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070060","UPMC Small Business Advantage Silver EPO $3,000 $30/$50  - Partner Network","16322PA007",,"PAN011","PAS009","PAF027","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070060-00","UPMC Small Business Advantage Silver EPO $3,000 $30/$50  - Partner Network","Standard Silver Off Exchange Plan","71.43%","0.717835184867964","No","Yes","No","100%",,"$3,000","$2,000","$0","$60","$0","$3,330","$0","$60","$800","$1,650","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP84_EPO_RX1F12_EB02_2018_16322PA007006000.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007006000"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040029","UPMC Advantage Inside Advantage for Individuals Bronze $6,950/$35 - Premium Network","16322PA004",,"PAN008","PAS006","PAF003","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040029-02","UPMC Advantage Inside Advantage for Individuals Bronze $0/$0 - Premium Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","90%","10%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZW_PPO_RX1D06_DOVC_2018_16322PA004002902.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040029","UPMC Advantage Inside Advantage for Individuals Bronze $6,950/$35 - Premium Network","16322PA004",,"PAN008","PAS006","PAF003","New","PPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040029-03","UPMC Advantage Inside Advantage for Individuals Bronze $6,950/$35 - Premium Network","Limited Cost Sharing Plan Variation","60.90%","0.609810328763542","Yes","Yes","Yes","90%","10%","$6,950","$190","$0","$60","$4,120","$1,210","$1,590","$60","$1,910","$0","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%","$6,950","$6950 per person","$13900 per group","30.00%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALP1_PPO_RX1F41_DOVC_2018_16322PA004002903.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070060","UPMC Small Business Advantage Silver EPO $3,000 $30/$50  - Partner Network","16322PA007",,"PAN011","PAS009","PAF027","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070060-01","UPMC Small Business Advantage Silver EPO $3,000 $30/$50  - Partner Network","Standard Silver On Exchange Plan","71.43%","0.717835184867964","No","Yes","No","100%",,"$3,000","$2,000","$0","$60","$0","$3,330","$0","$60","$800","$1,650","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP38_EPO_RX1F12_EB02_2018_16322PA007006001.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007006001"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070061","UPMC Small Business Advantage Bronze EPO $6,850 - Partner Network","16322PA007",,"PAN011","PAS009","PAF029","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070061-00","UPMC Small Business Advantage Bronze EPO $6,850 - Partner Network","Standard Bronze Off Exchange Plan","61.25%","0.591514537961228","Yes","Yes","No","100%",,"$6,850","$40","$0","$60","$5,140","$2,010","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NEP85_EPO_RX1F47_EB02_2018_16322PA007006100.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007006100"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","SHOP (Small Group)","No","46-2824626","16322PA0070061","UPMC Small Business Advantage Bronze EPO $6,850 - Partner Network","16322PA007",,"PAN011","PAS009","PAF029","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0070061-01","UPMC Small Business Advantage Bronze EPO $6,850 - Partner Network","Standard Bronze On Exchange Plan","61.25%","0.591514537961228","Yes","Yes","No","100%",,"$6,850","$40","$0","$60","$5,140","$2,010","$0","$60","$1,910","$0","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XEP39_EPO_RX1F47_EB02_2018_16322PA007006101.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_16322PA007006101"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040030","UPMC Advantage Inside Advantage for Individuals Silver HSA $2,700/20% - Premium Network","16322PA004",,"PAN008","PAS006","PAF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040030-00","UPMC Advantage Inside Advantage for Individuals Silver HSA $2,700/20% - Premium Network","Standard Silver Off Exchange Plan","71.32%","0.713137668296659","Yes","Yes","Yes","90%","10%","$2,700","$0","$1,600","$60","$2,700","$1,380","$220","$60","$1,530","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","$4,300","$4300 per person","$8600 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%","$3,000","$3000 per person","$6000 per group","30.00%","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NASP3_PPO_RX1F39_DOVC_2018_16322PA004003000.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040030","UPMC Advantage Inside Advantage for Individuals Silver HSA $2,700/20% - Premium Network","16322PA004",,"PAN008","PAS006","PAF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040030-01","UPMC Advantage Inside Advantage for Individuals  Silver HSA $2,700/20% - Premium Network","Standard Silver On Exchange Plan","71.32%","0.713137668296659","Yes","Yes","Yes","90%","10%","$2,700","$0","$1,600","$60","$2,700","$1,380","$220","$60","$1,530","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","$4,300","$4300 per person","$8600 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%","$3,000","$3000 per person","$6000 per group","30.00%","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASP5_PPO_RX1F39_DOVC_2018_16322PA004003001.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040030","UPMC Advantage Inside Advantage for Individuals Silver HSA $2,700/20% - Premium Network","16322PA004",,"PAN008","PAS006","PAF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040030-02","UPMC Advantage Inside Advantage for Individuals Silver $0/$0 - Premium Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","90%","10%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZX_PPO_RX1D06_DOVC_2018_16322PA004003002.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040030","UPMC Advantage Inside Advantage for Individuals Silver HSA $2,700/20% - Premium Network","16322PA004",,"PAN008","PAS006","PAF004","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040030-03","UPMC Advantage Inside Advantage for Individuals Silver HSA $2,700/20% - Premium Network","Limited Cost Sharing Plan Variation","71.32%","0.713137668296659","Yes","Yes","Yes","90%","10%","$2,700","$0","$1,600","$60","$2,700","$1,380","$220","$60","$1,530","$0","$400","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","$4,300","$4300 per person","$8600 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20.00%","$3,000","$3000 per person","$6000 per group","30.00%","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XASP8_PPO_RX1F43_DOVC_2018_16322PA004003003.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040031","UPMC Advantage Inside Advantage for Individuals Silver $1,750/$50 - Premium Network","16322PA004",,"PAN008","PAS006","PAF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040031-00","UPMC Advantage Inside Advantage for Individuals Silver $1,750/$50 - Premium Network","Standard Silver Off Exchange Plan","71.44%","0.717423448529872","No","Yes","Yes","90%","10%","$1,750","$1,480","$2,300","$60","$200","$4,890","$0","$60","$1,120","$440","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%","$2,500","$2500 per person","$5000 per group","30.00%","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP45_PPO_RX1I05_DOVC_2018_16322PA004003100.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040031","UPMC Advantage Inside Advantage for Individuals Silver $1,750/$50 - Premium Network","16322PA004",,"PAN008","PAS006","PAF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040031-01","UPMC Advantage Inside Advantage for Individuals Silver $1,750/$50 - Premium Network","Standard Silver On Exchange Plan","71.44%","0.717423448529872","No","Yes","Yes","90%","10%","$1,750","$1,480","$2,300","$60","$200","$4,890","$0","$60","$1,120","$440","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%","$2,500","$2500 per person","$5000 per group","30.00%","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP87_PPO_RX1I05_DOVC_2018_16322PA004003101.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040031","UPMC Advantage Inside Advantage for Individuals Silver $1,750/$50 - Premium Network","16322PA004",,"PAN008","PAS006","PAF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040031-02","UPMC Advantage Inside Advantage for Individuals Silver $0/$0 - Premium Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","90%","10%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZY_PPO_RX1D06_DOVC_2018_16322PA004003102.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040031","UPMC Advantage Inside Advantage for Individuals Silver $1,750/$50 - Premium Network","16322PA004",,"PAN008","PAS006","PAF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040031-03","UPMC Advantage Inside Advantage for Individuals Silver $1,750/$50 - Premium Network","Limited Cost Sharing Plan Variation","71.44%","0.717423448529872","No","Yes","Yes","90%","10%","$1,750","$1,480","$2,300","$60","$200","$4,890","$0","$60","$1,120","$440","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20.00%","$2,500","$2500 per person","$5000 per group","30.00%","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALP2_PPO_RX1I13_DOVC_2018_16322PA004003103.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040031","UPMC Advantage Inside Advantage for Individuals Silver $1,750/$50 - Premium Network","16322PA004",,"PAN008","PAS006","PAF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040031-04","UPMC Advantage Inside Advantage for Individuals Silver $1,425/$50 - Premium Network","73% AV Level Silver Plan","73.46%","0.737285340216186","No","Yes","Yes","90%","10%","$1,430","$1,480","$2,300","$60","$200","$4,890","$0","$60","$1,120","$440","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,425","$1425 per person","$2850 per group","20.00%","$2,500","$2500 per person","$5000 per group","30.00%","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP88_PPO_RX1I05_DOVC_2018_16322PA004003104.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040031","UPMC Advantage Inside Advantage for Individuals Silver $1,750/$50 - Premium Network","16322PA004",,"PAN008","PAS006","PAF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040031-05","UPMC Advantage Inside Advantage for Individuals Silver $600/$15 - Premium Network","87% AV Level Silver Plan","87.52%","0.875570567056245","No","Yes","Yes","90%","10%","$600","$260","$1,600","$60","$0","$1,250","$0","$60","$600","$150","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20.00%","$1,000","$1000 per person","$2000 per group","30.00%","$1,200","$1200 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP89_PPO_RX1F36_DOVC_2018_16322PA004003105.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040031","UPMC Advantage Inside Advantage for Individuals Silver $1,750/$50 - Premium Network","16322PA004",,"PAN008","PAS006","PAF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040031-06","UPMC Advantage Inside Advantage for Individuals Silver $75/$5 - Premium Network","94% AV Level Silver Plan","94.04%","0.938278331247233","No","Yes","Yes","90%","10%","$80","$170","$760","$60","$0","$990","$0","$60","$80","$50","$290","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","20.00%","$150","$150 per person","$300 per group","30.00%","$150","$150 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP90_PPO_RX1F37_DOVC_2018_16322PA004003106.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040032","UPMC Advantage Inside Advantage for Individuals Silver $3,500/$25 - Premium Network","16322PA004",,"PAN008","PAS006","PAF007","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040032-00","UPMC Advantage Inside Advantage for Individuals Silver $3,500/$25 - Premium Network","Standard Silver Off Exchange Plan","71.37%","0.716466222379557","No","Yes","Yes","90%","10%","$3,500","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%","$5,000","$5000 per person","$10000 per group","30.00%","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP46_PPO_RX1I04_DOVC_2018_16322PA004003200.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040032","UPMC Advantage Inside Advantage for Individuals Silver $3,500/$25 - Premium Network","16322PA004",,"PAN008","PAS006","PAF007","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040032-01","UPMC Advantage Inside Advantage for Individuals Silver $3,500/$25 - Premium Network","Standard Silver On Exchange Plan","71.37%","0.716466222379557","No","Yes","Yes","90%","10%","$3,500","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%","$5,000","$5000 per person","$10000 per group","30.00%","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP91_PPO_RX1I04_DOVC_2018_16322PA004003201.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040032","UPMC Advantage Inside Advantage for Individuals Silver $3,500/$25 - Premium Network","16322PA004",,"PAN008","PAS006","PAF007","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040032-02","UPMC Advantage Inside Advantage for Individuals Silver $0/$0 - Premium Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","90%","10%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPZZ_PPO_RX1D06_DOVC_2018_16322PA004003202.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040032","UPMC Advantage Inside Advantage for Individuals Silver $3,500/$25 - Premium Network","16322PA004",,"PAN008","PAS006","PAF007","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040032-03","UPMC Advantage Inside Advantage for Individuals Silver $3,500/$25 - Premium Network","Limited Cost Sharing Plan Variation","71.37%","0.716466222379557","No","Yes","Yes","90%","10%","$3,500","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%","$5,000","$5000 per person","$10000 per group","30.00%","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALP3_PPO_RX1I14_DOVC_2018_16322PA004003203.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040032","UPMC Advantage Inside Advantage for Individuals Silver $3,500/$25 - Premium Network","16322PA004",,"PAN008","PAS006","PAF007","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040032-04","UPMC Advantage Inside Advantage for Individuals Silver $2,650/$25 - Premium Network","73% AV Level Silver Plan","73.44%","0.737042781842771","No","Yes","Yes","90%","10%","$2,650","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","0.00%","$5,000","$5000 per person","$10000 per group","30.00%","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP92_PPO_RX1I04_DOVC_2018_16322PA004003204.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040032","UPMC Advantage Inside Advantage for Individuals Silver $3,500/$25 - Premium Network","16322PA004",,"PAN008","PAS006","PAF007","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040032-05","UPMC Advantage Inside Advantage for Individuals Silver $1,250/$5 - Premium Network","87% AV Level Silver Plan","87.66%","0.87724963534308","No","Yes","Yes","90%","10%","$1,250","$310","$0","$60","$0","$1,160","$0","$60","$820","$610","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0.00%","$1,500","$1500 per person","$3000 per group","30.00%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP93_PPO_RX1F36_DOVC_2018_16322PA004003205.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040032","UPMC Advantage Inside Advantage for Individuals Silver $3,500/$25 - Premium Network","16322PA004",,"PAN008","PAS006","PAF007","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040032-06","UPMC Advantage Inside Advantage for Individuals Silver $150/$5 - Premium Network","94% AV Level Silver Plan","94.71%","0.948105885051672","No","Yes","Yes","90%","10%","$150","$210","$0","$60","$0","$1,000","$0","$60","$150","$310","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%","$300","$300 per person","$600 per group","30.00%","$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP94_PPO_RX1F37_DOVC_2018_16322PA004003206.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040033","UPMC Advantage Inside Advantage for Individuals Silver $0/$50 - Premium Network","16322PA004",,"PAN008","PAS006","PAF011","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040033-00","UPMC Advantage Inside Advantage for Individuals Silver $0/$50 - Premium Network","Standard Silver Off Exchange Plan","70.24%","0.72545709185364","No","Yes","Yes","90%","10%","$0","$7,350","$0","$60","$80","$4,690","$0","$60","$0","$5,590","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","30.00%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP47_PPO_RX1I06_DOVC_2018_16322PA004003300.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040033","UPMC Advantage Inside Advantage for Individuals Silver $0/$50 - Premium Network","16322PA004",,"PAN008","PAS006","PAF011","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040033-01","UPMC Advantage Inside Advantage for Individuals Silver $0/$50 - Premium Network","Standard Silver On Exchange Plan","70.24%","0.72545709185364","No","Yes","Yes","90%","10%","$0","$7,350","$0","$60","$80","$4,690","$0","$60","$0","$5,590","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","30.00%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP95_PPO_RX1I06_DOVC_2018_16322PA004003301.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040033","UPMC Advantage Inside Advantage for Individuals Silver $0/$50 - Premium Network","16322PA004",,"PAN008","PAS006","PAF011","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040033-02","UPMC Advantage Inside Advantage for Individuals Silver $0/$0 - Premium Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","90%","10%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAZP1_PPO_RX1D06_DOVC_2018_16322PA004003302.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040033","UPMC Advantage Inside Advantage for Individuals Silver $0/$50 - Premium Network","16322PA004",,"PAN008","PAS006","PAF011","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040033-03","UPMC Advantage Inside Advantage for Individuals Silver $0/$50 - Premium Network","Limited Cost Sharing Plan Variation","70.24%","0.72545709185364","No","Yes","Yes","90%","10%","$0","$7,350","$0","$60","$80","$4,690","$0","$60","$0","$5,590","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","30.00%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALP4_PPO_RX1I12_DOVC_2018_16322PA004003303.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040033","UPMC Advantage Inside Advantage for Individuals Silver $0/$50 - Premium Network","16322PA004",,"PAN008","PAS006","PAF011","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040033-04","UPMC Advantage Inside Advantage for Individuals Silver $0/$50 - Premium Network","73% AV Level Silver Plan","72.72%","0.742988784053124","No","Yes","Yes","90%","10%","$0","$5,850","$0","$60","$80","$4,690","$0","$60","$0","$5,590","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","30.00%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP96_PPO_RX1I06_DOVC_2018_16322PA004003304.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040033","UPMC Advantage Inside Advantage for Individuals Silver $0/$50 - Premium Network","16322PA004",,"PAN008","PAS006","PAF011","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040033-05","UPMC Advantage Inside Advantage for Individuals Silver $0/$30 - Premium Network","87% AV Level Silver Plan","86.99%","0.880342782525509","No","Yes","Yes","90%","10%","$0","$1,150","$0","$60","$0","$1,680","$0","$60","$0","$2,430","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","30.00%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP97_PPO_RX1F36_DOVC_2018_16322PA004003305.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040033","UPMC Advantage Inside Advantage for Individuals Silver $0/$50 - Premium Network","16322PA004",,"PAN008","PAS006","PAF011","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040033-06","UPMC Advantage Inside Advantage for Individuals Silver $0/$10 - Premium Network","94% AV Level Silver Plan","93.70%","0.937335448522685","No","Yes","Yes","90%","10%","$0","$560","$0","$60","$0","$1,000","$0","$60","$0","$1,000","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","30.00%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP98_PPO_RX1F37_DOVC_2018_16322PA004003306.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040034","UPMC Advantage Inside Advantage for Individuals Gold $800/$20 - Premium Network","16322PA004",,"PAN008","PAS006","PAF013","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040034-00","UPMC Advantage Inside Advantage for Individuals Gold $800/$20 - Premium Network","Standard Gold Off Exchange Plan","81.47%","0.81466799581209","No","Yes","Yes","90%","10%","$800","$760","$1,150","$60","$0","$3,330","$0","$60","$800","$310","$160","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%","$1,200","$1200 per person","$2400 per group","30.00%","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP48_PPO_RX1F38_DOVC_2018_16322PA004003400.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040034","UPMC Advantage Inside Advantage for Individuals Gold $800/$20 - Premium Network","16322PA004",,"PAN008","PAS006","PAF013","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040034-01","UPMC Advantage Inside Advantage for Individuals Gold $800/$20 - Premium Network","Standard Gold On Exchange Plan","81.47%","0.81466799581209","No","Yes","Yes","90%","10%","$800","$760","$1,150","$60","$0","$3,330","$0","$60","$800","$310","$160","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%","$1,200","$1200 per person","$2400 per group","30.00%","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAP99_PPO_RX1F38_DOVC_2018_16322PA004003401.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040034","UPMC Advantage Inside Advantage for Individuals Gold $800/$20 - Premium Network","16322PA004",,"PAN008","PAS006","PAF013","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040034-02","UPMC Advantage Inside Advantage for Individuals Gold $0/$0 - Premium Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","90%","10%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAZP2_PPO_RX1D06_DOVC_2018_16322PA004003402.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040034","UPMC Advantage Inside Advantage for Individuals Gold $800/$20 - Premium Network","16322PA004",,"PAN008","PAS006","PAF013","New","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040034-03","UPMC Advantage Inside Advantage for Individuals Gold $800/$20 - Premium Network","Limited Cost Sharing Plan Variation","81.47%","0.81466799581209","No","Yes","Yes","90%","10%","$800","$760","$1,150","$60","$0","$3,330","$0","$60","$800","$310","$160","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%","$1,200","$1200 per person","$2400 per group","30.00%","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALP5_PPO_RX1F44_DOVC_2018_16322PA004003403.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040035","UPMC Advantage Inside Advantage for Individuals Platinum $250/$20 - Premium Network","16322PA004",,"PAN008","PAS006","PAF014","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040035-00","UPMC Advantage Inside Advantage for Individuals Platinum $250/$20 - Premium Network","Standard Platinum Off Exchange Plan","90.90%","0.907384478780073","Yes","Yes","Yes","90%","10%","$250","$10","$1,240","$60","$250","$1,210","$40","$60","$250","$0","$210","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%","$500","$500 per person","$1000 per group","30.00%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAP49_PPO_RX1F40_DOVC_2018_16322PA004003500.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040035","UPMC Advantage Inside Advantage for Individuals Platinum $250/$20 - Premium Network","16322PA004",,"PAN008","PAS006","PAF014","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040035-01","UPMC Advantage Inside Advantage for Individuals Platinum $250/$20 - Premium Network","Standard Platinum On Exchange Plan","90.90%","0.907384478780073","Yes","Yes","Yes","90%","10%","$250","$10","$1,240","$60","$250","$1,210","$40","$60","$250","$0","$210","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%","$500","$500 per person","$1000 per group","30.00%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAPA1_PPO_RX1F40_DOVC_2018_16322PA004003501.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040035","UPMC Advantage Inside Advantage for Individuals Platinum $250/$20 - Premium Network","16322PA004",,"PAN008","PAS006","PAF014","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040035-02","UPMC Advantage Inside Advantage for Individuals Platinum $0/$0 - Premium Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","90%","10%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAZP3_PPO_RX1D06_DOVC_2018_16322PA004003502.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0040035","UPMC Advantage Inside Advantage for Individuals Platinum $250/$20 - Premium Network","16322PA004",,"PAN008","PAS006","PAF014","New","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0040035-03","UPMC Advantage Inside Advantage for Individuals Platinum $250/$20 - Premium Network","Limited Cost Sharing Plan Variation","90.90%","0.907384478780073","Yes","Yes","Yes","90%","10%","$250","$10","$1,240","$60","$250","$1,210","$40","$60","$250","$0","$210","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10.00%","$500","$500 per person","$1000 per group","30.00%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALP6_PPO_RX1F45_DOVC_2018_16322PA004003503.pdf","https://www.upmchealthplan.com/docs/coverage/upmc/marketplace.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050117","Tower UPMC Advantage Silver $3,500/$25 - Tower Network","16322PA005",,"PAN009","PAS007","PAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050117-00","Tower UPMC Advantage Silver $3,500/$25 - Tower Network","Standard Silver Off Exchange Plan","71.91%","0.721578318069809","No","Yes","No","100%",,"$3,500","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE61_EPO_RX1I39_DOVC_2018_16322PA005011700.pdf","https://www.upmchealthplan.com/docs/coverage/reading/reading.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050117","Tower UPMC Advantage Silver $3,500/$25 - Tower Network","16322PA005",,"PAN009","PAS007","PAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050117-01","Tower UPMC Advantage Silver $3,500/$25 - Tower Network","Standard Silver On Exchange Plan","71.91%","0.721578318069809","No","Yes","No","100%",,"$3,500","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEF5_EPO_RX1I39_DOVC_2018_16322PA005011701.pdf","https://www.upmchealthplan.com/docs/coverage/reading/reading.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050117","Tower UPMC Advantage Silver $3,500/$25 - Tower Network","16322PA005",,"PAN009","PAS007","PAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050117-02","Tower UPMC Advantage Silver $0/$0 - Tower Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAZEE_EPO_RX1I40_DOVC_2018_16322PA005011702.pdf","https://www.upmchealthplan.com/docs/coverage/reading/reading.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050117","Tower UPMC Advantage Silver $3,500/$25 - Tower Network","16322PA005",,"PAN009","PAS007","PAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050117-03","Tower UPMC Advantage Silver $3,500/$25 - Tower Network","Limited Cost Sharing Plan Variation","71.91%","0.755340009240625","No","Yes","No","100%",,"$3,500","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALEE_EPO_RX1I41_DOVC_2018_16322PA005011703.pdf","https://www.upmchealthplan.com/docs/coverage/reading/reading.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050117","Tower UPMC Advantage Silver $3,500/$25 - Tower Network","16322PA005",,"PAN009","PAS007","PAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050117-04","Tower UPMC Advantage Silver $2,650/$25 - Tower Network","73% AV Level Silver Plan","73.94%","0.731617121411505","No","Yes","No","100%",,"$2,650","$890","$0","$60","$150","$4,670","$0","$60","$810","$2,860","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEF6_EPO_RX1I39_DOVC_2018_16322PA005011704.pdf","https://www.upmchealthplan.com/docs/coverage/reading/reading.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050117","Tower UPMC Advantage Silver $3,500/$25 - Tower Network","16322PA005",,"PAN009","PAS007","PAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050117-05","Tower UPMC Advantage Silver $1,250/$5 - Tower Network","87% AV Level Silver Plan","87.99%","0.879946226520846","No","Yes","No","100%",,"$1,250","$310","$0","$60","$0","$1,160","$0","$60","$820","$610","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEF7_EPO_RX1I42_DOVC_2018_16322PA005011705.pdf","https://www.upmchealthplan.com/docs/coverage/reading/reading.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050117","Tower UPMC Advantage Silver $3,500/$25 - Tower Network","16322PA005",,"PAN009","PAS007","PAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050117-06","Tower UPMC Advantage Silver $150/$5 - Tower Network","94% AV Level Silver Plan","94.96%","0.950624895089223","No","Yes","No","100%",,"$150","$210","$0","$60","$0","$1,000","$0","$60","$150","$310","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEF8_EPO_RX1I43_DOVC_2018_16322PA005011706.pdf","https://www.upmchealthplan.com/docs/coverage/reading/reading.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050118","Tower UPMC Advantage Gold $800/$20 - Tower Network","16322PA005",,"PAN009","PAS007","PAF013","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050118-00","Tower UPMC Advantage Gold $800/$20 - Tower Network","Standard Gold Off Exchange Plan","81.95%","0.819473325418308","No","Yes","No","100%",,"$800","$760","$1,150","$60","$0","$3,330","$0","$60","$800","$310","$160","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE62_EPO_RX1I46_DOVC_2018_16322PA005011800.pdf","https://www.upmchealthplan.com/docs/coverage/reading/reading.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050118","Tower UPMC Advantage Gold $800/$20 - Tower Network","16322PA005",,"PAN009","PAS007","PAF013","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050118-01","Tower UPMC Advantage Gold $800/$20 - Tower Network","Standard Gold On Exchange Plan","81.95%","0.819473325418308","No","Yes","No","100%",,"$800","$760","$1,150","$60","$0","$3,330","$0","$60","$800","$310","$160","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEF9_EPO_RX1I46_DOVC_2018_16322PA005011801.pdf","https://www.upmchealthplan.com/docs/coverage/reading/reading.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050118","Tower UPMC Advantage Gold $800/$20 - Tower Network","16322PA005",,"PAN009","PAS007","PAF013","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050118-02","Tower UPMC Advantage Gold $0/$0 - Tower Network","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAZEF_EPO_RX1I40_DOVC_2018_16322PA005011802.pdf","https://www.upmchealthplan.com/docs/coverage/reading/reading.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050118","Tower UPMC Advantage Gold $800/$20 - Tower Network","16322PA005",,"PAN009","PAS007","PAF013","New","EPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050118-03","Tower UPMC Advantage Gold $800/$20 - Tower Network","Limited Cost Sharing Plan Variation","81.95%","0.819473325418308","No","Yes","No","100%",,"$800","$760","$1,150","$60","$0","$3,330","$0","$60","$800","$310","$160","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALEF_EPO_RX1I47_DOVC_2018_16322PA005011803.pdf","https://www.upmchealthplan.com/docs/coverage/reading/reading.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050119","Tower UPMC Advantage Bronze $6,950/$35 - Tower Network","16322PA005",,"PAN009","PAS007","PAF003","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050119-00","Tower UPMC Advantage Bronze $6,950/$35 - Tower Network","Standard Bronze Off Exchange Plan","60.97%","0.610646860942347","Yes","Yes","No","100%",,"$6,950","$190","$0","$60","$4,120","$1,210","$1,590","$60","$1,910","$0","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NAE63_EPO_RX1I44_DOVC_2018_16322PA005011900.pdf","https://www.upmchealthplan.com/docs/coverage/reading/reading.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050119","Tower UPMC Advantage Bronze $6,950/$35 - Tower Network","16322PA005",,"PAN009","PAS007","PAF003","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050119-01","Tower UPMC Advantage Bronze $6,950/$35 - Tower Network","Standard Bronze On Exchange Plan","60.97%","0.610646860942347","Yes","Yes","No","100%",,"$6,950","$190","$0","$60","$4,120","$1,210","$1,590","$60","$1,910","$0","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAEG1_EPO_RX1I44_DOVC_2018_16322PA005011901.pdf","https://www.upmchealthplan.com/docs/coverage/reading/reading.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050119","Tower UPMC Advantage Bronze $6,950/$35 - Tower Network","16322PA005",,"PAN009","PAS007","PAF003","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050119-02","Tower UPMC Advantage Bronze $0/$0 - Tower Network","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XAZEG_EPO_RX1I40_DOVC_2018_16322PA005011902.pdf","https://www.upmchealthplan.com/docs/coverage/reading/reading.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010048","Geisinger Marketplace Extra HMO 10/50/4500","22444PA001",,"PAN001","PAS006","PAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010048-05","Geisinger Marketplace  Extra HMO 10/50/4500","87% AV Level Silver Plan","87.42%","0.878723926551024","No","Yes","Yes","65%","35%","$1,000","$12","$0","$10","$480","$720","$0","$60","$530","$365","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%","$1,000","$1000 per person","$2000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004805.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010048","Geisinger Marketplace Extra HMO 10/50/4500","22444PA001",,"PAN001","PAS006","PAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010048-06","Geisinger Marketplace  Extra HMO  10/50/4500","94% AV Level Silver Plan","94.04%","0.940116716588333","No","Yes","Yes","65%","35%","$400","$0","$0","$10","$400","$126","$0","$60","$400","$95","$0","$0","$75","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","0.00%","$400","$400 per person","$800 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004806.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010042","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS002","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010042-02","Geisinger Marketplace HMO 20/40/3000","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004202.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010042","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS002","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010042-03","Geisinger Marketplace HMO 20/40/3000","Limited Cost Sharing Plan Variation","79.26%","0.816380921513101","No","Yes","No","100%",,"$3,000","$262","$0","$10","$480","$770","$0","$60","$530","$570","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004203.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010038","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS001","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010038-00","Geisinger Marketplace HMO 30/60/4650","Standard Silver Off Exchange Plan","69.09%","0.718692203764093","No","Yes","No","100%",,"$4,690","$0","$1,598","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,650","$4650 per person","$9300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003800.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010043","Geisinger Marketplace Select HMO 20/40/3000","22444PA001",,"PAN002","PAS007","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010043-03","Geisinger Marketplace Select HMO 20/40/3000","Limited Cost Sharing Plan Variation","79.26%","0.816380921513101","No","Yes","No","100%",,"$3,000","$262","$0","$10","$480","$770","$0","$60","$530","$570","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004303.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010044","Geisinger Marketplace Select HMO 30/60/4650","22444PA001",,"PAN002","PAS007","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010044-00","Geisinger Marketplace Select HMO 30/60/4650","Standard Silver Off Exchange Plan","69.09%","0.718692203764093","No","Yes","No","100%",,"$4,690","$0","$1,598","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,650","$4650 per person","$9300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004400.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010044","Geisinger Marketplace Select HMO 30/60/4650","22444PA001",,"PAN002","PAS007","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010044-01","Geisinger Marketplace Select HMO 30/60/4650","Standard Silver On Exchange Plan","69.09%","0.718692203764093","No","Yes","No","100%",,"$4,690","$0","$1,598","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,650","$4650 per person","$9300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004401.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010044","Geisinger Marketplace Select HMO 30/60/4650","22444PA001",,"PAN002","PAS007","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010044-02","Geisinger Marketplace Select HMO 30/60/4650","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004402.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010044","Geisinger Marketplace Select HMO 30/60/4650","22444PA001",,"PAN002","PAS007","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010044-03","Geisinger Marketplace Select HMO 30/60/4650","Limited Cost Sharing Plan Variation","69.09%","0.718692203764093","No","Yes","No","100%",,"$4,690","$0","$1,598","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,650","$4650 per person","$9300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004403.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010044","Geisinger Marketplace Select HMO 30/60/4650","22444PA001",,"PAN002","PAS007","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010044-04","Geisinger Marketplace Select HMO 30/60/4650","73% AV Level Silver Plan","72.13%","0.738964413532606","No","Yes","No","100%",,"$3,540","$0","$1,768","$10","$980","$635","$0","$60","$1,090","$330","$0","$0","$5,850","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004404.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","16322","SERFF","2017-09-25 20:16:04","Individual","No","46-2824626","16322PA0050119","Tower UPMC Advantage Bronze $6,950/$35 - Tower Network","16322PA005",,"PAN009","PAS007","PAF003","New","EPO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9976",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","16322PA0050119-03","Tower UPMC Advantage Bronze $6,950/$35 - Tower Network","Limited Cost Sharing Plan Variation","60.97%","0.610646860942347","Yes","Yes","No","100%",,"$6,950","$190","$0","$60","$4,120","$1,210","$1,590","$60","$1,910","$0","$20","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XALEG_EPO_RX1I45_DOVC_2018_16322PA005011903.pdf","https://www.upmchealthplan.com/docs/coverage/reading/reading.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010045","Geisinger Marketplace Extra HMO 10/50/500","22444PA001",,"PAN001","PAS005","PAF009","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010045-00","Geisinger Marketplace Extra HMO 10/50/500","Standard Gold Off Exchange Plan","79.20%","0.793884248073021","No","Yes","Yes","65%","35%","$540","$300","$0","$10","$980","$870","$0","$60","$500","$500","$0","$0","$5,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004500.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010045","Geisinger Marketplace Extra HMO 10/50/500","22444PA001",,"PAN001","PAS005","PAF009","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010045-01","Geisinger Marketplace Extra HMO 10/50/500","Standard Gold On Exchange Plan","79.20%","0.793884248073021","No","Yes","Yes","65%","35%","$540","$300","$0","$10","$980","$870","$0","$60","$500","$500","$0","$0","$5,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004501.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010045","Geisinger Marketplace Extra HMO 10/50/500","22444PA001",,"PAN001","PAS005","PAF009","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010045-02","Geisinger  Marketplace  Extra HMO 10/50/500","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004502.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010045","Geisinger Marketplace Extra HMO 10/50/500","22444PA001",,"PAN001","PAS005","PAF009","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010045-03","Geisinger Marketplace  Extra HMO 10/50/500","Limited Cost Sharing Plan Variation","79.20%","0.793884248073021","No","Yes","Yes","65%","35%","$540","$300","$0","$10","$980","$870","$0","$60","$500","$500","$0","$0","$5,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004503.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010046","Geisinger Marketplace Extra HMO 10/50/500","22444PA001",,"PAN001","PAS006","PAF009","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010046-00","Geisinger Marketplace  Extra HMO 10/50/500","Standard Gold Off Exchange Plan","79.20%","0.793884248073021","No","Yes","Yes","65%","35%","$540","$300","$0","$10","$980","$870","$0","$60","$500","$500","$0","$0","$5,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004600.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010046","Geisinger Marketplace Extra HMO 10/50/500","22444PA001",,"PAN001","PAS006","PAF009","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010046-01","Geisinger Marketplace  Extra HMO 10/50/500","Standard Gold On Exchange Plan","79.20%","0.793884248073021","No","Yes","Yes","65%","35%","$540","$300","$0","$10","$980","$870","$0","$60","$500","$500","$0","$0","$5,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004601.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010046","Geisinger Marketplace Extra HMO 10/50/500","22444PA001",,"PAN001","PAS006","PAF009","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010046-02","Geisinger Marketplace  Extra HMO 10/50/500","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004602.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010046","Geisinger Marketplace Extra HMO 10/50/500","22444PA001",,"PAN001","PAS006","PAF009","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010046-03","Geisinger Marketplace  Extra HMO 10/50/500","Limited Cost Sharing Plan Variation","79.20%","0.788309940905547","No","Yes","Yes","65%","35%","$540","$0","$0","$10","$980","$870","$0","$60","$500","$500","$0","$0","$5,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20.00%","$500","$500 per person","$1000 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004603.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010047","Geisinger Marketplace Extra HMO 10/50/4500","22444PA001",,"PAN001","PAS005","PAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010047-00","Geisinger Marketplace  Extra  HMO 10/50/4500","Standard Silver Off Exchange Plan","68.99%","0.718774290723452","No","Yes","Yes","65%","35%","$4,540","$0","$2,442","$10","$980","$870","$0","$60","$1,130","$300","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%","$4,500","$4500 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004700.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010047","Geisinger Marketplace Extra HMO 10/50/4500","22444PA001",,"PAN001","PAS005","PAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010047-01","Geisinger Marketplace  Extra  HMO 10/50/4500","Standard Silver On Exchange Plan","68.99%","0.718774290723452","No","Yes","Yes","65%","35%","$4,540","$0","$2,442","$10","$980","$870","$0","$60","$1,130","$300","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%","$4,500","$4500 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004701.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010047","Geisinger Marketplace Extra HMO 10/50/4500","22444PA001",,"PAN001","PAS005","PAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010047-02","Geisinger Marketplace  Extra HMO 10/50/4500","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004702.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010047","Geisinger Marketplace Extra HMO 10/50/4500","22444PA001",,"PAN001","PAS005","PAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010047-03","Geisinger Marketplace  Extra HMO 10/50/4500","Limited Cost Sharing Plan Variation","68.99%","0.718774290723452","No","Yes","Yes","65%","35%","$4,540","$0","$2,442","$10","$980","$870","$0","$60","$1,130","$300","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%","$4,500","$4500 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004703.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010047","Geisinger Marketplace Extra HMO 10/50/4500","22444PA001",,"PAN001","PAS005","PAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010047-04","Geisinger Marketplace  Extra HMO  10/50/4500","73% AV Level Silver Plan","72.08%","0.738989531543049","No","Yes","Yes","65%","35%","$3,440","$0","$2,410","$10","$980","$870","$0","$60","$1,130","$300","$0","$0","$5,850","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,400","$3400 per person","$6800 per group","30.00%","$3,400","$3400 per person","$6800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004704.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010047","Geisinger Marketplace Extra HMO 10/50/4500","22444PA001",,"PAN001","PAS005","PAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010047-05","Geisinger Marketplace  Extra HMO 10/50/4500","87% AV Level Silver Plan","87.42%","0.878723926551024","No","Yes","Yes","65%","35%","$1,000","$12","$0","$10","$480","$720","$0","$60","$530","$365","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%","$1,000","$1000 per person","$2000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004705.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010047","Geisinger Marketplace Extra HMO 10/50/4500","22444PA001",,"PAN001","PAS005","PAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010047-06","Geisinger Marketplace  Extra  HMO  10/50/4500","94% AV Level Silver Plan","94.04%","0.942015827194695","No","Yes","Yes","65%","35%","$400","$0","$0","$10","$400","$126","$0","$60","$400","$95","$0","$0","$75","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","0.00%","$400","$400 per person","$800 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004706.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010048","Geisinger Marketplace Extra HMO 10/50/4500","22444PA001",,"PAN001","PAS006","PAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010048-00","Geisinger Marketplace  Extra  HMO 10/50/4500","Standard Silver Off Exchange Plan","68.99%","0.718774290723452","No","Yes","Yes","65%","35%","$4,540","$0","$2,442","$10","$980","$870","$0","$60","$1,130","$300","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%","$4,500","$4500 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004800.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010048","Geisinger Marketplace Extra HMO 10/50/4500","22444PA001",,"PAN001","PAS006","PAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010048-01","Geisinger Marketplace  Extra  HMO  10/50/4500","Standard Silver On Exchange Plan","68.99%","0.718774290723452","No","Yes","Yes","65%","35%","$4,540","$0","$2,442","$10","$980","$870","$0","$60","$1,130","$300","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%","$4,500","$4500 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004801.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010048","Geisinger Marketplace Extra HMO 10/50/4500","22444PA001",,"PAN001","PAS006","PAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010048-02","Geisinger Marketplace  Extra HMO  10/50/4500","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004802.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010048","Geisinger Marketplace Extra HMO 10/50/4500","22444PA001",,"PAN001","PAS006","PAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010048-03","Geisinger Marketplace  Extra HMO 10/50/4500","Limited Cost Sharing Plan Variation","68.99%","0.685269619816358","No","Yes","Yes","65%","35%","$4,540","$0","$2,442","$10","$980","$870","$0","$60","$1,130","$300","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","30.00%","$4,500","$4500 per person","$9000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004803.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010048","Geisinger Marketplace Extra HMO 10/50/4500","22444PA001",,"PAN001","PAS006","PAF009","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010048-04","Geisinger Marketplace  Extra  HMO 10/50/4500","73% AV Level Silver Plan","72.08%","0.738989531543049","No","Yes","Yes","65%","35%","$3,440","$0","$2,410","$10","$980","$870","$0","$60","$1,130","$300","$0","$0","$5,850","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","30.00%","$3,400","$3400 per person","$6800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%","$500","$500 per person","$1000 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004804.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010043","Geisinger Marketplace Select HMO 20/40/3000","22444PA001",,"PAN002","PAS007","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010043-00","Geisinger Marketplace Select HMO 20/40/3000","Standard Gold Off Exchange Plan","79.26%","0.816380921513101","No","Yes","No","100%",,"$3,000","$262","$0","$10","$480","$770","$0","$60","$530","$570","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004300.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010043","Geisinger Marketplace Select HMO 20/40/3000","22444PA001",,"PAN002","PAS007","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010043-01","Geisinger Marketplace Select HMO 20/40/3000","Standard Gold On Exchange Plan","79.26%","0.816380921513101","No","Yes","No","100%",,"$3,000","$262","$0","$10","$480","$770","$0","$60","$530","$570","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004301.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010043","Geisinger Marketplace Select HMO 20/40/3000","22444PA001",,"PAN002","PAS007","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010043-02","Geisinger Marketplace Select HMO 20/40/3000","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004302.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010044","Geisinger Marketplace Select HMO 30/60/4650","22444PA001",,"PAN002","PAS007","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010044-05","Geisinger Marketplace Select HMO 30/60/4650","87% AV Level Silver Plan","87.16%","0.876002841112631","No","Yes","No","100%",,"$1,000","$12","$0","$10","$480","$770","$0","$60","$530","$345","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004405.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010055","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS003","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010055-01","Geisinger Marketplace HMO 30/60/6100","Standard Bronze On Exchange Plan","64.87%","0.615766512117358","Yes","Yes","No","100%",,"$6,100","$0","$0","$10","$6,100","$180","$0","$60","$1,630","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005501.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010055","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS003","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010055-02","Geisinger Marketplace HMO 30/60/6100","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005502.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010055","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS003","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010055-03","Geisinger Marketplace HMO 30/60/6100","Limited Cost Sharing Plan Variation","64.87%","0.615766512117358","Yes","Yes","No","100%",,"$6,100","$0","$0","$10","$6,100","$180","$0","$60","$1,630","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005503.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010044","Geisinger Marketplace Select HMO 30/60/4650","22444PA001",,"PAN002","PAS007","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010044-06","Geisinger Marketplace Select HMO 30/60/4650","94% AV Level Silver Plan","94.35%","0.944516848626001","No","Yes","No","100%",,"$300","$0","$0","$10","$300","$151","$0","$60","$300","$110","$0","$0","$75","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004406.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0040080","Geisinger Marketplace Value","22444PA004",,"PAN001","PAS001","PAF011","Existing","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0040080-00","Geisinger Marketplace Value","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$7,040","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA004008000.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0040080","Geisinger Marketplace Value","22444PA004",,"PAN001","PAS001","PAF011","Existing","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0040080-01","Geisinger Marketplace Value","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$7,040","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA004008001.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0040081","Geisinger Marketplace Value","22444PA004",,"PAN001","PAS002","PAF011","Existing","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0040081-00","Geisinger Marketplace Value","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$7,040","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA004008100.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0040081","Geisinger Marketplace Value","22444PA004",,"PAN001","PAS002","PAF011","Existing","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0040081-01","Geisinger Marketplace Value","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$7,040","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA004008101.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0040082","Geisinger Marketplace Value","22444PA004",,"PAN001","PAS003","PAF011","Existing","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0040082-00","Geisinger Marketplace Value","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$7,040","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA004008200.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0040082","Geisinger Marketplace Value","22444PA004",,"PAN001","PAS003","PAF011","Existing","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0040082-01","Geisinger Marketplace Value","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$7,040","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA004008201.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0040083","Geisinger Marketplace Value","22444PA004",,"PAN001","PAS004","PAF011","Existing","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0040083-00","Geisinger Marketplace Value","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$7,040","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA004008300.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0040083","Geisinger Marketplace Value","22444PA004",,"PAN001","PAS004","PAF011","Existing","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0040083-01","Geisinger Marketplace Value","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$7,040","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA004008301.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010053","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS001","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010053-00","Geisinger Marketplace HMO 30/60/6100","Standard Bronze Off Exchange Plan","64.87%","0.615766512117358","Yes","Yes","No","100%",,"$6,100","$0","$0","$10","$6,100","$180","$0","$60","$1,630","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005300.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010053","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS001","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010053-01","Geisinger Marketplace HMO 30/60/6100","Standard Bronze On Exchange Plan","64.87%","0.615766512117358","Yes","Yes","No","100%",,"$6,100","$0","$0","$10","$6,100","$180","$0","$60","$1,630","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005301.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010053","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS001","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010053-02","Geisinger Marketplace HMO 30/60/6100","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005302.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010053","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS001","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010053-03","Geisinger Marketplace HMO 30/60/6100","Limited Cost Sharing Plan Variation","64.87%","0.615766512117358","Yes","Yes","No","100%",,"$6,100","$0","$0","$10","$6,100","$180","$0","$60","$1,630","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005303.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010054","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS002","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010054-00","Geisinger Marketplace HMO 30/60/6100","Standard Bronze Off Exchange Plan","64.87%","0.615766512117358","Yes","Yes","No","100%",,"$6,100","$0","$0","$10","$6,100","$0","$0","$60","$1,630","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005400.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010054","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS002","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010054-01","Geisinger Marketplace HMO 30/60/6100","Standard Bronze On Exchange Plan","64.87%","0.615766512117358","Yes","Yes","No","100%",,"$6,100","$0","$0","$10","$6,100","$180","$0","$60","$1,630","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005401.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010054","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS002","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010054-02","Geisinger Marketplace HMO 30/60/6100","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005402.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010054","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS002","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010054-03","Geisinger Marketplace HMO 30/60/6100","Limited Cost Sharing Plan Variation","64.87%","0.615766512117358","Yes","Yes","No","100%",,"$6,100","$0","$0","$10","$6,100","$180","$0","$60","$1,630","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005403.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010055","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS003","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010055-00","Geisinger Marketplace HMO 30/60/6100","Standard Bronze Off Exchange Plan","64.87%","0.615766512117358","Yes","Yes","No","100%",,"$6,100","$0","$0","$10","$6,100","$180","$0","$60","$1,630","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005500.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010056","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS004","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010056-00","Geisinger Marketplace HMO 30/60/6100","Standard Bronze Off Exchange Plan","64.87%","0.615766512117358","Yes","Yes","No","100%",,"$6,100","$0","$0","$10","$6,100","$180","$0","$60","$1,630","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005600.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010056","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS004","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010056-01","Geisinger Marketplace HMO 30/60/6100","Standard Bronze On Exchange Plan","64.87%","0.615766512117358","Yes","Yes","No","100%",,"$6,100","$0","$0","$10","$6,100","$180","$0","$60","$1,630","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005601.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010038","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS001","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010038-01","Geisinger Marketplace HMO 30/60/4650","Standard Silver On Exchange Plan","69.09%","0.718692203764093","No","Yes","No","100%",,"$4,690","$0","$1,598","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,650","$4650 per person","$9300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003801.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010067","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS011","PAF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010067-01","Geisinger Marketplace HMO 20/40/3000","Standard Gold On Exchange Plan","79.26%",,"No","Yes","No","100%",,"$3,000","$262","$0","$10","$480","$770","$0","$60","$530","$570","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001006701.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010039","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS002","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010039-01","Geisinger Marketplace HMO 30/60/4650","Standard Silver On Exchange Plan","69.09%","0.718692203764093","No","Yes","No","100%",,"$4,690","$0","$1,598","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,650","$4650 per person","$9300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003901.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010039","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS002","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010039-02","Geisinger Marketplace HMO 30/60/4650","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003902.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010039","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS002","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010039-03","Geisinger Marketplace HMO 30/60/4650","Limited Cost Sharing Plan Variation","69.09%","0.718692203764093","No","Yes","No","100%",,"$4,690","$0","$1,598","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,650","$4650 per person","$9300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003903.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010039","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS002","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010039-04","Geisinger Marketplace HMO 30/60/4650","73% AV Level Silver Plan","72.13%","0.738964413532606","No","Yes","No","100%",,"$3,840","$0","$1,768","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$5,850","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003904.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010039","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS002","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010039-05","Geisinger Marketplace HMO 30/60/4650","87% AV Level Silver Plan","87.16%","0.876002841112631","No","Yes","No","100%",,"$1,000","$12","$0","$10","$780","$770","$0","$60","$530","$345","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003905.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010068","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS011","PAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010068-04","Geisinger Marketplace HMO 30/60/4650","73% AV Level Silver Plan","72.13%",,"No","Yes","No","100%",,"$3,840","$0","$1,768","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$5,850","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001006804.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010067","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS011","PAF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010067-02","Geisinger Marketplace HMO 20/40/3000","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001006702.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010056","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS004","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010056-02","Geisinger Marketplace HMO 30/60/6100","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005602.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010056","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS004","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010056-03","Geisinger Marketplace HMO 30/60/6100","Limited Cost Sharing Plan Variation","64.87%","0.615766512117358","Yes","Yes","No","100%",,"$6,100","$0","$0","$10","$6,100","$180","$0","$60","$1,630","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005603.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010058","Geisinger Marketplace Select HMO 30/60/6100","22444PA001",,"PAN002","PAS007","PAF011","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010058-00","Geisinger Marketplace Select HMO 30/60/6100","Standard Bronze Off Exchange Plan","64.87%","0.621622881300192","Yes","Yes","No","100%",,"$6,100","$0","$0","$10","$6,100","$180","$0","$60","$1,630","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005800.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010058","Geisinger Marketplace Select HMO 30/60/6100","22444PA001",,"PAN002","PAS007","PAF011","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010058-01","Geisinger Marketplace Select HMO 30/60/6100","Standard Bronze On Exchange Plan","64.87%","0.621622881300192","Yes","Yes","No","100%",,"$6,100","$0","$0","$10","$6,100","$180","$0","$60","$1,630","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005801.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010058","Geisinger Marketplace Select HMO 30/60/6100","22444PA001",,"PAN002","PAS007","PAF011","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010058-02","Geisinger Marketplace Select HMO 30/60/6100","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005802.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010058","Geisinger Marketplace Select HMO 30/60/6100","22444PA001",,"PAN002","PAS007","PAF011","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010058-03","Geisinger Marketplace Select HMO 30/60/6100","Limited Cost Sharing Plan Variation","64.87%","0.621622881300192","Yes","Yes","No","100%",,"$6,100","$0","$0","$10","$6,100","$180","$0","$60","$1,630","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001005803.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010035","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS001","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010035-00","Geisinger Marketplace HMO 20/40/3000","Standard Gold Off Exchange Plan","79.26%","0.816380921513101","No","Yes","No","100%",,"$3,000","$262","$0","$10","$480","$770","$0","$60","$530","$570","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003500.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010035","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS001","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010035-01","Geisinger Marketplace HMO 20/40/3000","Standard Gold On Exchange Plan","79.26%","0.816380921513101","No","Yes","No","100%",,"$3,000","$262","$0","$10","$480","$770","$0","$60","$530","$570","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003501.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010035","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS001","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010035-02","Geisinger Marketplace HMO 20/40/3000","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003502.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010035","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS001","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010035-03","Geisinger Marketplace HMO 20/40/3000","Limited Cost Sharing Plan Variation","79.26%","0.816380921513101","No","Yes","No","100%",,"$3,000","$262","$0","$10","$480","$770","$0","$60","$530","$570","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003503.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010036","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS003","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010036-00","Geisinger Marketplace HMO 20/40/3000","Standard Gold Off Exchange Plan","79.26%","0.816380921513101","No","Yes","No","100%",,"$3,000","$262","$0","$10","$480","$770","$0","$60","$530","$570","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003600.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010036","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS003","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010036-01","Geisinger Marketplace HMO 20/40/3000","Standard Gold On Exchange Plan","79.26%","0.816380921513101","No","Yes","No","100%",,"$3,000","$262","$0","$10","$480","$770","$0","$60","$530","$570","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003601.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010036","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS003","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010036-02","Geisinger Marketplace HMO 20/40/3000","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003602.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010036","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS003","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010036-03","Geisinger Marketplace HMO 20/40/3000","Limited Cost Sharing Plan Variation","79.26%","0.816380921513101","No","Yes","No","100%",,"$3,000","$262","$0","$10","$480","$770","$0","$60","$530","$570","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003603.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010037","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS004","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010037-00","Geisinger Marketplace HMO 20/40/3000","Standard Gold Off Exchange Plan","79.26%","0.816380921513101","No","Yes","No","100%",,"$3,000","$262","$0","$10","$480","$770","$0","$60","$530","$570","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003700.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010037","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS004","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010037-01","Geisinger Marketplace HMO 20/40/3000","Standard Gold On Exchange Plan","79.26%","0.816380921513101","No","Yes","No","100%",,"$3,000","$262","$0","$10","$480","$770","$0","$60","$530","$570","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003701.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010037","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS004","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010037-02","Geisinger Marketplace HMO 20/40/3000","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003702.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010037","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS004","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010037-03","Geisinger Marketplace HMO 20/40/3000","Limited Cost Sharing Plan Variation","79.26%","0.816380921513101","No","Yes","No","100%",,"$3,000","$262","$0","$10","$480","$770","$0","$60","$530","$570","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003703.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010042","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS002","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010042-00","Geisinger Marketplace HMO 20/40/3000","Standard Gold Off Exchange Plan","79.26%","0.816380921513101","No","Yes","No","100%",,"$3,000","$262","$0","$10","$480","$770","$0","$60","$530","$570","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004200.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010042","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS002","PAF004","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010042-01","Geisinger Marketplace HMO 20/40/3000","Standard Gold On Exchange Plan","79.26%","0.816380921513101","No","Yes","No","100%",,"$3,000","$262","$0","$10","$480","$770","$0","$60","$530","$570","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004201.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010038","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS001","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010038-02","Geisinger Marketplace HMO 30/60/4650","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003802.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010038","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS001","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010038-03","Geisinger Marketplace HMO 30/60/4650","Limited Cost Sharing Plan Variation","69.09%","0.718692203764093","No","Yes","No","100%",,"$4,690","$0","$1,598","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,650","$4650 per person","$9300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003803.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010038","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS001","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010038-04","Geisinger Marketplace HMO 30/60/4650","73% AV Level Silver Plan","72.13%","0.738964413532606","No","Yes","No","100%",,"$3,840","$0","$1,768","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$5,850","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003804.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010038","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS001","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010038-05","Geisinger Marketplace HMO 30/60/4650","87% AV Level Silver Plan","87.16%","0.876002841112631","No","Yes","No","100%",,"$1,000","$12","$0","$10","$780","$770","$0","$60","$530","$345","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003805.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010038","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS001","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010038-06","Geisinger Marketplace HMO 30/60/4650","94% AV Level Silver Plan","94.47%","0.944516848626001","No","Yes","No","100%",,"$300","$4","$0","$10","$300","$216","$0","$60","$300","$110","$0","$0","$75","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003806.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010039","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS002","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010039-00","Geisinger Marketplace HMO 30/60/4650","Standard Silver Off Exchange Plan","69.09%","0.718692203764093","No","Yes","No","100%",,"$4,690","$0","$1,598","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,650","$4650 per person","$9300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003900.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010039","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS002","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010039-06","Geisinger Marketplace HMO 30/60/4650","94% AV Level Silver Plan","94.47%","0.944516848626001","No","Yes","No","100%",,"$300","$0","$0","$10","$300","$151","$0","$60","$300","$110","$0","$0","$75","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001003906.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010040","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS003","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010040-00","Geisinger Marketplace HMO 30/60/4650","Standard Silver Off Exchange Plan","69.09%","0.751436855464385","No","Yes","No","100%",,"$4,690","$0","$1,598","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,650","$4650 per person","$9300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004000.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010040","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS003","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010040-01","Geisinger Marketplace HMO 30/60/4650","Standard Silver On Exchange Plan","69.09%","0.751436855464385","No","Yes","No","100%",,"$4,690","$0","$1,598","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,650","$4650 per person","$9300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004001.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010040","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS003","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010040-02","Geisinger Marketplace HMO 30/60/4650","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004002.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010040","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS003","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010040-03","Geisinger Marketplace HMO 30/60/4650","Limited Cost Sharing Plan Variation","69.09%","0.751436855464385","No","Yes","No","100%",,"$4,690","$0","$1,598","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,650","$4650 per person","$9300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004003.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010040","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS003","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010040-04","Geisinger Marketplace HMO 30/60/4650","73% AV Level Silver Plan","72.13%","0.738964413532606","No","Yes","No","100%",,"$3,840","$0","$1,768","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$5,850","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004004.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010040","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS003","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010040-05","Geisinger Marketplace HMO 30/60/4650","87% AV Level Silver Plan","87.16%","0.874445125431853","No","Yes","No","100%",,"$1,000","$12","$0","$10","$780","$770","$0","$60","$530","$345","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004005.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010040","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS003","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010040-06","Geisinger Marketplace HMO 30/60/4650","94% AV Level Silver Plan","94.47%","0.944516848626001","No","Yes","No","100%",,"$300","$0","$0","$10","$300","$151","$0","$60","$300","$110","$0","$0","$75","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004006.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010041","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS004","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010041-00","Geisinger Marketplace HMO 30/60/4650","Standard Silver Off Exchange Plan","69.09%","0.723688735236962","No","Yes","No","100%",,"$4,690","$0","$1,598","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,650","$4650 per person","$9300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004100.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010041","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS004","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010041-01","Geisinger Marketplace HMO 30/60/4650","Standard Silver On Exchange Plan","69.09%","0.723688735236962","No","Yes","No","100%",,"$4,690","$0","$1,598","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,650","$4650 per person","$9300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004101.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010041","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS004","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010041-02","Geisinger Marketplace HMO 30/60/4650","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004102.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010041","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS004","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010041-03","Geisinger Marketplace HMO 30/60/4650","Limited Cost Sharing Plan Variation","69.09%","0.718692203764093","No","Yes","No","100%",,"$4,690","$0","$1,598","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,650","$4650 per person","$9300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004103.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010041","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS004","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010041-04","Geisinger Marketplace HMO 30/60/4650","73% AV Level Silver Plan","72.13%","0.738964413532606","No","Yes","No","100%",,"$3,840","$0","$1,768","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$5,850","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004104.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010041","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS004","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010041-05","Geisinger Marketplace HMO 30/60/4650","87% AV Level Silver Plan","87.16%","0.876002841112631","No","Yes","No","100%",,"$1,000","$12","$0","$10","$780","$770","$0","$60","$530","$345","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004105.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010041","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS004","PAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010041-06","Geisinger Marketplace HMO 30/60/4650","94% AV Level Silver Plan","94.47%","0.944516848626001","No","Yes","No","100%",,"$300","$0","$0","$10","$300","$151","$0","$60","$300","$110","$0","$0","$75","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001004106.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010067","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS011","PAF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010067-00","Geisinger Marketplace HMO 20/40/3000","Standard Gold Off Exchange Plan","79.26%",,"No","Yes","No","100%",,"$3,000","$262","$0","$10","$480","$770","$0","$60","$530","$570","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001006700.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010067","Geisinger Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS011","PAF004","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010067-03","Geisinger Marketplace HMO 20/40/3000","Limited Cost Sharing Plan Variation","79.26%",,"No","Yes","No","100%",,"$3,000","$262","$0","$10","$480","$770","$0","$60","$530","$570","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001006703.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010068","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS011","PAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010068-00","Geisinger Marketplace HMO 30/60/4650","Standard Silver Off Exchange Plan","69.09%",,"No","Yes","No","100%",,"$4,690","$0","$1,598","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,650","$4650 per person","$9300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001006800.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010068","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS011","PAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010068-01","Geisinger Marketplace HMO 30/60/4650","Standard Silver On Exchange Plan","69.09%",,"No","Yes","No","100%",,"$4,690","$0","$1,598","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,650","$4650 per person","$9300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001006801.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF014","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9907",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","31609PA0070003-02","Personal Choice PPO Silver","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.ibx4you.com/pdfs/ffm/2018/pposilverZeroCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF014","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9907",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","31609PA0070003-03","Personal Choice PPO Silver","Limited Cost Sharing Plan Variation","71.08%",,"Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0","$700","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2018/pposilverLimitedCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF014","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9907",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","31609PA0070003-04","Personal Choice PPO Silver","73% AV Level Silver Plan","73.97%",,"Yes","Yes","No","100%",,"$2,500","$30","$1,800","$10","$2,500","$600","$800","$60","$1,500","$300","$0","$0","$700","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2018/pposilver73CSR2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF014","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9907",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","31609PA0070003-05","Personal Choice PPO Silver","87% AV Level Silver Plan","87.95%",,"Yes","Yes","No","100%",,"$0","$20","$1,200","$10","$1,850","$200","$400","$60","$700","$200","$90","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2018/pposilver87CSR2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF014","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9907",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","31609PA0070003-06","Personal Choice PPO Silver","94% AV Level Silver Plan","94.65%",,"Yes","Yes","No","100%",,"$0","$0","$1,000","$10","$0","$200","$800","$60","$0","$80","$200","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2018/pposilver94CSR2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010068","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS011","PAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010068-02","Geisinger Marketplace HMO 30/60/4650","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001006802.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010068","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS011","PAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010068-03","Geisinger Marketplace HMO 30/60/4650","Limited Cost Sharing Plan Variation","69.09%",,"No","Yes","No","100%",,"$4,690","$0","$1,598","$10","$980","$1,025","$0","$60","$1,130","$330","$0","$0","$7,350","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,650","$4650 per person","$9300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001006803.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010068","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS011","PAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010068-05","Geisinger Marketplace HMO 30/60/4650","87% AV Level Silver Plan","87.16%",,"No","Yes","No","100%",,"$1,000","$12","$0","$10","$780","$770","$0","$60","$530","$345","$0","$0","$150","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001006805.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010068","Geisinger Marketplace HMO 30/60/4650","22444PA001",,"PAN001","PAS011","PAF010","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010068-06","Geisinger Marketplace HMO 30/60/4650","94% AV Level Silver Plan","94.35%",,"No","Yes","No","100%",,"$300","$0","$0","$10","$300","$151","$0","$60","$300","$110","$0","$0","$75","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001006806.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0160003","Personal Choice Silver Reserve","31609PA016",,"PAN001","PAS001","PAF011","New","EPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4v","31609PA0160003-05","Personal Choice Silver Reserve","87% AV Level Silver Plan",,"0.863530285173399","Yes","Yes","No","100%",,"$500","$0","$1,500","$10","$500","$0","$1,300","$60","$500","$0","$300","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2018/eposilverreserve87CSR2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0160003","Personal Choice Silver Reserve","31609PA016",,"PAN001","PAS001","PAF011","New","EPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4v","31609PA0160003-06","Personal Choice Silver Reserve","94% AV Level Silver Plan",,"0.930393165268784","Yes","Yes","No","100%",,"$100","$0","$1,200","$10","$100","$0","$700","$60","$100","$0","$200","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2018/eposilverreserve94CSR2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","32561","SERFF","2017-08-14 20:15:51","Individual","Yes","13-5123390","32561PA0200001","Guardian Essentials for Families and Individuals","32561PA020",,"PAN002","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","32561PA0200001-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/pennsylvania/","https://dentalexchange.guardianlife.com/our-plans/pennsylvania/"
"2018","PA","32561","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","13-5123390","32561PA0090003","Guardian Pediatric Advantage","32561PA009",,"PAN001","PAS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","32561PA0090003-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","PA","32561","SERFF","2017-08-14 20:15:51","Individual","Yes","13-5123390","32561PA0200001","Guardian Essentials for Families and Individuals","32561PA020",,"PAN002","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","32561PA0200001-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/pennsylvania/","https://dentalexchange.guardianlife.com/our-plans/pennsylvania/"
"2018","PA","32561","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","13-5123390","32561PA0100004","Guardian Pediatric Essentials","32561PA010",,"PAN001","PAS002",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","32561PA0100004-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","68.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","PA","32561","SERFF","2017-08-14 20:15:51","Individual","Yes","13-5123390","32561PA0210001","Guardian Select for Families and Individuals","32561PA021",,"PAN002","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","32561PA0210001-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/pennsylvania/","https://dentalexchange.guardianlife.com/our-plans/pennsylvania/"
"2018","PA","32561","SERFF","2017-08-14 20:15:51","Individual","Yes","13-5123390","32561PA0210001","Guardian Select for Families and Individuals","32561PA021",,"PAN002","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","32561PA0210001-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/pennsylvania/","https://dentalexchange.guardianlife.com/our-plans/pennsylvania/"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010069","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS011","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010069-00","Geisinger Marketplace HMO 30/60/6100","Standard Bronze Off Exchange Plan","64.87%",,"Yes","Yes","No","100%",,"$6,100","$0","$0","$10","$6,100","$180","$0","$60","$1,630","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001006900.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010069","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS011","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010069-01","Geisinger Marketplace HMO 30/60/6100","Standard Bronze On Exchange Plan","64.87%",,"Yes","Yes","No","100%",,"$6,100","$0","$0","$10","$6,100","$180","$0","$60","$1,630","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001006901.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010069","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS011","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010069-02","Geisinger Marketplace HMO 30/60/6100","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001006902.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0010069","Geisinger Marketplace HMO 30/60/6100","22444PA001",,"PAN001","PAS011","PAF011","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0010069-03","Geisinger Marketplace HMO 30/60/6100","Limited Cost Sharing Plan Variation","64.87%",,"Yes","Yes","No","100%",,"$6,100","$0","$0","$10","$6,100","$180","$0","$60","$1,630","$180","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA001006903.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0040084","Geisinger Marketplace Value","22444PA004",,"PAN001","PAS011","PAF011","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0040084-00","Geisinger Marketplace Value","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$7,040","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA004008400.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","22444","SERFF","2017-11-03 20:15:26","Individual","No","23-2311553","22444PA0040084","Geisinger Marketplace Value","22444PA004",,"PAN001","PAS011","PAF011","New","POS","Catastrophic","Not Applicable","Yes","Both","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids,  Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Weight Loss Programs","1",,,"2018-01-01","2018-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/Pharmacy.aspx?formulary=MARKETPLACE","22444PA0040084-01","Geisinger Marketplace Value","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$7,040","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2018/22444PA004008401.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2018/AllPlansBrochureIndividual.pdf"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0160001","Personal Choice Catastrophic","31609PA016",,"PAN001","PAS001","PAF010","Existing","EPO","Catastrophic","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4v","31609PA0160001-01","Personal Choice Catastrophic","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$50","$2,500","$200","$0","$4,300","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2018/epocatastrophic2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0160004","Personal Choice Platinum","31609PA016",,"PAN001","PAS001","PAF001","New","EPO","Platinum","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4v","31609PA0160004-01","Personal Choice Platinum","Standard Platinum On Exchange Plan","87.38%",,"No","Yes","No","100%",,"$0","$700","$0","$10","$0","$2,300","$0","$60","$0","$300","$40","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/epoplatinum2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0160004","Personal Choice Platinum","31609PA016",,"PAN001","PAS001","PAF001","New","EPO","Platinum","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4v","31609PA0160004-02","Personal Choice Platinum","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/epoplatinumZeroCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0160004","Personal Choice Platinum","31609PA016",,"PAN001","PAS001","PAF001","New","EPO","Platinum","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4v","31609PA0160004-03","Personal Choice Platinum","Limited Cost Sharing Plan Variation","87.38%",,"No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/epoplatinumLimitedCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0070002","Personal Choice PPO Gold","31609PA007",,"PAN001","PAS001","PAF013","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","31609PA0070002-01","Personal Choice PPO Gold","Standard Gold On Exchange Plan","79.85%",,"No","Yes","No","100%",,"$0","$1,600","$500","$10","$0","$700","$2,100","$60","$0","$400","$60","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/ppogold2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0070002","Personal Choice PPO Gold","31609PA007",,"PAN001","PAS001","PAF013","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","31609PA0070002-02","Personal Choice PPO Gold","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/ppogoldZeroCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0070002","Personal Choice PPO Gold","31609PA007",,"PAN001","PAS001","PAF013","Existing","PPO","Gold","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","31609PA0070002-03","Personal Choice PPO Gold","Limited Cost Sharing Plan Variation","79.85%",,"No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/ppogoldLimitedCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF014","Existing","PPO","Silver","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9907",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","31609PA0070003-01","Personal Choice PPO Silver","Standard Silver On Exchange Plan","71.08%",,"Yes","Yes","No","100%",,"$2,500","$40","$2,800","$10","$2,500","$700","$1,400","$60","$1,500","$300","$0","$0","$700","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2018/pposilver2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0070004","Personal Choice PPO Bronze","31609PA007",,"PAN001","PAS001","PAF009","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","31609PA0070004-01","Personal Choice PPO Bronze","Standard Bronze On Exchange Plan","61.40%",,"Yes","Yes","No","100%",,"$5,500","$0","$1,900","$10","$5,500","$400","$400","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2018/ppobronze2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0070004","Personal Choice PPO Bronze","31609PA007",,"PAN001","PAS001","PAF009","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","31609PA0070004-02","Personal Choice PPO Bronze","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.ibx4you.com/pdfs/ffm/2018/ppobronzeZeroCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0070004","Personal Choice PPO Bronze","31609PA007",,"PAN001","PAS001","PAF009","Existing","PPO","Bronze","Not Applicable","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","31609PA0070004-03","Personal Choice PPO Bronze","Limited Cost Sharing Plan Variation","61.40%",,"Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50.00%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2018/ppobronzeLimitedCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0160005","Personal Choice Bronze Reserve","31609PA016",,"PAN001","PAS001","PAF010","New","EPO","Bronze","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4v","31609PA0160005-01","Personal Choice Bronze Reserve","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"$6,650","$0","$0","$10","$6,650","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.ibx4you.com/pdfs/ffm/2018/epobronzereserve2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0870001","my Direct Blue EPO 1000G","33709PA087",,"PAN002","PAS005","PAF026","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0870001-02","my Direct Blue EPO 1000G","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0870001-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33871","SERFF","2017-08-14 20:15:51","Individual","No","23-2405376","33871PA0040005","Keystone HMO Gold Proactive","33871PA004",,"PAN001","PAS001","PAF014","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","33871PA0040005-02","Keystone HMO Gold Proactive","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","45%","55%","$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/hmogoldproactiveZeroCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0160005","Personal Choice Bronze Reserve","31609PA016",,"PAN001","PAS001","PAF010","New","EPO","Bronze","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4v","31609PA0160005-02","Personal Choice Bronze Reserve","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.ibx4you.com/pdfs/ffm/2018/epobronzereserveZeroCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0160005","Personal Choice Bronze Reserve","31609PA016",,"PAN001","PAS001","PAF010","New","EPO","Bronze","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4v","31609PA0160005-03","Personal Choice Bronze Reserve","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.ibx4you.com/pdfs/ffm/2018/epobronzereserveLimitedCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0160003","Personal Choice Silver Reserve","31609PA016",,"PAN001","PAS001","PAF011","New","EPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4v","31609PA0160003-01","Personal Choice Silver Reserve","Standard Silver On Exchange Plan",,"0.668174259381898","Yes","Yes","No","100%",,"$2,700","$0","$3,000","$10","$2,700","$0","$1,300","$60","$1,900","$0","$0","$0","$700","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.ibx4you.com/pdfs/ffm/2018/eposilverreserve2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0160003","Personal Choice Silver Reserve","31609PA016",,"PAN001","PAS001","PAF011","New","EPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4v","31609PA0160003-02","Personal Choice Silver Reserve","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/pdfs/ffm/2018/eposilverreserveZeroCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0160003","Personal Choice Silver Reserve","31609PA016",,"PAN001","PAS001","PAF011","New","EPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4v","31609PA0160003-03","Personal Choice Silver Reserve","Limited Cost Sharing Plan Variation",,"0.668174259381898","Yes","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0","$700","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.ibx4you.com/pdfs/ffm/2018/eposilverreserveLimitedCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","31609","SERFF","2017-08-14 20:15:51","Individual","No","23-2184623","31609PA0160003","Personal Choice Silver Reserve","31609PA016",,"PAN001","PAS001","PAF011","New","EPO","Silver","Not Applicable","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4v","31609PA0160003-04","Personal Choice Silver Reserve","73% AV Level Silver Plan",,"0.720262581251655","Yes","Yes","No","100%",,"$2,700","$0","$1,100","$10","$2,700","$0","$1,100","$60","$1,900","$0","$0","$0","$700","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.ibx4you.com/pdfs/ffm/2018/eposilverreserve73CSR2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","32561","SERFF","2017-08-14 20:15:51","Individual","Yes","13-5123390","32561PA0220001","Guardian Basics for Families and Individuals","32561PA022",,"PAN002","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","32561PA0220001-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/pennsylvania/","https://dentalexchange.guardianlife.com/our-plans/pennsylvania/"
"2018","PA","32561","SERFF","2017-08-14 20:15:51","Individual","Yes","13-5123390","32561PA0220001","Guardian Basics for Families and Individuals","32561PA022",,"PAN002","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","32561PA0220001-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$120","$120 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/pennsylvania/","https://dentalexchange.guardianlife.com/our-plans/pennsylvania/"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0870001","my Direct Blue EPO 1000G","33709PA087",,"PAN002","PAS005","PAF026","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0870001-03","my Direct Blue EPO 1000G","Limited Cost Sharing Plan Variation",,"0.791593648646614","No","Yes","No","100%",,"$1,000","$100","$2,100","$0","$1,000","$1,300","$200","$0","$800","$700","$0","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0870001-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33871","SERFF","2017-08-14 20:15:51","Individual","No","23-2405376","33871PA0040005","Keystone HMO Gold Proactive","33871PA004",,"PAN001","PAS001","PAF014","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","33871PA0040005-01","Keystone HMO Gold Proactive","Standard Gold On Exchange Plan","76.26%",,"No","Yes","Yes","45%","55%","$0","$800","$0","$10","$0","$600","$2,700","$60","$0","$400","$40","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/hmogoldproactive_indiv_2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","33871","SERFF","2017-08-14 20:15:51","Individual","No","23-2405376","33871PA0040005","Keystone HMO Gold Proactive","33871PA004",,"PAN001","PAS001","PAF014","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","33871PA0040005-03","Keystone HMO Gold Proactive","Limited Cost Sharing Plan Variation","76.26%",,"No","Yes","Yes","45%","55%","$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/hmogoldproactiveLimitedCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","33871","SERFF","2017-08-14 20:15:51","Individual","No","23-2405376","33871PA0040001","Keystone HMO Platinum","33871PA004",,"PAN001","PAS001","PAF010","Existing","HMO","Platinum","Not Applicable","No","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4v","33871PA0040001-01","Keystone HMO Platinum","Standard Platinum On Exchange Plan",,"0.879631375887079","No","Yes","No","100%",,"$0","$900","$0","$10","$0","$2,300","$0","$60","$0","$300","$40","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/hmoplatinum2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","38949","SERFF","2017-08-14 20:15:51","Individual","No","25-1522457","38949PA0080007","my Direct Blue HMO 6950B","38949PA008",,"PAN002","PAS001","PAF030","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","38949PA0080007-03","my Direct Blue HMO 6950B","Limited Cost Sharing Plan Variation",,"0.613867445999214","Yes","Yes","No","100%",,"$6,950","$0","$0","$0","$6,500","$200","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_38949PA0080007-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","Yes","45-5492167","45127PA0050001","Dental Select Basic","45127PA005",,"PAN001","PAS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency","Yes","Emergency","No","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0050001-00","Dental Select Basic","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2018/dental-select-basic.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0380004","Major Events PPO 7350 a Community Blue Plan","33709PA038",,"PAN001","PAS007","PAF030","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0380004-00","Major Events PPO 7350 a Community Blue Plan","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$7,350","$0","$0","$0","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0380004","Major Events PPO 7350 a Community Blue Plan","33709PA038",,"PAN001","PAS007","PAF030","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0380004-01","Major Events PPO 7350 a Community Blue Plan","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$7,350","$0","$0","$0","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0380004-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0860001","my Direct Blue Conemaugh EPO 1000G","33709PA086",,"PAN002","PAS009","PAF026","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0860001-00","my Direct Blue Conemaugh EPO 1000G","Standard Gold Off Exchange Plan",,"0.791593648646614","No","Yes","No","100%",,"$1,000","$100","$2,100","$0","$1,000","$1,300","$200","$0","$800","$700","$0","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0860001","my Direct Blue Conemaugh EPO 1000G","33709PA086",,"PAN002","PAS009","PAF026","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0860001-01","my Direct Blue Conemaugh EPO 1000G","Standard Gold On Exchange Plan",,"0.791593648646614","No","Yes","No","100%",,"$1,000","$100","$2,100","$0","$1,000","$1,300","$200","$0","$800","$700","$0","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0860001-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0860001","my Direct Blue Conemaugh EPO 1000G","33709PA086",,"PAN002","PAS009","PAF026","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0860001-02","my Direct Blue Conemaugh EPO 1000G","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0860001-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0860001","my Direct Blue Conemaugh EPO 1000G","33709PA086",,"PAN002","PAS009","PAF026","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0860001-03","my Direct Blue Conemaugh EPO 1000G","Limited Cost Sharing Plan Variation",,"0.791593648646614","No","Yes","No","100%",,"$1,000","$100","$2,100","$0","$1,000","$1,300","$200","$0","$800","$700","$0","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0860001-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0860004","my Direct Blue Conemaugh EPO 7150S","33709PA086",,"PAN002","PAS009","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0860004-00","my Direct Blue Conemaugh EPO 7150S","Standard Silver Off Exchange Plan","66.21%","0.662814921962097","No","Yes","No","100%",,"$7,150","$200","$0","$0","$2,100","$1,600","$0","$0","$800","$900","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0860004","my Direct Blue Conemaugh EPO 7150S","33709PA086",,"PAN002","PAS009","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0860004-01","my Direct Blue Conemaugh EPO 7150S","Standard Silver On Exchange Plan","66.21%","0.662814921962097","No","Yes","No","100%",,"$7,150","$200","$0","$0","$2,100","$1,600","$0","$0","$800","$900","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0860004-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0860004","my Direct Blue Conemaugh EPO 7150S","33709PA086",,"PAN002","PAS009","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0860004-02","my Direct Blue Conemaugh EPO 7150S","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0860004-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0860004","my Direct Blue Conemaugh EPO 7150S","33709PA086",,"PAN002","PAS009","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0860004-03","my Direct Blue Conemaugh EPO 7150S","Limited Cost Sharing Plan Variation","66.21%","0.662814921962097","No","Yes","No","100%",,"$7,150","$200","$0","$0","$2,100","$1,600","$0","$0","$800","$900","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0860004-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0860004","my Direct Blue Conemaugh EPO 7150S","33709PA086",,"PAN002","PAS009","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0860004-04","my Direct Blue Conemaugh EPO 7150S","73% AV Level Silver Plan","73.90%","0.740101072632562","No","Yes","No","100%",,"$4,500","$200","$1,000","$0","$2,100","$1,300","$0","$0","$800","$800","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0860004-04_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0860004","my Direct Blue Conemaugh EPO 7150S","33709PA086",,"PAN002","PAS009","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0860004-05","my Direct Blue Conemaugh EPO 7150S","87% AV Level Silver Plan","87.83%","0.879649036638162","No","Yes","No","100%",,"$800","$200","$700","$0","$800","$800","$100","$0","$800","$500","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0860004-05_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0860004","my Direct Blue Conemaugh EPO 7150S","33709PA086",,"PAN002","PAS009","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0860004-06","my Direct Blue Conemaugh EPO 7150S","94% AV Level Silver Plan","94.77%","0.948188027567066","No","Yes","No","100%",,"$250","$100","$200","$0","$250","$100","$200","$0","$250","$200","$40","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0860004-06_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0860006","my Direct Blue Conemaugh EPO 7000B","33709PA086",,"PAN002","PAS009","PAF026","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0860006-00","my Direct Blue Conemaugh EPO 7000B","Standard Bronze Off Exchange Plan",,"0.649717681712372","No","Yes","No","100%",,"$7,000","$300","$50","$0","$2,100","$1,600","$0","$0","$1,600","$200","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0860006","my Direct Blue Conemaugh EPO 7000B","33709PA086",,"PAN002","PAS009","PAF026","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0860006-01","my Direct Blue Conemaugh EPO 7000B","Standard Bronze On Exchange Plan",,"0.649717681712372","No","Yes","No","100%",,"$7,000","$300","$50","$0","$2,100","$1,600","$0","$0","$1,600","$200","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0860006-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0860006","my Direct Blue Conemaugh EPO 7000B","33709PA086",,"PAN002","PAS009","PAF026","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0860006-02","my Direct Blue Conemaugh EPO 7000B","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0860006-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0860006","my Direct Blue Conemaugh EPO 7000B","33709PA086",,"PAN002","PAS009","PAF026","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0860006-03","my Direct Blue Conemaugh EPO 7000B","Limited Cost Sharing Plan Variation",,"0.649717681712372","No","Yes","No","100%",,"$7,000","$300","$50","$0","$2,100","$1,600","$0","$0","$1,600","$200","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0860006-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0860007","my Direct Blue Conemaugh EPO 6950B","33709PA086",,"PAN002","PAS009","PAF030","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0860007-00","my Direct Blue Conemaugh EPO 6950B","Standard Bronze Off Exchange Plan",,"0.613867445999214","Yes","Yes","No","100%",,"$6,950","$0","$0","$0","$6,500","$200","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0860007","my Direct Blue Conemaugh EPO 6950B","33709PA086",,"PAN002","PAS009","PAF030","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0860007-01","my Direct Blue Conemaugh EPO 6950B","Standard Bronze On Exchange Plan",,"0.613867445999214","Yes","Yes","No","100%",,"$6,950","$0","$0","$0","$6,500","$200","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0860007-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0860007","my Direct Blue Conemaugh EPO 6950B","33709PA086",,"PAN002","PAS009","PAF030","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0860007-02","my Direct Blue Conemaugh EPO 6950B","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0860007-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0860007","my Direct Blue Conemaugh EPO 6950B","33709PA086",,"PAN002","PAS009","PAF030","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0860007-03","my Direct Blue Conemaugh EPO 6950B","Limited Cost Sharing Plan Variation",,"0.613867445999214","Yes","Yes","No","100%",,"$6,950","$0","$0","$0","$6,500","$200","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0860007-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0870001","my Direct Blue EPO 1000G","33709PA087",,"PAN002","PAS005","PAF026","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0870001-00","my Direct Blue EPO 1000G","Standard Gold Off Exchange Plan",,"0.791593648646614","No","Yes","No","100%",,"$1,000","$100","$2,100","$0","$1,000","$1,300","$200","$0","$800","$700","$0","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0870001","my Direct Blue EPO 1000G","33709PA087",,"PAN002","PAS005","PAF026","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0870001-01","my Direct Blue EPO 1000G","Standard Gold On Exchange Plan",,"0.791593648646614","No","Yes","No","100%",,"$1,000","$100","$2,100","$0","$1,000","$1,300","$200","$0","$800","$700","$0","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0870001-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0870004","my Direct Blue EPO 7150S","33709PA087",,"PAN002","PAS005","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0870004-00","my Direct Blue EPO 7150S","Standard Silver Off Exchange Plan","66.21%","0.662814921962097","No","Yes","No","100%",,"$7,150","$200","$0","$0","$2,100","$1,600","$0","$0","$800","$900","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0870004","my Direct Blue EPO 7150S","33709PA087",,"PAN002","PAS005","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0870004-01","my Direct Blue EPO 7150S","Standard Silver On Exchange Plan","66.21%","0.662814921962097","No","Yes","No","100%",,"$7,150","$200","$0","$0","$2,100","$1,600","$0","$0","$800","$900","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0870004-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0870004","my Direct Blue EPO 7150S","33709PA087",,"PAN002","PAS005","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0870004-02","my Direct Blue EPO 7150S","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0870004-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0870004","my Direct Blue EPO 7150S","33709PA087",,"PAN002","PAS005","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0870004-03","my Direct Blue EPO 7150S","Limited Cost Sharing Plan Variation","66.21%","0.662814921962097","No","Yes","No","100%",,"$7,150","$200","$0","$0","$2,100","$1,600","$0","$0","$800","$900","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0870004-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0870004","my Direct Blue EPO 7150S","33709PA087",,"PAN002","PAS005","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0870004-04","my Direct Blue EPO 7150S","73% AV Level Silver Plan","73.90%","0.740101072632562","No","Yes","No","100%",,"$4,500","$200","$1,000","$0","$2,100","$1,300","$0","$0","$800","$800","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0870004-04_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0870004","my Direct Blue EPO 7150S","33709PA087",,"PAN002","PAS005","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0870004-05","my Direct Blue EPO 7150S","87% AV Level Silver Plan","87.83%","0.879649036638162","No","Yes","No","100%",,"$800","$200","$700","$0","$800","$800","$100","$0","$800","$500","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0870004-05_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0870004","my Direct Blue EPO 7150S","33709PA087",,"PAN002","PAS005","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0870004-06","my Direct Blue EPO 7150S","94% AV Level Silver Plan","94.77%","0.948188027567066","No","Yes","No","100%",,"$250","$100","$200","$0","$250","$100","$200","$0","$250","$200","$40","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0870004-06_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0870006","my Direct Blue EPO 7000B","33709PA087",,"PAN002","PAS005","PAF026","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0870006-00","my Direct Blue EPO 7000B","Standard Bronze Off Exchange Plan",,"0.649717681712372","No","Yes","No","100%",,"$7,000","$300","$50","$0","$2,100","$1,600","$0","$0","$1,600","$200","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0870006","my Direct Blue EPO 7000B","33709PA087",,"PAN002","PAS005","PAF026","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0870006-01","my Direct Blue EPO 7000B","Standard Bronze On Exchange Plan",,"0.649717681712372","No","Yes","No","100%",,"$7,000","$300","$50","$0","$2,100","$1,600","$0","$0","$1,600","$200","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0870006-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0870006","my Direct Blue EPO 7000B","33709PA087",,"PAN002","PAS005","PAF026","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0870006-02","my Direct Blue EPO 7000B","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0870006-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0870006","my Direct Blue EPO 7000B","33709PA087",,"PAN002","PAS005","PAF026","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0870006-03","my Direct Blue EPO 7000B","Limited Cost Sharing Plan Variation",,"0.649717681712372","No","Yes","No","100%",,"$7,000","$300","$50","$0","$2,100","$1,600","$0","$0","$1,600","$200","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0870006-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0870007","my Direct Blue EPO 6950B","33709PA087",,"PAN002","PAS005","PAF030","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0870007-00","my Direct Blue EPO 6950B","Standard Bronze Off Exchange Plan",,"0.613867445999214","Yes","Yes","No","100%",,"$6,950","$0","$0","$0","$6,500","$200","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0870007","my Direct Blue EPO 6950B","33709PA087",,"PAN002","PAS005","PAF030","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0870007-01","my Direct Blue EPO 6950B","Standard Bronze On Exchange Plan",,"0.613867445999214","Yes","Yes","No","100%",,"$6,950","$0","$0","$0","$6,500","$200","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0870007-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0870007","my Direct Blue EPO 6950B","33709PA087",,"PAN002","PAS005","PAF030","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0870007-02","my Direct Blue EPO 6950B","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0870007-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33709","SERFF","2017-08-14 20:15:51","Individual","No","23-1294723","33709PA0870007","my Direct Blue EPO 6950B","33709PA087",,"PAN002","PAS005","PAF030","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","33709PA0870007-03","my Direct Blue EPO 6950B","Limited Cost Sharing Plan Variation",,"0.613867445999214","Yes","Yes","No","100%",,"$6,950","$0","$0","$0","$6,500","$200","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_33709PA0870007-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","33871","SERFF","2017-08-14 20:15:51","Individual","No","23-2405376","33871PA0040002","Keystone HMO Gold","33871PA004",,"PAN001","PAS001","PAF011","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","33871PA0040002-01","Keystone HMO Gold","Standard Gold On Exchange Plan","80.06%",,"No","Yes","No","100%",,"$0","$1,600","$500","$10","$0","$700","$2,100","$60","$0","$400","$60","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/hmogold2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","33871","SERFF","2017-08-14 20:15:51","Individual","No","23-2405376","33871PA0040002","Keystone HMO Gold","33871PA004",,"PAN001","PAS001","PAF011","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","33871PA0040002-02","Keystone HMO Gold","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/hmogoldZeroCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","33871","SERFF","2017-08-14 20:15:51","Individual","No","23-2405376","33871PA0040002","Keystone HMO Gold","33871PA004",,"PAN001","PAS001","PAF011","Existing","HMO","Gold","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","33871PA0040002-03","Keystone HMO Gold","Limited Cost Sharing Plan Variation","80.06%",,"No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/hmogoldLimitedCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","33871","SERFF","2017-08-14 20:15:51","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF015","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","33871PA0040006-01","Keystone HMO Silver Proactive","Standard Silver On Exchange Plan","71.72%",,"No","Yes","Yes","47%","53%","$0","$1,200","$0","$10","$0","$800","$2,700","$60","$0","$600","$40","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$5,500","$5500 per person","$11000 per group","5.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/hmosilverproactive_indiv_2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","33871","SERFF","2017-08-14 20:15:51","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF015","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","33871PA0040006-02","Keystone HMO Silver Proactive","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","47%","53%","$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/hmosilverproactiveZeroCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","33871","SERFF","2017-08-14 20:15:51","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF015","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","33871PA0040006-03","Keystone HMO Silver Proactive","Limited Cost Sharing Plan Variation","71.72%",,"No","Yes","Yes","47%","53%","$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$5,500","$5500 per person","$11000 per group","5.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/hmosilverproactiveLimitedCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","33871","SERFF","2017-08-14 20:15:51","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF015","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","33871PA0040006-04","Keystone HMO Silver Proactive","73% AV Level Silver Plan","73.93%",,"No","Yes","Yes","47%","53%","$0","$1,200","$0","$10","$0","$800","$2,700","$60","$0","$600","$40","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$5,500","$5500 per person","$11000 per group","5.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/hmosilverproactive73CSR2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","33871","SERFF","2017-08-14 20:15:51","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF015","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","33871PA0040006-05","Keystone HMO Silver Proactive","87% AV Level Silver Plan","86.66%",,"No","Yes","Yes","47%","53%","$0","$300","$0","$10","$0","$300","$1,600","$60","$0","$300","$10","$0","$500","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$1,000","$1000 per person","$2000 per group","5.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/hmosilverproactive87CSR2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","33871","SERFF","2017-08-14 20:15:51","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF015","Existing","HMO","Silver","Not Applicable","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5v","33871PA0040006-06","Keystone HMO Silver Proactive","94% AV Level Silver Plan","93.50%",,"No","Yes","Yes","47%","53%","$0","$200","$0","$10","$0","$200","$500","$60","$0","$100","$10","$0","$500","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$250","$250 per person","$500 per group","5.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%","$0","$0 per person","$0 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/hmosilverproactive94CSR2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","33871","SERFF","2017-08-14 20:15:51","Individual","No","23-2405376","33871PA0040001","Keystone HMO Platinum","33871PA004",,"PAN001","PAS001","PAF010","Existing","HMO","Platinum","Not Applicable","No","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4v","33871PA0040001-02","Keystone HMO Platinum","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/hmoplatinumZeroCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","33871","SERFF","2017-08-14 20:15:51","Individual","No","23-2405376","33871PA0040001","Keystone HMO Platinum","33871PA004",,"PAN001","PAS001","PAF010","Existing","HMO","Platinum","Not Applicable","No","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"2018-01-01",,"No",,"No",,"No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4v","33871PA0040001-03","Keystone HMO Platinum","Limited Cost Sharing Plan Variation",,"0.879631375887079","No","Yes","No","100%",,"$0","$0","$0","$10","$0","$0","$0","$60","$0","$0","$0","$0","$700","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/pdfs/ffm/2018/hmoplatinumLimitedCost2018.pdf","https://www.ibx4you.com/ffm/brochure2018"
"2018","PA","36160","SERFF","2017-09-26 20:16:14","Individual","Yes","20-4023720","36160PA0010001","EMI Health Choice PPO (High)","36160PA001",,"PAN001","PAS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.9651","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","36160PA0010001-01","EMI Health Choice PPO (High)","Standard High On Exchange Plan","86.34%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,"$100","$100 per person","$300 per group",,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/pa-federal-marketplace-dental.aspx"
"2018","PA","36160","SERFF","2017-09-26 20:16:14","Individual","Yes","20-4023720","36160PA0010002","EMI Health Choice PPO (Low)","36160PA001",,"PAN001","PAS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","36160PA0010002-01","EMI Health Choice PPO (Low)","Standard Low On Exchange Plan","70.71%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,"$100","$100 per person","$300 per group",,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/pa-federal-marketplace-dental.aspx"
"2018","PA","36160","SERFF","2017-09-26 20:16:14","Individual","Yes","20-4023720","36160PA0010003","EMI Health Advantage Co-Pay","36160PA001",,"PAN002","PAS002",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","36160PA0010003-01","EMI Health Advantage Co-Pay","Standard Low On Exchange Plan","71.46%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/pa-federal-marketplace-dental.aspx"
"2018","PA","38949","SERFF","2017-08-14 20:15:51","Individual","No","25-1522457","38949PA0080001","my Direct Blue HMO 1000G","38949PA008",,"PAN002","PAS001","PAF026","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9983",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","38949PA0080001-00","my Direct Blue HMO 1000G","Standard Gold Off Exchange Plan",,"0.790119744632957","No","Yes","No","100%",,"$1,000","$100","$2,100","$0","$1,000","$1,300","$200","$0","$800","$700","$0","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","38949","SERFF","2017-08-14 20:15:51","Individual","No","25-1522457","38949PA0080001","my Direct Blue HMO 1000G","38949PA008",,"PAN002","PAS001","PAF026","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9983",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","38949PA0080001-01","my Direct Blue HMO 1000G","Standard Gold On Exchange Plan",,"0.790119744632957","No","Yes","No","100%",,"$1,000","$100","$2,100","$0","$1,000","$1,300","$200","$0","$800","$700","$0","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_38949PA0080001-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","38949","SERFF","2017-08-14 20:15:51","Individual","No","25-1522457","38949PA0080001","my Direct Blue HMO 1000G","38949PA008",,"PAN002","PAS001","PAF026","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9983",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","38949PA0080001-02","my Direct Blue HMO 1000G","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_38949PA0080001-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","38949","SERFF","2017-08-14 20:15:51","Individual","No","25-1522457","38949PA0080001","my Direct Blue HMO 1000G","38949PA008",,"PAN002","PAS001","PAF026","New","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9983",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","38949PA0080001-03","my Direct Blue HMO 1000G","Limited Cost Sharing Plan Variation",,"0.790119744632957","No","Yes","No","100%",,"$1,000","$100","$2,100","$0","$1,000","$1,300","$200","$0","$800","$700","$0","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_38949PA0080001-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","38949","SERFF","2017-08-14 20:15:51","Individual","No","25-1522457","38949PA0080004","my Direct Blue HMO 7150S","38949PA008",,"PAN002","PAS001","PAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","38949PA0080004-00","my Direct Blue HMO 7150S","Standard Silver Off Exchange Plan","66.21%","0.662814921962097","No","Yes","No","100%",,"$7,150","$200","$0","$0","$2,100","$1,600","$0","$0","$800","$900","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","38949","SERFF","2017-08-14 20:15:51","Individual","No","25-1522457","38949PA0080004","my Direct Blue HMO 7150S","38949PA008",,"PAN002","PAS001","PAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","38949PA0080004-01","my Direct Blue HMO 7150S","Standard Silver On Exchange Plan","66.21%","0.662814921962097","No","Yes","No","100%",,"$7,150","$200","$0","$0","$2,100","$1,600","$0","$0","$800","$900","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_38949PA0080004-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","38949","SERFF","2017-08-14 20:15:51","Individual","No","25-1522457","38949PA0080004","my Direct Blue HMO 7150S","38949PA008",,"PAN002","PAS001","PAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","38949PA0080004-02","my Direct Blue HMO 7150S","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_38949PA0080004-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","38949","SERFF","2017-08-14 20:15:51","Individual","No","25-1522457","38949PA0080004","my Direct Blue HMO 7150S","38949PA008",,"PAN002","PAS001","PAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","38949PA0080004-03","my Direct Blue HMO 7150S","Limited Cost Sharing Plan Variation","66.21%","0.662814921962097","No","Yes","No","100%",,"$7,150","$200","$0","$0","$2,100","$1,600","$0","$0","$800","$900","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_38949PA0080004-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","38949","SERFF","2017-08-14 20:15:51","Individual","No","25-1522457","38949PA0080004","my Direct Blue HMO 7150S","38949PA008",,"PAN002","PAS001","PAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","38949PA0080004-04","my Direct Blue HMO 7150S","73% AV Level Silver Plan","73.90%","0.740038954206808","No","Yes","No","100%",,"$4,500","$200","$1,000","$0","$2,100","$1,300","$0","$0","$800","$800","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_38949PA0080004-04_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","38949","SERFF","2017-08-14 20:15:51","Individual","No","25-1522457","38949PA0080004","my Direct Blue HMO 7150S","38949PA008",,"PAN002","PAS001","PAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","38949PA0080004-05","my Direct Blue HMO 7150S","87% AV Level Silver Plan","87.83%","0.878936475234421","No","Yes","No","100%",,"$800","$200","$700","$0","$800","$800","$100","$0","$800","$500","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_38949PA0080004-05_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","38949","SERFF","2017-08-14 20:15:51","Individual","No","25-1522457","38949PA0080004","my Direct Blue HMO 7150S","38949PA008",,"PAN002","PAS001","PAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","38949PA0080004-06","my Direct Blue HMO 7150S","94% AV Level Silver Plan","94.77%","0.947866688730995","No","Yes","No","100%",,"$250","$100","$200","$0","$250","$100","$200","$0","$250","$200","$40","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_38949PA0080004-06_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","38949","SERFF","2017-08-14 20:15:51","Individual","No","25-1522457","38949PA0080006","my Direct Blue HMO 7000B","38949PA008",,"PAN002","PAS001","PAF026","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","38949PA0080006-00","my Direct Blue HMO 7000B","Standard Bronze Off Exchange Plan",,"0.649716962116238","No","Yes","No","100%",,"$7,000","$300","$50","$0","$2,100","$1,600","$0","$0","$1,600","$200","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","38949","SERFF","2017-08-14 20:15:51","Individual","No","25-1522457","38949PA0080006","my Direct Blue HMO 7000B","38949PA008",,"PAN002","PAS001","PAF026","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","38949PA0080006-01","my Direct Blue HMO 7000B","Standard Bronze On Exchange Plan",,"0.649716962116238","No","Yes","No","100%",,"$7,000","$300","$50","$0","$2,100","$1,600","$0","$0","$1,600","$200","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_38949PA0080006-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","38949","SERFF","2017-08-14 20:15:51","Individual","No","25-1522457","38949PA0080006","my Direct Blue HMO 7000B","38949PA008",,"PAN002","PAS001","PAF026","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","38949PA0080006-02","my Direct Blue HMO 7000B","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_38949PA0080006-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","38949","SERFF","2017-08-14 20:15:51","Individual","No","25-1522457","38949PA0080006","my Direct Blue HMO 7000B","38949PA008",,"PAN002","PAS001","PAF026","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","38949PA0080006-03","my Direct Blue HMO 7000B","Limited Cost Sharing Plan Variation",,"0.649716962116238","No","Yes","No","100%",,"$7,000","$300","$50","$0","$2,100","$1,600","$0","$0","$1,600","$200","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_38949PA0080006-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","38949","SERFF","2017-08-14 20:15:51","Individual","No","25-1522457","38949PA0080007","my Direct Blue HMO 6950B","38949PA008",,"PAN002","PAS001","PAF030","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","38949PA0080007-00","my Direct Blue HMO 6950B","Standard Bronze Off Exchange Plan",,"0.613867445999214","Yes","Yes","No","100%",,"$6,950","$0","$0","$0","$6,500","$200","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","38949","SERFF","2017-08-14 20:15:51","Individual","No","25-1522457","38949PA0080007","my Direct Blue HMO 6950B","38949PA008",,"PAN002","PAS001","PAF030","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","38949PA0080007-01","my Direct Blue HMO 6950B","Standard Bronze On Exchange Plan",,"0.613867445999214","Yes","Yes","No","100%",,"$6,950","$0","$0","$0","$6,500","$200","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_38949PA0080007-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","38949","SERFF","2017-08-14 20:15:51","Individual","No","25-1522457","38949PA0080007","my Direct Blue HMO 6950B","38949PA008",,"PAN002","PAS001","PAF030","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","38949PA0080007-02","my Direct Blue HMO 6950B","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://shop.highmark.com/content/sbcs/2018/WPA/Individual/I_38949PA0080007-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA2018_ProductBrochure.pdf"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","No","45-5492167","45127PA0020020","Bronze PPO 7350/0/60","45127PA002","7588667726","PAN003","PAS004","PAF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","http://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCAPLinks/Rxinfo/Formulary-SelectivelyClosed","45127PA0020020-00","Bronze PPO 7350/0/60","Standard Bronze Off Exchange Plan",,"0.61331669662342","Yes","Yes","Yes","40%","60%","$7,350","$0","$0","$60","$6,300","$0","$0","$60","$700","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%","$7,350","$7350 per person","$14700 per group","0.00%","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2018/sbc-bronze-ppo-7350-18.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","No","45-5492167","45127PA0020020","Bronze PPO 7350/0/60","45127PA002","7588667726","PAN003","PAS004","PAF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","http://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCAPLinks/Rxinfo/Formulary-SelectivelyClosed","45127PA0020020-01","Bronze PPO 7350/0/60","Standard Bronze On Exchange Plan",,"0.61331669662342","Yes","Yes","Yes","40%","60%","$7,350","$0","$0","$60","$6,300","$0","$0","$60","$700","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%","$7,350","$7350 per person","$14700 per group","0.00%","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2018/sbc-bronze-ppo-std-18.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","Yes","45-5492167","45127PA0050001","Dental Select Basic","45127PA005",,"PAN001","PAS001",,"Existing","HMO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency","Yes","Emergency","No","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0050001-01","Dental Select Basic","Standard Low On Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2018/dental-select-basic.pdf"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","No","45-5492167","45127PA0020020","Bronze PPO 7350/0/60","45127PA002","7588667726","PAN003","PAS004","PAF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","http://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCAPLinks/Rxinfo/Formulary-SelectivelyClosed","45127PA0020020-02","Bronze PPO 7350/0/60","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2018/sbc-bronze-ppo-zero-18.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","No","45-5492167","45127PA0020020","Bronze PPO 7350/0/60","45127PA002","7588667726","PAN003","PAS004","PAF001","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","http://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCAPLinks/Rxinfo/Formulary-SelectivelyClosed","45127PA0020020-03","Bronze PPO 7350/0/60","Limited Cost Sharing Plan Variation",,"0.61331669662342","Yes","Yes","Yes","40%","60%","$7,350","$0","$0","$60","$6,300","$0","$0","$60","$700","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%","$7,350","$7350 per person","$14700 per group","0.00%","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2018/sbc-bronze-ppo-limited-18.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","No","45-5492167","45127PA0020008","Silver PPO 5000/10/30","45127PA002","7588667726","PAN003","PAS004","PAF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","http://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCAPLinks/Rxinfo/Formulary-SelectivelyClosed","45127PA0020008-00","Silver PPO 5000/10/30","Standard Silver Off Exchange Plan",,"0.666297993427239","Yes","Yes","Yes","40%","60%","$5,000","$20","$700","$60","$5,000","$600","$0","$60","$700","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10.00%","$5,000","$5000 per person","$10000 per group","10.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2018/sbc-silver-ppo-5000-18.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","Yes","45-5492167","45127PA0030001","Dental PPO Plan 1","45127PA003",,"PAN002","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0030001-00","Dental PPO Plan 1","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2018/dental-ppo-1.pdf"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","Yes","45-5492167","45127PA0030001","Dental PPO Plan 1","45127PA003",,"PAN002","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0030001-01","Dental PPO Plan 1","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2018/dental-ppo-1.pdf"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","No","45-5492167","45127PA0020008","Silver PPO 5000/10/30","45127PA002","7588667726","PAN003","PAS004","PAF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","http://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCAPLinks/Rxinfo/Formulary-SelectivelyClosed","45127PA0020008-01","Silver PPO 5000/10/30","Standard Silver On Exchange Plan",,"0.666297993427239","Yes","Yes","Yes","40%","60%","$5,000","$20","$700","$60","$5,000","$600","$0","$60","$700","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10.00%","$5,000","$5000 per person","$10000 per group","10.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2018/sbc-silver-ppo-std-18.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","No","45-5492167","45127PA0020008","Silver PPO 5000/10/30","45127PA002","7588667726","PAN003","PAS004","PAF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","http://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCAPLinks/Rxinfo/Formulary-SelectivelyClosed","45127PA0020008-02","Silver PPO 5000/10/30","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2018/sbc-silver-ppo-zero-18.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","No","45-5492167","45127PA0020008","Silver PPO 5000/10/30","45127PA002","7588667726","PAN003","PAS004","PAF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","http://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCAPLinks/Rxinfo/Formulary-SelectivelyClosed","45127PA0020008-03","Silver PPO 5000/10/30","Limited Cost Sharing Plan Variation",,"0.666297993427239","Yes","Yes","Yes","40%","60%","$5,000","$20","$700","$60","$5,000","$600","$0","$60","$700","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10.00%","$5,000","$5000 per person","$10000 per group","10.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2018/sbc-silver-ppo-limited-18.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","No","45-5492167","45127PA0020008","Silver PPO 5000/10/30","45127PA002","7588667726","PAN003","PAS004","PAF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","http://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCAPLinks/Rxinfo/Formulary-SelectivelyClosed","45127PA0020008-04","Silver PPO 5000/10/30","73% AV Level Silver Plan",,"0.723129149844657","Yes","Yes","Yes","40%","60%","$4,500","$10","$600","$60","$4,500","$400","$0","$60","$700","$0","$0","$0","$800","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","8.00%","$4,500","$4500 per person","$9000 per group","8.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2018/sbc-silver-ppo-csr73-18.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","No","45-5492167","45127PA0020008","Silver PPO 5000/10/30","45127PA002","7588667726","PAN003","PAS004","PAF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","http://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCAPLinks/Rxinfo/Formulary-SelectivelyClosed","45127PA0020008-05","Silver PPO 5000/10/30","87% AV Level Silver Plan",,"0.862976544589809","Yes","Yes","Yes","40%","60%","$1,200","$10","$600","$60","$1,200","$600","$10","$60","$700","$0","$0","$0","$500","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","5.00%","$1,200","$1200 per person","$2400 per group","5.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2018/sbc-silver-ppo-csr87-18.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","No","45-5492167","45127PA0020008","Silver PPO 5000/10/30","45127PA002","7588667726","PAN003","PAS004","PAF002","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","http://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCAPLinks/Rxinfo/Formulary-SelectivelyClosed","45127PA0020008-06","Silver PPO 5000/10/30","94% AV Level Silver Plan",,"0.945001616605636","Yes","Yes","Yes","40%","60%","$250","$0","$0","$60","$250","$500","$0","$60","$250","$30","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","$1,250","$1250 per person","$2500 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0.00%","$250","$250 per person","$500 per group","0.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2018/sbc-silver-ppo-csr94-18.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","No","45-5492167","45127PA0020013","Gold PPO 2000/10/20","45127PA002","7588667726","PAN003","PAS004","PAF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","http://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCAPLinks/Rxinfo/Formulary-SelectivelyClosed","45127PA0020013-00","Gold PPO 2000/10/20","Standard Gold Off Exchange Plan",,"0.762832800752554","Yes","Yes","Yes","40%","60%","$2,000","$10","$1,000","$60","$2,000","$900","$20","$60","$700","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","10.00%","$2,000","$2000 per person","$4000 per group","10.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2018/sbc-gold-ppo-2000-18.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","Yes","45-5492167","45127PA0030002","Dental PPO Plan 2","45127PA003",,"PAN002","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0030002-00","Dental PPO Plan 2","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2018/dental-ppo-2.pdf"
"2018","PA","67430","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","25-1844144","67430PA0040006","UPMC Dental Advantage Premium","67430PA004",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"Yes","Allows Adult and Child-Only",,,,,"0.15","Guaranteed Rate","2018-01-01",,"No",,"Yes","Through contracted Wrap Network","Yes",,"","67430PA0040006-00","UPMC Dental Advantage Premium","Standard Low Off Exchange Plan","68.68%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$75","$75 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","PA","67430","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","25-1844144","67430PA0040006","UPMC Dental Advantage Premium","67430PA004",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"Yes","Allows Adult and Child-Only",,,,,"0.15","Guaranteed Rate","2018-01-01",,"No",,"Yes","Through contracted Wrap Network","Yes",,"","67430PA0040006-01","UPMC Dental Advantage Premium","Standard Low On Exchange Plan","68.68%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$75","$75 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","PA","68711","SERFF","2017-08-11 20:15:53","Individual","Yes","59-0397210","68711PA0030005","DentaQuest EPO Family Preventative","68711PA003",,"PAN002","PAS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0030005-01","DentaQuest EPO Family Preventative","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","No","45-5492167","45127PA0020013","Gold PPO 2000/10/20","45127PA002","7588667726","PAN003","PAS004","PAF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","http://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCAPLinks/Rxinfo/Formulary-SelectivelyClosed","45127PA0020013-01","Gold PPO 2000/10/20","Standard Gold On Exchange Plan",,"0.762832800752554","Yes","Yes","Yes","40%","60%","$2,000","$10","$1,000","$60","$2,000","$900","$20","$60","$700","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","10.00%","$2,000","$2000 per person","$4000 per group","10.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2018/sbc-gold-ppo-std-18.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","No","45-5492167","45127PA0020013","Gold PPO 2000/10/20","45127PA002","7588667726","PAN003","PAS004","PAF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","http://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCAPLinks/Rxinfo/Formulary-SelectivelyClosed","45127PA0020013-02","Gold PPO 2000/10/20","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2018/sbc-gold-ppo-zero-18.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","No","45-5492167","45127PA0020013","Gold PPO 2000/10/20","45127PA002","7588667726","PAN003","PAS004","PAF003","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Out of Country services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","Out of Service Area services are covered in accordance with your certificate of coverage. Certain services may not be covered.","Yes","https://w2.capbluecross.com/sp/ACS.saml2","http://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCAPLinks/Rxinfo/Formulary-SelectivelyClosed","45127PA0020013-03","Gold PPO 2000/10/20","Limited Cost Sharing Plan Variation",,"0.762832800752554","Yes","Yes","Yes","40%","60%","$2,000","$10","$1,000","$60","$2,000","$900","$20","$60","$700","$0","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","10.00%","$2,000","$2000 per person","$4000 per group","10.00%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2018/sbc-gold-ppo-limited-18.pdf","https://www.capbluecross.com/wps/wcm/connect/CBC-Public/pdf/sales/plan-brochure"
"2018","PA","45127","SERFF","2017-09-25 20:16:04","Individual","Yes","45-5492167","45127PA0030003","Dental PPO Plan 3","45127PA003",,"PAN002","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0030003-00","Dental PPO Plan 3","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2018/dental-ppo-3.pdf"
"2018","PA","46518","SERFF","2017-08-14 20:15:51","Individual","Yes","75-1233841","46518PA0010001","Dentegra Dental PPO Pediatric Basic Plan","46518PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","46518PA0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/pa/46518pa0010001-18"
"2018","PA","46518","SERFF","2017-08-14 20:15:51","Individual","Yes","75-1233841","46518PA0010008","Dentegra Dental PPO Family Preferred Plan","46518PA001",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","46518PA0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$40","$40 per person","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/pa/46518pa0010008-18"
"2018","PA","46518","SERFF","2017-08-14 20:15:51","Individual","Yes","75-1233841","46518PA0010007","Dentegra Dental PPO Family Basic Plan","46518PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","46518PA0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","$55 per person","per group not applicable",,,,,,"$55","$55 per person","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/pa/46518pa0010007-18"
"2018","PA","55995","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","31-1185262","55995PA0020003","DentaSpan Family High Option","55995PA002","7083617077","PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0020003-00","DentaSpan Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdspa.dentalcareplus.com","http://hixpbdspa.dentalcareplus.com"
"2018","PA","55995","SERFF","2017-08-14 20:15:51","Individual","Yes","31-1185262","55995PA0010001","DentaTrust PPO - Pediatric High Option","55995PA001","7083617077","PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0010001-00","DentaTrust PPO - Pediatric High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtpa.dentalcareplus.com","http://hixpbdtpa.dentalcareplus.com"
"2018","PA","55995","SERFF","2017-08-14 20:15:51","Individual","Yes","31-1185262","55995PA0010001","DentaTrust PPO - Pediatric High Option","55995PA001","7083617077","PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0010001-01","DentaTrust PPO - Pediatric High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtpa.dentalcareplus.com","http://hixpbdtpa.dentalcareplus.com"
"2018","PA","55995","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","31-1185262","55995PA0020003","DentaSpan Family High Option","55995PA002","7083617077","PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0020003-01","DentaSpan Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdspa.dentalcareplus.com","http://hixpbdspa.dentalcareplus.com"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020072","UPMC Small Business Advantage Platinum HMO $500 $20/$40 - Standard Network","62560PA002",,"PAN001","PAS001","PAF039","New","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020072-01","UPMC Small Business Advantage Platinum HMO $500 $20/$40 - Standard Network","Standard Platinum On Exchange Plan","91.66%","0.915745137558156","No","Yes","No","100%",,"$500.00","$460.00","$0.00","$60.00","$0.00","$1,000.00","$0.00","$60.00","$500.00","$480.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM25_HMO_RX1I17_EB02_2018_62560PA002007201.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007201"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020055","UPMC Small Business Advantage Silver HMO $3,000 $30/$50 - Standard Network","62560PA002",,"PAN001","PAS001","PAF031","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020055-00","UPMC Small Business Advantage Silver HMO $3,000 $30/$50 - Standard Network","Standard Silver Off Exchange Plan","71.43%",,"No","Yes","No","100%",,"$3,000.00","$2,000.00","$0.00","$60.00","$0.00","$3,330.00","$0.00","$60.00","$800.00","$1,650.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM65_HMO_RX1F12_EB02_2018_62560PA002005500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002005500"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020055","UPMC Small Business Advantage Silver HMO $3,000 $30/$50 - Standard Network","62560PA002",,"PAN001","PAS001","PAF031","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020055-01","UPMC Small Business Advantage Silver HMO $3,000 $30/$50 - Standard Network","Standard Silver On Exchange Plan","71.43%",,"No","Yes","No","100%",,"$3,000.00","$2,000.00","$0.00","$60.00","$0.00","$3,330.00","$0.00","$60.00","$800.00","$1,650.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM29_HMO_RX1F12_EB02_2018_62560PA002005501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002005501"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020078","UPMC Small Business Advantage Silver HMO $3,000 $30/$50 - Standard Network","62560PA002",,"PAN001","PAS001","PAF039","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020078-00","UPMC Small Business Advantage Silver HMO $3,000 $30/$50 - Standard Network","Standard Silver Off Exchange Plan","71.37%",,"No","Yes","No","100%",,"$3,000.00","$2,020.00","$0.00","$60.00","$0.00","$3,490.00","$0.00","$60.00","$800.00","$1,650.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM65_HMO_RX1I17_EB02_2018_62560PA002007800.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007800"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020078","UPMC Small Business Advantage Silver HMO $3,000 $30/$50 - Standard Network","62560PA002",,"PAN001","PAS001","PAF039","New","HMO","Silver","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020078-01","UPMC Small Business Advantage Silver HMO $3,000 $30/$50 - Standard Network","Standard Silver On Exchange Plan","71.37%",,"No","Yes","No","100%",,"$3,000.00","$2,020.00","$0.00","$60.00","$0.00","$3,490.00","$0.00","$60.00","$800.00","$1,650.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM29_HMO_RX1I17_EB02_2018_62560PA002007801.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007801"
"2018","PA","55995","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","31-1185262","55995PA0020004","DentaSpan Family Low Option","55995PA002","7083617077","PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0020004-00","DentaSpan Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdspa.dentalcareplus.com","http://hixpbdspa.dentalcareplus.com"
"2018","PA","55995","SERFF","2017-08-14 20:15:51","Individual","Yes","31-1185262","55995PA0010002","DentaTrust PPO - Pediatric Low Option","55995PA001","7083617077","PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0010002-00","DentaTrust PPO - Pediatric Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtpa.dentalcareplus.com","http://hixpbdtpa.dentalcareplus.com"
"2018","PA","55995","SERFF","2017-08-14 20:15:51","Individual","Yes","31-1185262","55995PA0010002","DentaTrust PPO - Pediatric Low Option","55995PA001","7083617077","PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0010002-01","DentaTrust PPO - Pediatric Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtpa.dentalcareplus.com","http://hixpbdtpa.dentalcareplus.com"
"2018","PA","55995","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","31-1185262","55995PA0020004","DentaSpan Family Low Option","55995PA002","7083617077","PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0020004-01","DentaSpan Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdspa.dentalcareplus.com","http://hixpbdspa.dentalcareplus.com"
"2018","PA","55995","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","31-1185262","55995PA0030003","DentaSpan Dental-Family High Option-Off Exchange","55995PA003","7083617077","PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0030003-00","DentaSpan Dental-Family High Option-Off Exchange","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdspa.dentalcareplus.com","http://hiopbdspa.dentalcareplus.com"
"2018","PA","55995","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","31-1185262","55995PA0030004","DentaSpan Dental-Family Low Option-Off Exchange","55995PA003","7083617077","PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0030004-00","DentaSpan Dental-Family Low Option-Off Exchange","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdspa.dentalcareplus.com","http://hiopbdspa.dentalcareplus.com"
"2018","PA","55995","SERFF","2017-08-14 20:15:51","Individual","Yes","31-1185262","55995PA0010003","DentaTrust-PPO Family High Option","55995PA001","7083617077","PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0010003-00","DentaTrust-PPO Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtpa.dentalcareplus.com","http://hixpbdtpa.dentalcareplus.com"
"2018","PA","55995","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","31-1185262","55995PA0030001","DentaSpan Pediatric High Option- Off Exchange","55995PA003","7083617077","PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No",".https://hixenroll.insxcloud.com/payment","","55995PA0030001-00","DentaSpan Pediatric High Option- Off Exchange","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdspa.dentalcareplus.com","http://hiopbdspa.dentalcareplus.com"
"2018","PA","55995","SERFF","2017-08-14 20:15:51","Individual","Yes","31-1185262","55995PA0010003","DentaTrust-PPO Family High Option","55995PA001","7083617077","PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0010003-01","DentaTrust-PPO Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtpa.dentalcareplus.com","http://hixpbdtpa.dentalcareplus.com"
"2018","PA","55995","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","31-1185262","55995PA0030002","DentaSpan Pediatric Low Option- Off Exchange","55995PA003","7083617077","PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No",".https://hixenroll.insxcloud.com/payment","","55995PA0030002-00","DentaSpan Pediatric Low Option- Off Exchange","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdspa.dentalcareplus.com","http://hiopbdspa.dentalcareplus.com"
"2018","PA","55995","SERFF","2017-08-14 20:15:51","Individual","Yes","31-1185262","55995PA0010004","DentaTrust-PPO Family Low Option","55995PA001","7083617077","PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0010004-00","DentaTrust-PPO Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtpa.dentalcareplus.com","http://hixpbdtpa.dentalcareplus.com"
"2018","PA","55995","SERFF","2017-08-14 20:15:51","Individual","Yes","31-1185262","55995PA0010004","DentaTrust-PPO Family Low Option","55995PA001","7083617077","PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","55995PA0010004-01","DentaTrust-PPO Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtpa.dentalcareplus.com","http://hixpbdtpa.dentalcareplus.com"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020065","UPMC Small Business Advantage Platinum HMO $10/$25 - Standard Network","62560PA002",,"PAN001","PAS001","PAF031","New","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020065-00","UPMC Small Business Advantage Platinum HMO $10/$25 - Standard Network","Standard Platinum Off Exchange Plan","91.90%","0.919026150204349","No","Yes","No","100%",,"$0.00","$510.00","$0.00","$60.00","$0.00","$1,300.00","$0.00","$60.00","$0.00","$730.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM66_HMO_RX1F12_EB02_2018_62560PA002006500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002006500"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020065","UPMC Small Business Advantage Platinum HMO $10/$25 - Standard Network","62560PA002",,"PAN001","PAS001","PAF031","New","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020065-01","UPMC Small Business Advantage Platinum HMO $10/$25 - Standard Network","Standard Platinum On Exchange Plan","91.91%","0.919026150204349","No","Yes","No","100%",,"$0.00","$510.00","$0.00","$60.00","$0.00","$1,300.00","$0.00","$60.00","$0.00","$730.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM30_HMO_RX1F12_EB02_2018_62560PA002006501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002006501"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020067","UPMC Small Business Advantage Platinum HMO $500 $20/$40 - Standard Network","62560PA002",,"PAN001","PAS001","PAF031","New","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020067-00","UPMC Small Business Advantage Platinum HMO $500 $20/$40 - Standard Network","Standard Platinum Off Exchange Plan","91.72%","0.916336034120679","No","Yes","No","100%",,"$500.00","$440.00","$0.00","$60.00","$0.00","$1,000.00","$0.00","$60.00","$500.00","$480.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM53_HMO_RX1F12_EB02_2018_62560PA002006700.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002006700"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020067","UPMC Small Business Advantage Platinum HMO $500 $20/$40 - Standard Network","62560PA002",,"PAN001","PAS001","PAF031","New","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020067-01","UPMC Small Business Advantage Platinum HMO $500 $20/$40 - Standard Network","Standard Platinum On Exchange Plan","91.72%","0.916336034120679","No","Yes","No","100%",,"$500.00","$440.00","$0.00","$60.00","$0.00","$1,000.00","$0.00","$60.00","$500.00","$480.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM25_HMO_RX1F12_EB02_2018_62560PA002006701.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002006701"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020071","UPMC Small Business Advantage Platinum HMO $10/$25 - Standard Network","62560PA002",,"PAN001","PAS001","PAF039","New","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020071-00","UPMC Small Business Advantage Platinum HMO $10/$25 - Standard Network","Standard Platinum Off Exchange Plan","91.51%","0.915052240195496","No","Yes","No","100%",,"$0.00","530","$0.00","$60.00","$0.00","$1,300.00","$0.00","$60.00","$0.00","$730.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM66_HMO_RX1I17_EB02_2018_62560PA002007100.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007100"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020071","UPMC Small Business Advantage Platinum HMO $10/$25 - Standard Network","62560PA002",,"PAN001","PAS001","PAF039","New","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020071-01","UPMC Small Business Advantage Platinum HMO $10/$25 - Standard Network","Standard Platinum On Exchange Plan","91.51%","0.915052240195496","No","Yes","No","100%",,"$0.00","530","$0.00","$60.00","$0.00","$1,300.00","$0.00","$60.00","$0.00","$730.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM30_HMO_RX1I17_EB02_2018_62560PA002007101.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007101"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020072","UPMC Small Business Advantage Platinum HMO $500 $20/$40 - Standard Network","62560PA002",,"PAN001","PAS001","PAF039","New","HMO","Platinum","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020072-00","UPMC Small Business Advantage Platinum HMO $500 $20/$40 - Standard Network","Standard Platinum Off Exchange Plan","91.66%","0.915745137558156","No","Yes","No","100%",,"$500.00","$460.00","$0.00","$60.00","$0.00","$1,000.00","$0.00","$60.00","$500.00","$480.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM53_HMO_RX1I17_EB02_2018_62560PA002007200.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007200"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020066","UPMC Small Business Advantage Gold HMO $1,000 $25/$50 - Standard Network","62560PA002",,"PAN001","PAS001","PAF031","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020066-00","UPMC Small Business Advantage Gold HMO $1,000 $25/$50 - Standard Network","Standard Gold Off Exchange Plan","81.88%","0.817739940120507","No","Yes","No","100%",,"$1,000.00","$1,900.00","$0.00","$60.00","$0.00","$3,210.00","$0.00","$60.00","$980.00","$900.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM67_HMO_RX1F12_EB02_2018_62560PA002006600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002006600"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020066","UPMC Small Business Advantage Gold HMO $1,000 $25/$50 - Standard Network","62560PA002",,"PAN001","PAS001","PAF031","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020066-01","UPMC Small Business Advantage Gold HMO $1,000 $25/$50 - Standard Network","Standard Gold On Exchange Plan","81.88%","0.817739940120507","No","Yes","No","100%",,"$1,000.00","$1,900.00","$0.00","$60.00","$0.00","$3,210.00","$0.00","$60.00","$980.00","$900.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM31_HMO_RX1F12_EB02_2018_62560PA002006601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002006601"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020068","UPMC Small Business Advantage Gold HMO $2,000 $20/$40 - Standard Network","62560PA002",,"PAN001","PAS001","PAF031","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020068-00","UPMC Small Business Advantage Gold HMO $2,000 $20/$40 - Standard Network","Standard Gold Off Exchange Plan","81.96%","0.819556953183541","No","Yes","No","100%",,"$2,000.00","$800.00","$0.00","$60.00","$0.00","$3,070.00","$0.00","$60.00","$810.00","$620.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM70_HMO_RX1F12_EB02_2018_62560PA002006800.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002006800"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020068","UPMC Small Business Advantage Gold HMO $2,000 $20/$40 - Standard Network","62560PA002",,"PAN001","PAS001","PAF031","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020068-01","UPMC Small Business Advantage Gold HMO $2,000 $20/$40 - Standard Network","Standard Gold On Exchange Plan","81.96%","0.819556953183541","No","Yes","No","100%",,"$2,000.00","$800.00","$0.00","$60.00","$0.00","$3,070.00","$0.00","$60.00","$810.00","$620.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM34_HMO_RX1F12_EB02_2018_62560PA002006801.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002006801"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0540001","my Direct Blue Lehigh Valley EPO 1000G","70194PA054",,"PAN003","PAS004","PAF026","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0540001-01","my Direct Blue Lehigh Valley EPO 1000G","Standard Gold On Exchange Plan",,"0.813565510107516","No","Yes","No","100%",,"$1,000","$100","$2,100","$0","$1,000","$1,300","$200","$0","$800","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0540001-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0540001","my Direct Blue Lehigh Valley EPO 1000G","70194PA054",,"PAN003","PAS004","PAF026","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0540001-02","my Direct Blue Lehigh Valley EPO 1000G","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0540001-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020069","UPMC Small Business Advantage Gold HMO $1,500 $25/$50 - Standard Network","62560PA002",,"PAN001","PAS001","PAF031","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020069-00","UPMC Small Business Advantage Gold HMO $1,500 $25/$50 - Standard Network","Standard Gold Off Exchange Plan","81.82%","0.818194351317122","No","Yes","No","100%",,"$1,500.00","$990.00","$0.00","$60.00","$0.00","$3,290.00","$0.00","$60.00","$810.00","$930.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM68_HMO_RX1F12_EB02_2018_62560PA002006900.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002006900"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020069","UPMC Small Business Advantage Gold HMO $1,500 $25/$50 - Standard Network","62560PA002",,"PAN001","PAS001","PAF031","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020069-01","UPMC Small Business Advantage Gold HMO $1,500 $25/$50 - Standard Network","Standard Gold On Exchange Plan","81.82%","0.818194351317122","No","Yes","No","100%",,"$1,500.00","$990.00","$0.00","$60.00","$0.00","$3,290.00","$0.00","$60.00","$810.00","$930.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM32_HMO_RX1F12_EB02_2018_62560PA002006901.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002006901"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020073","UPMC Small Business Advantage Gold HMO $1,000 $25/$50 - Standard Network","62560PA002",,"PAN001","PAS001","PAF039","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020073-00","UPMC Small Business Advantage Gold HMO $1,000 $25/$50 - Standard Network","Standard Gold Off Exchange Plan","81.66%","0.815533738920068","No","Yes","No","100%",,"$1,000.00","$1,920.00","$0.00","$60.00","$0.00","$3,370.00","$0.00","$60.00","$980.00","$900.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM67_HMO_RX1I17_EB02_2018_62560PA002007300.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007300"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020073","UPMC Small Business Advantage Gold HMO $1,000 $25/$50 - Standard Network","62560PA002",,"PAN001","PAS001","PAF039","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020073-01","UPMC Small Business Advantage Gold HMO $1,000 $25/$50 - Standard Network","Standard Gold On Exchange Plan","81.66%","0.815533738920068","No","Yes","No","100%",,"$1,000.00","$1,920.00","$0.00","$60.00","$0.00","$3,370.00","$0.00","$60.00","$980.00","$900.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM31_HMO_RX1I17_EB02_2018_62560PA002007301.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007301"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020074","UPMC Small Business Advantage Gold HMO $1,500 $25/$50 - Standard Network","62560PA002",,"PAN001","PAS001","PAF039","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020074-00","UPMC Small Business Advantage Gold HMO $1,500 $25/$50 - Standard Network","Standard Gold Off Exchange Plan","81.66%","0.816580930541325","No","Yes","No","100%",,"$1,500.00","$1,010.00","$0.00","$60.00","$0.00","$3,450.00","$0.00","$60.00","$810.00","$930.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM68_HMO_RX1I17_EB02_2018_62560PA002007400.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007400"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020074","UPMC Small Business Advantage Gold HMO $1,500 $25/$50 - Standard Network","62560PA002",,"PAN001","PAS001","PAF039","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020074-01","UPMC Small Business Advantage Gold HMO $1,500 $25/$50 - Standard Network","Standard Gold On Exchange Plan","81.66%","0.816580930541325","No","Yes","No","100%",,"$1,500.00","$1,010.00","$0.00","$60.00","$0.00","$3,450.00","$0.00","$60.00","$810.00","$930.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM32_HMO_RX1I17_EB02_2018_62560PA002007401.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007401"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020075","UPMC Small Business Advantage Gold HMO $1,750 $30/$50 - Standard Network","62560PA002",,"PAN001","PAS001","PAF039","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020075-00","UPMC Small Business Advantage Gold HMO $1,750 $30/$50 - Standard Network","Standard Gold Off Exchange Plan","81.53%","0.81584626691273","No","Yes","No","100%",,"$1,750.00","$1,020.00","$0.00","$60.00","$0.00","$3,490.00","$0.00","$60.00","$810.00","$1,000.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM69_HMO_RX1I17_EB02_2018_62560PA002007500.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007500"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020075","UPMC Small Business Advantage Gold HMO $1,750 $30/$50 - Standard Network","62560PA002",,"PAN001","PAS001","PAF039","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020075-01","UPMC Small Business Advantage Gold HMO $1,750 $30/$50 - Standard Network","Standard Gold On Exchange Plan","81.53%","0.815334843524248","No","Yes","No","100%",,"$1,750.00","$1,020.00","$0.00","$60.00","$0.00","$3,490.00","$0.00","$60.00","$810.00","$1,000.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM33_HMO_RX1I17_EB02_2018_62560PA002007501.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007501"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020076","UPMC Small Business Advantage Gold HMO $2,000 $20/$40 - Standard Network","62560PA002",,"PAN001","PAS001","PAF039","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020076-00","UPMC Small Business Advantage Gold HMO $2,000 $20/$40 - Standard Network","Standard Gold Off Exchange Plan","81.82%","0.818238726687189","No","Yes","No","100%",,"$2,000.00","$820.00","$0.00","$60.00","$0.00","$3,230.00","$0.00","$60.00","$810.00","$620.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM70_HMO_RX1I17_EB02_2018_62560PA002007600.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007600"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020076","UPMC Small Business Advantage Gold HMO $2,000 $20/$40 - Standard Network","62560PA002",,"PAN001","PAS001","PAF039","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020076-01","UPMC Small Business Advantage Gold HMO $2,000 $20/$40 - Standard Network","Standard Gold On Exchange Plan","81.82%","0.818238726687189","No","Yes","No","100%",,"$2,000.00","$820.00","$0.00","$60.00","$0.00","$3,230.00","$0.00","$60.00","$810.00","$620.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM34_HMO_RX1I17_EB02_2018_62560PA002007601.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007601"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020077","UPMC Small Business Advantage Gold HMO $2,500 $20/$40 - Standard Network","62560PA002",,"PAN001","PAS001","PAF039","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020077-00","UPMC Small Business Advantage Gold HMO $2,500 $20/$40 - Standard Network","Standard Gold Off Exchange Plan","81.59%","0.815902152250536","No","Yes","No","100%",,"$2,500.00","$820.00","$0.00","$60.00","$0.00","$3,230.00","$0.00","$60.00","$810.00","$620.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM71_HMO_RX1I17_EB02_2018_62560PA002007700.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007700"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020077","UPMC Small Business Advantage Gold HMO $2,500 $20/$40 - Standard Network","62560PA002",,"PAN001","PAS001","PAF039","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020077-01","UPMC Small Business Advantage Gold HMO $2,500 $20/$40 - Standard Network","Standard Gold On Exchange Plan","81.59%","0.815902152250536","No","Yes","No","100%",,"$2,500.00","$820.00","$0.00","$60.00","$0.00","$3,230.00","$0.00","$60.00","$810.00","$620.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM35_HMO_RX1I17_EB02_2018_62560PA002007701.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007701"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020080","UPMC Small Business Advantage Gold HMO $1,750 $30/$50 - Standard Network","62560PA002",,"PAN001","PAS001","PAF031","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020080-00","UPMC Small Business Advantage Gold HMO $1,750 $30/$50 - Standard Network","Standard Gold Off Exchange Plan","81.67%","0.817470418807045","No","Yes","No","100%",,"$1,500.00","$990.00","$0.00","$60.00","$0.00","$3,290.00","$0.00","$60.00","$810.00","$930.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM69_HMO_RX1F12_EB02_2018_62560PA002008000.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002008000"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020080","UPMC Small Business Advantage Gold HMO $1,750 $30/$50 - Standard Network","62560PA002",,"PAN001","PAS001","PAF031","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020080-01","UPMC Small Business Advantage Gold HMO $1,750 $30/$50 - Standard Network","Standard Gold On Exchange Plan","81.67%","0.816702588644044","No","Yes","No","100%",,"$1,750.00","$990.00","$0.00","$60.00","$0.00","$3,290.00","$0.00","$60.00","$810.00","$930.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM33_HMO_RX1F12_EB02_2018_62560PA002008001.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002008001"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020081","UPMC Small Business Advantage Gold HMO $2,500 $20/$40 - Standard Network","62560PA002",,"PAN001","PAS001","PAF031","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020081-00","UPMC Small Business Advantage Gold HMO $2,500 $20/$40 - Standard Network","Standard Gold Off Exchange Plan","81.68%","0.816761686137813","No","Yes","No","100%",,"$2,500.00","$800.00","$0.00","$60.00","$0.00","$3,070.00","$0.00","$60.00","$810.00","$620.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM71_HMO_RX1F12_EB02_2018_62560PA002008100.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002008100"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020081","UPMC Small Business Advantage Gold HMO $2,500 $20/$40 - Standard Network","62560PA002",,"PAN001","PAS001","PAF031","New","HMO","Gold","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020081-01","UPMC Small Business Advantage Gold HMO $2,500 $20/$40 - Standard Network","Standard Gold On Exchange Plan","81.68%","0.816761686137813","No","Yes","No","100%",,"$2,500.00","$800.00","$0.00","$60.00","$0.00","$3,070.00","$0.00","$60.00","$810.00","$620.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM35_HMO_RX1F12_EB02_2018_62560PA002008101.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002008101"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020070","UPMC Small Business Advantage Bronze HMO $6,850 - Standard Network","62560PA002",,"PAN001","PAS001","PAF033","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020070-00","UPMC Small Business Advantage Bronze HMO $6,850 - Standard Network","Standard Bronze Off Exchange Plan","61.25%","0.591514537961228","Yes","Yes","No","100%",,"$6,850.00","$40.00","$0.00","$60.00","$5,140.00","$2,010.00","$0.00","$60.00","$1,910.00","$0.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM56_HMO_RX1F47_EB02_2018_62560PA002007000.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007000"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020070","UPMC Small Business Advantage Bronze HMO $6,850 - Standard Network","62560PA002",,"PAN001","PAS001","PAF033","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020070-01","UPMC Small Business Advantage Bronze HMO $6,850 - Standard Network","Standard Bronze On Exchange Plan","61.25%","0.591514537961228","Yes","Yes","No","100%",,"$6,850.00","$40.00","$0.00","$60.00","$5,140.00","$2,010.00","$0.00","$60.00","$1,910.00","$0.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM28_HMO_RX1F47_EB02_2018_62560PA002007001.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007001"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020079","UPMC Small Business Advantage Bronze HMO $6,850 - Standard Network","62560PA002",,"PAN001","PAS001","PAF041","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020079-00","UPMC Small Business Advantage Bronze HMO $6,850 - Standard Network","Standard Bronze Off Exchange Plan","61.25%","0.591471679656028","Yes","Yes","No","100%",,"$6,850.00","$60.00","$0.00","$60.00","$4,990.00","$2,160.00","$0.00","$60.00","$1,910.00","$0.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=NHM56_HMO_RX1I19_EB02_2018_62560PA002007900.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007900"
"2018","PA","62560","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","No","46-2824537","62560PA0020079","UPMC Small Business Advantage Bronze HMO $6,850 - Standard Network","62560PA002",,"PAN001","PAS001","PAF041","New","HMO","Bronze","Not Applicable","Yes","Both","No","Yes","A PCP is required for specialist visits and services.  Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","https://www.upmchealthplan.com/marketplace/2018_RxList.aspx","62560PA0020079-01","UPMC Small Business Advantage Bronze HMO $6,850 - Standard Network","Standard Bronze On Exchange Plan","61.25%","0.591471679656028","Yes","Yes","No","100%",,"$6,850.00","$60.00","$0.00","$60.00","$4,990.00","$2,160.00","$0.00","$60.00","$1,910.00","$0.00","$20.00","$0.00",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.upmchealthplan.com/pdf/BenefitPlanInfo/details.aspx?plan=XHM28_HMO_RX1I19_EB02_2018_62560PA002007901.pdf","https://www.upmchealthplan.com/marketplace/details.aspx?plan=2018_SG_62560PA002007901"
"2018","PA","67430","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","25-1844144","67430PA0040004","UPMC Dental Advantage Basic","67430PA004",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"Yes","Allows Adult and Child-Only",,,,,"0.325","Guaranteed Rate","2018-01-01",,"No",,"Yes","Coverage is through a wrap network","Yes",,"","67430PA0040004-00","UPMC Dental Advantage Basic","Standard Low Off Exchange Plan","68.68%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$75","$75 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","PA","67430","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","25-1844144","67430PA0040004","UPMC Dental Advantage Basic","67430PA004",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"Yes","Allows Adult and Child-Only",,,,,"0.325","Guaranteed Rate","2018-01-01",,"No",,"Yes","Coverage is through a wrap network","Yes",,"","67430PA0040004-01","UPMC Dental Advantage Basic","Standard Low On Exchange Plan","68.68%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$75","$75 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","PA","67430","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","25-1844144","67430PA0040005","UPMC Dental Advantage Standard","67430PA004",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"Yes","Allows Adult and Child-Only",,,,,"0.174","Guaranteed Rate","2018-01-01",,"No",,"Yes","Through contracted Wrap Network","Yes",,"","67430PA0040005-00","UPMC Dental Advantage Standard","Standard Low Off Exchange Plan","68.68%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$75","$75 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","PA","67430","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","25-1844144","67430PA0040005","UPMC Dental Advantage Standard","67430PA004",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"Yes","Allows Adult and Child-Only",,,,,"0.174","Guaranteed Rate","2018-01-01",,"No",,"Yes","Through contracted Wrap Network","Yes",,"","67430PA0040005-01","UPMC Dental Advantage Standard","Standard Low On Exchange Plan","68.68%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$75","$75 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","PA","67499","SERFF","2017-08-14 20:15:51","Individual","Yes","39-1263473","67499PA0010002","Humana Dental Smart Choice","67499PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.988","Guaranteed Rate","2018-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","67499PA0010002-01","Humana Dental Smart Choice","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110406"
"2018","PA","68711","SERFF","2017-08-11 20:15:53","Individual","Yes","59-0397210","68711PA0030001","DentaQuest EPO Pediatric High","68711PA003",,"PAN002","PAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0030001-00","DentaQuest EPO Pediatric High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2018","PA","68711","SERFF","2017-08-11 20:15:53","Individual","Yes","59-0397210","68711PA0030001","DentaQuest EPO Pediatric High","68711PA003",,"PAN002","PAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0030001-01","DentaQuest EPO Pediatric High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2018","PA","68711","SERFF","2017-08-11 20:15:53","Individual","Yes","59-0397210","68711PA0030003","DentaQuest EPO Family High","68711PA003",,"PAN002","PAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0030003-00","DentaQuest EPO Family High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2018","PA","68711","SERFF","2017-08-11 20:15:53","Individual","Yes","59-0397210","68711PA0030003","DentaQuest EPO Family High","68711PA003",,"PAN002","PAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0030003-01","DentaQuest EPO Family High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2018","PA","68711","SERFF","2017-08-11 20:15:53","Individual","Yes","59-0397210","68711PA0030004","DentaQuest EPO Family Low","68711PA003",,"PAN002","PAS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0030004-00","DentaQuest EPO Family Low","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2018","PA","68711","SERFF","2017-08-11 20:15:53","Individual","Yes","59-0397210","68711PA0030004","DentaQuest EPO Family Low","68711PA003",,"PAN002","PAS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0030004-01","DentaQuest EPO Family Low","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2018","PA","68711","SERFF","2017-08-11 20:15:53","Individual","Yes","59-0397210","68711PA0030005","DentaQuest EPO Family Preventative","68711PA003",,"PAN002","PAS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","68711PA0030005-00","DentaQuest EPO Family Preventative","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0550001","my Direct Blue Lehigh Valley Major Events EPO 7350","70194PA055",,"PAN003","PAS004","PAF030","New","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0550001-00","my Direct Blue Lehigh Valley Major Events EPO 7350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$7,350","$0","$0","$0","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0550001","my Direct Blue Lehigh Valley Major Events EPO 7350","70194PA055",,"PAN003","PAS004","PAF030","New","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0550001-01","my Direct Blue Lehigh Valley Major Events EPO 7350","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$7,350","$0","$0","$0","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0550001-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0540007","my Direct  Blue Lehigh Valley EPO 6950B","70194PA054",,"PAN003","PAS004","PAF030","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0540007-02","my Direct  Blue Lehigh Valley EPO 6950B","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0540007-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","72299","SERFF","2017-08-14 20:15:51","Individual","Yes","36-3757528","72299PA0020001","TruAssure Preferred Adult or Child Dental Plan","72299PA002",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72299PA0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=PA","https://www.truassure.com/brochure?state=PA"
"2018","PA","72299","SERFF","2017-08-14 20:15:51","Individual","Yes","36-3757528","72299PA0020001","TruAssure Preferred Adult or Child Dental Plan","72299PA002",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72299PA0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=PA","https://www.truassure.com/brochure?state=PA"
"2018","PA","82110","SERFF","2017-08-14 20:15:51","Individual","Yes","23-1667011","82110PA0010001","Delta Dental PPO Pediatric Basic Plan","82110PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0010001-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0010001-18"
"2018","PA","82110","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","23-1667011","82110PA0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","82110PA002",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0020001-00","Delta Dental PPO Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0020001-18"
"2018","PA","82110","SERFF","2017-08-14 20:15:51","Individual","Yes","23-1667011","82110PA0010002","Delta Dental PPO Pediatric Preferred Plan","82110PA001",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0010002-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$40","$40 per person","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0010002-18"
"2018","PA","82110","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","23-1667011","82110PA0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","82110PA002",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0020002-00","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$40","$40 per person","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0020002-18"
"2018","PA","82110","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","23-1667011","82110PA0040001","DeltaCare USA Pediatric Basic Plan for Small Businesses","82110PA004",,"PAN002","PAS002",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0040001-00","DeltaCare USA Pediatric Basic Plan for Small Businesses","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0040001-18"
"2018","PA","82110","SERFF","2017-08-14 20:15:51","Individual","Yes","23-1667011","82110PA0010006","Delta Dental PPO Basic Plan for Families","82110PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0010006-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0010006-18"
"2018","PA","82110","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","23-1667011","82110PA0040002","DeltaCare USA Pediatric Preferred Plan for Small Businesses","82110PA004",,"PAN002","PAS002",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0040002-00","DeltaCare USA Pediatric Preferred Plan for Small Businesses","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0040002-18"
"2018","PA","82110","SERFF","2017-08-14 20:15:51","Individual","Yes","23-1667011","82110PA0010004","Delta Dental PPO Preferred Plan for Families","82110PA001",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0010004-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$40","$40 per person","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0010004-18"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0530001","my Direct Blue EPO 1000G","70194PA053",,"PAN003","PAS005","PAF026","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0530001-00","my Direct  Blue EPO 1000G","Standard Gold Off Exchange Plan",,"0.813565510107516","No","Yes","No","100%",,"$1,000","$100","$2,100","$0","$1,000","$1,300","$200","$0","$800","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0530001","my Direct Blue EPO 1000G","70194PA053",,"PAN003","PAS005","PAF026","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0530001-01","my Direct  Blue EPO 1000G","Standard Gold On Exchange Plan",,"0.813565510107516","No","Yes","No","100%",,"$1,000","$100","$2,100","$0","$1,000","$1,300","$200","$0","$800","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0530001-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0530001","my Direct Blue EPO 1000G","70194PA053",,"PAN003","PAS005","PAF026","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0530001-02","my Direct  Blue EPO 1000G","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0530001-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0530001","my Direct Blue EPO 1000G","70194PA053",,"PAN003","PAS005","PAF026","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0530001-03","my Direct  Blue EPO 1000G","Limited Cost Sharing Plan Variation",,"0.813565510107516","No","Yes","No","100%",,"$1,000","$100","$2,100","$0","$1,000","$1,300","$200","$0","$800","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0530001-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0530007","my Direct Blue EPO 6950B","70194PA053",,"PAN003","PAS005","PAF030","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0530007-00","my Direct  Blue EPO 6950B","Standard Bronze Off Exchange Plan",,"0.613867445999214","Yes","Yes","No","100%",,"$6,950","$0","$0","$0","$6,500","$200","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0530007","my Direct Blue EPO 6950B","70194PA053",,"PAN003","PAS005","PAF030","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0530007-01","my Direct  Blue EPO 6950B","Standard Bronze On Exchange Plan",,"0.613867445999214","Yes","Yes","No","100%",,"$6,950","$0","$0","$0","$6,500","$200","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0530007-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0530007","my Direct Blue EPO 6950B","70194PA053",,"PAN003","PAS005","PAF030","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0530007-02","my Direct  Blue EPO 6950B","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0530007-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0530007","my Direct Blue EPO 6950B","70194PA053",,"PAN003","PAS005","PAF030","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0530007-03","my Direct  Blue EPO 6950B","Limited Cost Sharing Plan Variation",,"0.613867445999214","Yes","Yes","No","100%",,"$6,950","$0","$0","$0","$6,500","$200","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0530007-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0530006","my Direct Blue EPO 7000B","70194PA053",,"PAN003","PAS005","PAF026","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0530006-00","my Direct  Blue EPO 7000B","Standard Bronze Off Exchange Plan",,"0.649717681712372","No","Yes","No","100%",,"$7,000","$300","$50","$0","$2,100","$1,600","$0","$0","$800","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0530006","my Direct Blue EPO 7000B","70194PA053",,"PAN003","PAS005","PAF026","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0530006-01","my Direct  Blue EPO 7000B","Standard Bronze On Exchange Plan",,"0.649717681712372","No","Yes","No","100%",,"$7,000","$300","$50","$0","$2,100","$1,600","$0","$0","$800","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0530006-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0530006","my Direct Blue EPO 7000B","70194PA053",,"PAN003","PAS005","PAF026","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0530006-02","my Direct  Blue EPO 7000B","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0530006-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0530006","my Direct Blue EPO 7000B","70194PA053",,"PAN003","PAS005","PAF026","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0530006-03","my Direct  Blue EPO 7000B","Limited Cost Sharing Plan Variation",,"0.649717681712372","No","Yes","No","100%",,"$7,000","$300","$50","$0","$2,100","$1,600","$0","$0","$800","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0530006-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0530004","my Direct Blue EPO 7150S","70194PA053",,"PAN003","PAS005","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0530004-00","my Direct  Blue EPO 7150S","Standard Silver Off Exchange Plan","66.21%","0.662814921962097","No","Yes","No","100%",,"$7,150","$200","$0","$0","$2,100","$1,600","$0","$0","$800","$900","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0530004","my Direct Blue EPO 7150S","70194PA053",,"PAN003","PAS005","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0530004-01","my Direct  Blue EPO 7150S","Standard Silver On Exchange Plan","66.21%","0.662814921962097","No","Yes","No","100%",,"$7,150","$200","$0","$0","$2,100","$1,600","$0","$0","$800","$900","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0530004-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0530004","my Direct Blue EPO 7150S","70194PA053",,"PAN003","PAS005","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0530004-02","my Direct  Blue EPO 7150S","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0530004-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0530004","my Direct Blue EPO 7150S","70194PA053",,"PAN003","PAS005","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0530004-03","my Direct  Blue EPO 7150S","Limited Cost Sharing Plan Variation","66.21%","0.662814921962097","No","Yes","No","100%",,"$7,150","$200","$0","$0","$2,100","$1,600","$0","$0","$800","$900","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0530004-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0530004","my Direct Blue EPO 7150S","70194PA053",,"PAN003","PAS005","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0530004-04","my Direct  Blue EPO 7150S","73% AV Level Silver Plan","73.90%","0.740101072632562","No","Yes","No","100%",,"$4,500","$200","$1,000","$0","$2,100","$1,300","$0","$0","$800","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0530004-04_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0530004","my Direct Blue EPO 7150S","70194PA053",,"PAN003","PAS005","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0530004-05","my Direct  Blue EPO 7150S","87% AV Level Silver Plan","87.83%","0.879649036638162","No","Yes","No","100%",,"$800","$200","$700","$0","$800","$800","$100","$0","$800","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0530004-05_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0530004","my Direct Blue EPO 7150S","70194PA053",,"PAN003","PAS005","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0530004-06","my Direct  Blue EPO 7150S","94% AV Level Silver Plan","94.77%","0.948188027567066","No","Yes","No","100%",,"$250","$100","$200","$0","$250","$200","$100","$0","$250","$200","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0530004-06_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0540001","my Direct Blue Lehigh Valley EPO 1000G","70194PA054",,"PAN003","PAS004","PAF026","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0540001-00","my Direct Blue Lehigh Valley EPO 1000G","Standard Gold Off Exchange Plan",,"0.813565510107516","No","Yes","No","100%",,"$1,000","$100","$2,100","$0","$1,000","$1,300","$200","$0","$800","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0540001","my Direct Blue Lehigh Valley EPO 1000G","70194PA054",,"PAN003","PAS004","PAF026","New","EPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0540001-03","my Direct Blue Lehigh Valley EPO 1000G","Limited Cost Sharing Plan Variation",,"0.813565510107516","No","Yes","No","100%",,"$1,000","$100","$2,100","$0","$1,000","$1,300","$200","$0","$800","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0540001-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0540007","my Direct  Blue Lehigh Valley EPO 6950B","70194PA054",,"PAN003","PAS004","PAF030","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0540007-00","my Direct  Blue Lehigh Valley EPO 6950B","Standard Bronze Off Exchange Plan",,"0.613867445999214","Yes","Yes","No","100%",,"$6,950","$0","$0","$0","$6,500","$200","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0540007","my Direct  Blue Lehigh Valley EPO 6950B","70194PA054",,"PAN003","PAS004","PAF030","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0540007-01","my Direct  Blue Lehigh Valley EPO 6950B","Standard Bronze On Exchange Plan",,"0.613867445999214","Yes","Yes","No","100%",,"$6,950","$0","$0","$0","$6,500","$200","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0540007-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0540007","my Direct  Blue Lehigh Valley EPO 6950B","70194PA054",,"PAN003","PAS004","PAF030","New","EPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9978",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0540007-03","my Direct  Blue Lehigh Valley EPO 6950B","Limited Cost Sharing Plan Variation",,"0.613867445999214","Yes","Yes","No","100%",,"$6,950","$0","$0","$0","$6,500","$200","$0","$0","$1,600","$100","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,950","$6950 per person","$13900 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0540007-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0540006","my Direct  Blue Lehigh Valley EPO 7000B","70194PA054",,"PAN003","PAS004","PAF026","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0540006-00","my Direct  Blue Lehigh Valley EPO 7000B","Standard Bronze Off Exchange Plan",,"0.649717681712372","No","Yes","No","100%",,"$7,000","$300","$50","$0","$2,100","$1,600","$0","$0","$800","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0540006","my Direct  Blue Lehigh Valley EPO 7000B","70194PA054",,"PAN003","PAS004","PAF026","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0540006-01","my Direct  Blue Lehigh Valley EPO 7000B","Standard Bronze On Exchange Plan",,"0.649717681712372","No","Yes","No","100%",,"$7,000","$300","$50","$0","$2,100","$1,600","$0","$0","$800","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0540006-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0540006","my Direct  Blue Lehigh Valley EPO 7000B","70194PA054",,"PAN003","PAS004","PAF026","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0540006-02","my Direct  Blue Lehigh Valley EPO 7000B","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0540006-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0540006","my Direct  Blue Lehigh Valley EPO 7000B","70194PA054",,"PAN003","PAS004","PAF026","New","EPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9979",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0540006-03","my Direct  Blue Lehigh Valley EPO 7000B","Limited Cost Sharing Plan Variation",,"0.649717681712372","No","Yes","No","100%",,"$7,000","$300","$50","$0","$2,100","$1,600","$0","$0","$800","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,000","$7000 per person","$14000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0540006-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0540004","my Direct  Blue Lehigh Valley EPO 7150S","70194PA054",,"PAN003","PAS004","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0540004-00","my Direct  Blue Lehigh Valley EPO 7150S","Standard Silver Off Exchange Plan","66.21%","0.662814921962097","No","Yes","No","100%",,"$7,150","$200","$0","$0","$2,100","$1,600","$0","$0","$800","$900","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0540004","my Direct  Blue Lehigh Valley EPO 7150S","70194PA054",,"PAN003","PAS004","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0540004-01","my Direct  Blue Lehigh Valley EPO 7150S","Standard Silver On Exchange Plan","66.21%","0.662814921962097","No","Yes","No","100%",,"$7,150","$200","$0","$0","$2,100","$1,600","$0","$0","$800","$900","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0540004-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0540004","my Direct  Blue Lehigh Valley EPO 7150S","70194PA054",,"PAN003","PAS004","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0540004-02","my Direct  Blue Lehigh Valley EPO 7150S","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0540004-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0540004","my Direct  Blue Lehigh Valley EPO 7150S","70194PA054",,"PAN003","PAS004","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0540004-03","my Direct  Blue Lehigh Valley EPO 7150S","Limited Cost Sharing Plan Variation","66.21%","0.662814921962097","No","Yes","No","100%",,"$7,150","$200","$0","$0","$2,100","$1,600","$0","$0","$800","$900","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0540004-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0540004","my Direct  Blue Lehigh Valley EPO 7150S","70194PA054",,"PAN003","PAS004","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0540004-04","my Direct  Blue Lehigh Valley EPO 7150S","73% AV Level Silver Plan","73.90%","0.740101072632562","No","Yes","No","100%",,"$4,500","$200","$1,000","$0","$2,100","$1,300","$0","$0","$800","$800","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0540004-04_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0540004","my Direct  Blue Lehigh Valley EPO 7150S","70194PA054",,"PAN003","PAS004","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0540004-05","my Direct  Blue Lehigh Valley EPO 7150S","87% AV Level Silver Plan","87.83%","0.879649036638162","No","Yes","No","100%",,"$800","$200","$700","$0","$800","$800","$100","$0","$800","$500","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0540004-05_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0540004","my Direct  Blue Lehigh Valley EPO 7150S","70194PA054",,"PAN003","PAS004","PAF026","New","EPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0540004-06","my Direct  Blue Lehigh Valley EPO 7150S","94% AV Level Silver Plan","94.77%","0.948188027567066","No","Yes","No","100%",,"$250","$100","$200","$0","$250","$200","$100","$0","$250","$200","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0540004-06_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","71933PA0020005","BESTOne Plus Silver","71933PA002",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/PA/current/PA_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","71933PA0010009","BESTDental Standard - L","71933PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/pa/current/PA_BESTDental_Standard-L_Plan.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","71933PA0010009","BESTDental Standard - L","71933PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/pa/current/PA_BESTDental_Standard-L_Plan.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","71933PA0020005","BESTOne Plus Silver","71933PA002",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/PA/current/PA_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","71933PA0020006","BESTOne Basic Silver","71933PA002",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/PA/current/PA_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","71933PA0010011","BESTDental Choice - L","71933PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/pa/current/PA_BESTDental_Choice-L_Plan.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","71933PA0010011","BESTDental Choice - L","71933PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/pa/current/PA_BESTDental_Choice-L_Plan.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","71933PA0020006","BESTOne Basic Silver","71933PA002",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/PA/current/PA_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","71933PA0010012","BESTDental Value","71933PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/pa/current/PA_BESTDental_Value_Plan.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","71933PA0010012","BESTDental Value","71933PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/pa/current/PA_BESTDental_Value_Plan.pdf"
"2018","PA","72299","SERFF","2017-08-14 20:15:51","Individual","Yes","36-3757528","72299PA0010001","TruAssure Basic Adult or Child Dental Plan","72299PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72299PA0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","68.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$120","$120 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=PA","https://www.truassure.com/brochure?state=PA"
"2018","PA","72299","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","36-3757528","72299PA0030001","TruAssure Dental Small Group Basic Plan","72299PA003",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","72299PA0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","PA","72299","SERFF","2017-08-14 20:15:51","Individual","Yes","36-3757528","72299PA0010001","TruAssure Basic Adult or Child Dental Plan","72299PA001",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72299PA0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","68.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$120","$120 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=PA","https://www.truassure.com/brochure?state=PA"
"2018","PA","72299","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","36-3757528","72299PA0040001","TruAssure Dental Small Group Preferred Plan","72299PA004",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","72299PA0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0560001","my Direct Blue Major Events EPO 7350","70194PA056",,"PAN003","PAS005","PAF030","New","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0560001-00","my Direct Blue Major Events EPO 7350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$7,350","$0","$0","$0","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","70194","SERFF","2017-08-14 20:15:51","Individual","No","54-1637426","70194PA0560001","my Direct Blue Major Events EPO 7350","70194PA056",,"PAN003","PAS005","PAF030","New","EPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","70194PA0560001-01","my Direct Blue Major Events EPO 7350","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$7,350","$0","$0","$0","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/CPA/Individual/I_70194PA0560001-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA2018_ProductBrochure.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","71933PA0020003","BESTOne Advantage Gold","71933PA002",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/PA/current/PA_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","71933PA0010007","BESTDental Premium","71933PA001",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010007-00","BESTDental Premium","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/pa/current/PA_BESTDental_Premium_Plan.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","71933PA0010007","BESTDental Premium","71933PA001",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010007-01","BESTDental Premium","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/pa/current/PA_BESTDental_Premium_Plan.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","71933PA0020003","BESTOne Advantage Gold","71933PA002",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/PA/current/PA_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","71933PA0010008","BESTDental Standard - H","71933PA001",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/pa/current/PA_BESTDental_Standard-H_Plan.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","71933PA0020004","BESTOne Plus Gold","71933PA002",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/PA/current/PA_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","Individual","Yes","95-6042390","71933PA0020004","BESTOne Plus Gold","71933PA002",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/PA/current/PA_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","71933PA0010008","BESTDental Standard - H","71933PA001",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/pa/current/PA_BESTDental_Standard-H_Plan.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","71933PA0010010","BESTDental Choice - H","71933PA001",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/pa/curren/PA_BESTDental_Choice-H_Plan.pdf"
"2018","PA","71933","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","95-6042390","71933PA0010010","BESTDental Choice - H","71933PA001",,"PAN001","PAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/pa/curren/PA_BESTDental_Choice-H_Plan.pdf"
"2018","PA","82110","SERFF","2017-08-14 20:15:51","Individual","Yes","23-1667011","82110PA0030001","DeltaCare USA Pediatric Basic Plan","82110PA003",,"PAN002","PAS002",,"Existing","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0030001-00","DeltaCare USA Pediatric Basic Plan","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0030001-18"
"2018","PA","82110","SERFF","2017-08-14 20:15:51","Individual","Yes","23-1667011","82110PA0030002","DeltaCare USA Pediatric Preferred Plan","82110PA003",,"PAN002","PAS002",,"Existing","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0030002-00","DeltaCare USA Pediatric Preferred Plan","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0030002-18"
"2018","PA","82110","SERFF","2017-08-14 20:15:51","Individual","Yes","23-1667011","82110PA0030006","DeltaCare USA Basic Plan for Families","82110PA003",,"PAN002","PAS002",,"Existing","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0030006-01","DeltaCare USA Basic Plan for Families","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0030006-18"
"2018","PA","82110","SERFF","2017-08-14 20:15:51","Individual","Yes","23-1667011","82110PA0030004","DeltaCare USA Preferred Plan for Families","82110PA003",,"PAN002","PAS002",,"Existing","HMO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0030004-01","DeltaCare USA Preferred Plan for Families","Standard High On Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0030004-18"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0060001","my Priority Blue Flex HMO 7150B","83731PA006",,"PAN001","PAS002","PAF026","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060001-00","my Priority Blue Flex HMO 7150B","Standard Bronze Off Exchange Plan",,"0.649669357300969","No","Yes","Yes","90%","10%","$7,150","$20","$180","$0","$2,100","$1,200","$0","$0","$1,600","$300","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","30.00%","$7,150","$7150 per person","$14300 per group","60.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090010","Sanford Simplicity $4500 HSA/HDHP","31195SD009",,"SDN001","SDS001","SDF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090010-01","Sanford Simplicity $4500 HSA/HDHP","Standard Silver On Exchange Plan",,"0.681162826616788","Yes","Yes","No","100%",,"$4,500","$0","$0","$60","$4,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_simplicity_4500.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080003","Sanford Simplicity $5,000 HSA/HDHP","31195SD008",,"SDN001","SDS001","SDF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080003-01","Sanford Simplicity $5,000 HSA/HDHP","Standard Bronze On Exchange Plan",,"0.612130834321578","Yes","Yes","No","100%",,"$5,000","$0","$1,600","$60","$5,000","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","$10,000","$10000 per person","$20000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080003","Sanford Simplicity $5,000 HSA/HDHP","31195SD008",,"SDN001","SDS001","SDF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080003-02","Sanford Simplicity $5,000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_5000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090003","Sanford Simplicity $3,500","31195SD009",,"SDN001","SDS001","SDF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090003-00","Sanford Simplicity $3,500","Standard Silver Off Exchange Plan",,"0.719799914352739","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$100","$1,800","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2018.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0070002","my Lehigh Valley Flex Blue HMO 1000G","83731PA007",,"PAN001","PAS001","PAF026","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0070002-00","my Lehigh Valley Flex Blue HMO 1000G","Standard Gold Off Exchange Plan",,"0.787658204004394","No","Yes","Yes","85%","15%","$1,000","$20","$2,100","$0","$1,000","$1,300","$200","$0","$800","$400","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%","$3,000","$3000 per person","$6000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0070002","my Lehigh Valley Flex Blue HMO 1000G","83731PA007",,"PAN001","PAS001","PAF026","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0070002-01","my Lehigh Valley Flex Blue HMO 1000G","Standard Gold On Exchange Plan",,"0.787658204004394","No","Yes","Yes","85%","15%","$1,000","$20","$2,100","$0","$1,000","$1,300","$200","$0","$800","$400","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%","$3,000","$3000 per person","$6000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/NEPA/Individual/I_83731PA0070002-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","98060","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","13-5581829","98060PA0170001","EHB Basic Dental Plan (Low)","98060PA017",,"PAN001","PAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98060PA0170001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","SD","25868","SERFF","2017-06-22 20:15:42","Individual","Yes","46-0309258","25868SD0010003","Delta Dental Individual and Family Standard Plan","25868SD001","7164425200","SDN001","SDS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier or PPO provider is considered covered. The Delta Dental Plan Association has a nationwide Premier and PPO network presence.","Yes","n/a","","25868SD0010003-00","Delta Dental Individual and Family Standard Plan","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","SD","25868","SERFF","2017-06-22 20:15:42","Individual","Yes","46-0309258","25868SD0010003","Delta Dental Individual and Family Standard Plan","25868SD001","7164425200","SDN001","SDS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier or PPO provider is considered covered. The Delta Dental Plan Association has a nationwide Premier and PPO network presence.","Yes","n/a","","25868SD0010003-01","Delta Dental Individual and Family Standard Plan","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","SD","25868","SERFF","2017-06-22 20:15:42","Individual","Yes","46-0309258","25868SD0010004","Delta Dental Individual and Family Enhanced Plan","25868SD001","7164425200","SDN001","SDS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier or PPO provider is considered covered. The Delta Dental Plan Association has a nationwide Premier and PPO network presence.","Yes","n/a","","25868SD0010004-00","Delta Dental Individual and Family Enhanced Plan","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","SD","25868","SERFF","2017-06-22 20:15:42","Individual","Yes","46-0309258","25868SD0010004","Delta Dental Individual and Family Enhanced Plan","25868SD001","7164425200","SDN001","SDS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier or PPO provider is considered covered. The Delta Dental Plan Association has a nationwide Premier and PPO network presence.","Yes","n/a","","25868SD0010004-01","Delta Dental Individual and Family Enhanced Plan","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","SD","25868","SERFF","2017-06-22 20:15:42","Individual","Yes","46-0309258","25868SD0020003","Delta Dental Small Group Standard Plan","25868SD002","7164425200","SDN001","SDS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier or PPO provider is considered covered. The Delta Dental Plan Association has a nationwide Premier and PPO network presence.","Yes","n/a","","25868SD0020003-00","Delta Dental Small Group Standard Plan","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","SD","25868","SERFF","2017-06-22 20:15:42","Individual","Yes","46-0309258","25868SD0020003","Delta Dental Small Group Standard Plan","25868SD002","7164425200","SDN001","SDS001",,"Existing","Indemnity","Low","Not Applicable",,"Off the Exchange",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier or PPO provider is considered covered. The Delta Dental Plan Association has a nationwide Premier and PPO network presence.","Yes","n/a","","25868SD0020003-01","Delta Dental Small Group Standard Plan","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","SD","25868","SERFF","2017-06-22 20:15:42","Individual","Yes","46-0309258","25868SD0020004","Delta Dental Small Group Enhanced Plan","25868SD002","7164425200","SDN001","SDS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier or PPO provider is considered covered. The Delta Dental Plan Association has a nationwide Premier and PPO network presence.","Yes","n/a","","25868SD0020004-00","Delta Dental Small Group Enhanced Plan","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $4,000 HSA/HDHP","31195SD008",,"SDN002","SDS002","SDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-03","Sanford TRUE $4,000 HSA/HDHP","Limited Cost Sharing Plan Variation",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_4000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $4,000 HSA/HDHP","31195SD008",,"SDN002","SDS002","SDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-04","Sanford TRUE $4,000 HSA/HDHP","73% AV Level Silver Plan",,"0.722667595838822","Yes","Yes","No","100%",,"$3,500","$0","$0","$60","$3,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_4000_73.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $4,000 HSA/HDHP","31195SD008",,"SDN002","SDS002","SDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-05","Sanford TRUE $4,000 HSA/HDHP","87% AV Level Silver Plan",,"0.862986557484674","Yes","Yes","No","100%",,"$1,250","$0","$0","$60","$1,250","$0","$0","$60","$1,250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_4000_87.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0070002","my Lehigh Valley Flex Blue HMO 1000G","83731PA007",,"PAN001","PAS001","PAF026","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0070002-02","my Lehigh Valley Flex Blue HMO 1000G","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/NEPA/Individual/I_83731PA0070002-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0070002","my Lehigh Valley Flex Blue HMO 1000G","83731PA007",,"PAN001","PAS001","PAF026","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0070002-03","my Lehigh Valley Flex Blue HMO 1000G","Limited Cost Sharing Plan Variation",,"0.787658204004394","No","Yes","Yes","85%","15%","$1,000","$20","$2,100","$0","$1,000","$1,300","$200","$0","$800","$400","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20.00%","$3,000","$3000 per person","$6000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/NEPA/Individual/I_83731PA0070002-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0060001","my Priority Blue Flex HMO 7150B","83731PA006",,"PAN001","PAS002","PAF026","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060001-01","my Priority Blue Flex HMO 7150B","Standard Bronze On Exchange Plan",,"0.649669357300969","No","Yes","Yes","90%","10%","$7,150","$20","$180","$0","$2,100","$1,200","$0","$0","$1,600","$300","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","30.00%","$7,150","$7150 per person","$14300 per group","60.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/NEPA/Individual/I_83731PA0060001-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0060001","my Priority Blue Flex HMO 7150B","83731PA006",,"PAN001","PAS002","PAF026","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060001-02","my Priority Blue Flex HMO 7150B","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","90%","10%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/NEPA/Individual/I_83731PA0060001-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0060001","my Priority Blue Flex HMO 7150B","83731PA006",,"PAN001","PAS002","PAF026","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060001-03","my Priority Blue Flex HMO 7150B","Limited Cost Sharing Plan Variation",,"0.649669357300969","No","Yes","Yes","90%","10%","$7,150","$20","$180","$0","$2,100","$1,200","$0","$0","$1,600","$300","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group","30.00%","$7,150","$7150 per person","$14300 per group","60.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/NEPA/Individual/I_83731PA0060001-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0060004","my Priority Blue Flex HMO 1000G","83731PA006",,"PAN001","PAS002","PAF026","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060004-00","my Priority Blue Flex HMO 1000G","Standard Gold Off Exchange Plan",,"0.803167223756034","No","Yes","Yes","90%","10%","$1,000","$20","$1,100","$0","$1,000","$1,300","$100","$0","$800","$400","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%","$2,000","$2000 per person","$4000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0060004","my Priority Blue Flex HMO 1000G","83731PA006",,"PAN001","PAS002","PAF026","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060004-01","my Priority Blue Flex HMO 1000G","Standard Gold On Exchange Plan",,"0.803167223756034","No","Yes","Yes","90%","10%","$1,000","$20","$1,100","$0","$1,000","$1,300","$100","$0","$800","$400","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%","$2,000","$2000 per person","$4000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/NEPA/Individual/I_83731PA0060004-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0060004","my Priority Blue Flex HMO 1000G","83731PA006",,"PAN001","PAS002","PAF026","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060004-02","my Priority Blue Flex HMO 1000G","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","90%","10%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/NEPA/Individual/I_83731PA0060004-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0060004","my Priority Blue Flex HMO 1000G","83731PA006",,"PAN001","PAS002","PAF026","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060004-03","my Priority Blue Flex HMO 1000G","Limited Cost Sharing Plan Variation",,"0.803167223756034","No","Yes","Yes","90%","10%","$1,000","$20","$1,100","$0","$1,000","$1,000","$100","$0","$800","$400","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10.00%","$2,000","$2000 per person","$4000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/NEPA/Individual/I_83731PA0060004-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0060009","my Priority Blue Flex HMO 6900S","83731PA006",,"PAN001","PAS002","PAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060009-00","my Priority Blue Flex HMO 6900S","Standard Silver Off Exchange Plan","66.07%","0.661419500720985","No","Yes","Yes","90%","10%","$6,900","$20","$430","$0","$2,100","$1,500","$0","$0","$1,600","$200","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","40.00%","$7,150","$7150 per person","$14300 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0060009","my Priority Blue Flex HMO 6900S","83731PA006",,"PAN001","PAS002","PAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060009-01","my Priority Blue Flex HMO 6900S","Standard Silver On Exchange Plan","66.07%","0.661419500720985","No","Yes","Yes","90%","10%","$6,900","$20","$430","$0","$2,100","$1,500","$0","$0","$1,600","$200","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","40.00%","$7,150","$7150 per person","$14300 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/NEPA/Individual/I_83731PA0060009-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0060009","my Priority Blue Flex HMO 6900S","83731PA006",,"PAN001","PAS002","PAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060009-02","my Priority Blue Flex HMO 6900S","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","90%","10%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/NEPA/Individual/I_83731PA0060009-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0060009","my Priority Blue Flex HMO 6900S","83731PA006",,"PAN001","PAS002","PAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060009-03","my Priority Blue Flex HMO 6900S","Limited Cost Sharing Plan Variation","66.07%","0.661419500720985","No","Yes","Yes","90%","10%","$6,900","$20","$430","$0","$2,100","$1,500","$0","$0","$1,600","$200","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,900","$6900 per person","$13800 per group","40.00%","$7,150","$7150 per person","$14300 per group","50.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/NEPA/Individual/I_83731PA0060009-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0060009","my Priority Blue Flex HMO 6900S","83731PA006",,"PAN001","PAS002","PAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060009-04","my Priority Blue Flex HMO 6900S","73% AV Level Silver Plan","73.13%","0.733320734509904","No","Yes","Yes","90%","10%","$4,000","$20","$1,700","$0","$2,100","$1,000","$0","$0","$800","$100","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20.00%","$4,500","$4500 per person","$9000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/NEPA/Individual/I_83731PA0060009-04_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0060009","my Priority Blue Flex HMO 6900S","83731PA006",,"PAN001","PAS002","PAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060009-05","my Priority Blue Flex HMO 6900S","87% AV Level Silver Plan","87.87%","0.881839659848308","No","Yes","Yes","90%","10%","$500","$20","$1,100","$0","$500","$800","$200","$0","$500","$60","$10","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","$2,100","$2100 per person","$4200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10.00%","$1,000","$1000 per person","$2000 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/NEPA/Individual/I_83731PA0060009-05_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0060009","my Priority Blue Flex HMO 6900S","83731PA006",,"PAN001","PAS002","PAF026","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0060009-06","my Priority Blue Flex HMO 6900S","94% AV Level Silver Plan","94.41%","0.945980989374028","No","Yes","Yes","90%","10%","$100","$20","$580","$0","$100","$400","$200","$0","$100","$30","$50","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10.00%","$400","$400 per person","$800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/NEPA/Individual/I_83731PA0060009-06_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0080001","my Priority Blue Major Events HMO 7350","83731PA008",,"PAN001","PAS002","PAF030","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0080001-00","my Priority Blue Major Events HMO 7350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$7,350","$0","$0","$0","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0080001","my Priority Blue Major Events HMO 7350","83731PA008",,"PAN001","PAS002","PAF030","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0080001-01","my Priority Blue Major Events HMO 7350","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$7,350","$0","$0","$0","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/NEPA/Individual/I_83731PA0080001-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0090002","my Priority Blue Flex HMO 6200BQE","83731PA009",,"PAN001","PAS002","PAF028","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0090002-00","my Priority Blue Flex HMO 6200BQE","Standard Bronze Off Exchange Plan",,"0.606579890670753","Yes","Yes","Yes","90%","10%","$6,200","$0","$350","$0","$6,200","$0","$100","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","10.00%","$6,200","$6200 per person","$12400 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0090002","my Priority Blue Flex HMO 6200BQE","83731PA009",,"PAN001","PAS002","PAF028","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0090002-01","my Priority Blue Flex HMO 6200BQE","Standard Bronze On Exchange Plan",,"0.606579890670753","Yes","Yes","Yes","90%","10%","$6,200","$0","$350","$0","$6,200","$0","$100","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","10.00%","$6,200","$6200 per person","$12400 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://shop.highmark.com/content/sbcs/2018/NEPA/Individual/I_83731PA0090002-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0090002","my Priority Blue Flex HMO 6200BQE","83731PA009",,"PAN001","PAS002","PAF028","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0090002-02","my Priority Blue Flex HMO 6200BQE","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://shop.highmark.com/content/sbcs/2018/NEPA/Individual/I_83731PA0090002-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","PA","83731","SERFF","2017-08-14 20:15:51","Individual","No","23-2413324","83731PA0090002","my Priority Blue Flex HMO 6200BQE","83731PA009",,"PAN001","PAS002","PAF028","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"2018-01-01",,"Yes","Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement.","Yes","The Plan covers only limited health care services received outside of the Network Service Area. As used in this Subsection, “Out-of-Area Covered Services” includes Emergency Care Services and Urgent Care Services obtained outside of the Network Service Area. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless authorized by the Plan.","No","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","83731PA0090002-03","my Priority Blue Flex HMO 6200BQE","Limited Cost Sharing Plan Variation",,"0.606579890670753","Yes","Yes","Yes","90%","10%","$6,200","$0","$350","$0","$6,200","$0","$100","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","10.00%","$6,200","$6200 per person","$12400 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/NEPA/Individual/I_83731PA0090002-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/NEPA2018_ProductBrochure.pdf"
"2018","SD","25868","SERFF","2017-06-22 20:15:42","Individual","Yes","46-0309258","25868SD0020004","Delta Dental Small Group Enhanced Plan","25868SD002","7164425200","SDN001","SDS001",,"Existing","Indemnity","High","Not Applicable",,"Off the Exchange",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier or PPO provider is considered covered. The Delta Dental Plan Association has a nationwide Premier and PPO network presence.","Yes","n/a","","25868SD0020004-01","Delta Dental Small Group Enhanced Plan","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080004","Sanford Simplicity $7,350","31195SD008",,"SDN001","SDS001","SDF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080004-00","Sanford Simplicity $7,350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$0","$0","$60","$1,700","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$29,400","$29400 per person","$58800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_7350.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090019","Sanford Simplicity $5,000","31195SD009",,"SDN001","SDS001","SDF026","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090019-00","Sanford Simplicity $5,000","Standard Bronze Off Exchange Plan",,"0.649614631115679","Yes","Yes","No","100%",,"$5,000","$40","$1,600","$60","$300","$2,600","$0","$60","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","$10,000","$10000 per person","$20000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_simplicity_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090019","Sanford Simplicity $5,000","31195SD009",,"SDN001","SDS001","SDF026","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090019-01","Sanford Simplicity $5,000","Standard Bronze On Exchange Plan",,"0.649614631115679","Yes","Yes","No","100%",,"$5,000","$40","$1,600","$60","$300","$2,600","$0","$60","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","$10,000","$10000 per person","$20000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_simplicity_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080004","Sanford Simplicity $7,350","31195SD008",,"SDN001","SDS001","SDF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080004-01","Sanford Simplicity $7,350","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,800","$0","$0","$60","$1,700","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$29,400","$29400 per person","$58800 per group","$29,400","$29400 per person","$58800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_7350.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080015","Sanford TRUE $7,350","31195SD008",,"SDN002","SDS002","SDF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080015-00","Sanford TRUE $7,350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,700","$0","$0","$60","$1,800","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_7350.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090007","Sanford Simplicity $1,250","31195SD009",,"SDN001","SDS001","SDF008","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090007-00","Sanford Simplicity $1,250","Standard Gold Off Exchange Plan",,"0.812484821028003","Yes","Yes","No","100%",,"$1,250","$30","$1,500","$60","$100","$1,200","$0","$60","$1,250","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_simplicity_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090007","Sanford Simplicity $1,250","31195SD009",,"SDN001","SDS001","SDF008","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090007-01","Sanford Simplicity $1,250","Standard Gold On Exchange Plan",,"0.812484821028003","Yes","Yes","No","100%",,"$1,250","$30","$1,500","$60","$100","$1,200","$0","$60","$1,250","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_simplicity_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080015","Sanford TRUE $7,350","31195SD008",,"SDN002","SDS002","SDF001","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080015-01","Sanford TRUE $7,350","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,700","$0","$0","$60","$1,800","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_7350.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090001","Sanford Simplicity $500","31195SD009",,"SDN001","SDS001","SDF027","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090001-00","Sanford Simplicity $500","Standard Platinum Off Exchange Plan",,"0.909971278107127","Yes","Yes","No","100%",,"$500","$0","$500","$60","$100","$900","$0","$60","$500","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_simplicity_500.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090001","Sanford Simplicity $500","31195SD009",,"SDN001","SDS001","SDF027","Existing","HMO","Platinum","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090001-01","Sanford Simplicity $500","Standard Platinum On Exchange Plan",,"0.909971278107127","Yes","Yes","No","100%",,"$500","$0","$500","$60","$100","$900","$0","$60","$500","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_simplicity_500.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080003","Sanford Simplicity $5,000 HSA/HDHP","31195SD008",,"SDN001","SDS001","SDF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080003-00","Sanford Simplicity $5,000 HSA/HDHP","Standard Bronze Off Exchange Plan",,"0.612130834321578","Yes","Yes","No","100%",,"$5,000","$0","$1,600","$60","$5,000","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","$10,000","$10000 per person","$20000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090010","Sanford Simplicity $4500 HSA/HDHP","31195SD009",,"SDN001","SDS001","SDF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090010-00","Sanford Simplicity $4500 HSA/HDHP","Standard Silver Off Exchange Plan",,"0.681162826616788","Yes","Yes","No","100%",,"$4,500","$0","$0","$60","$4,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%",,,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_simplicity_4500.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090003","Sanford Simplicity $3,500","31195SD009",,"SDN001","SDS001","SDF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090003-01","Sanford Simplicity $3,500","Standard Silver On Exchange Plan",,"0.719799914352739","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$100","$1,800","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080003","Sanford Simplicity $5,000 HSA/HDHP","31195SD008",,"SDN001","SDS001","SDF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080003-03","Sanford Simplicity $5,000 HSA/HDHP","Limited Cost Sharing Plan Variation",,"0.612130834321578","Yes","Yes","No","100%",,"$5,000","$0","$1,600","$60","$5,000","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$13,100","$13100 per person","$26200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","$10,000","$10000 per person","$20000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_5000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080009","Sanford TRUE $5,000 HSA/HDHP","31195SD008",,"SDN002","SDS002","SDF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080009-00","Sanford TRUE $5,000 HSA/HDHP","Standard Bronze Off Exchange Plan",,"0.612130834321578","Yes","Yes","No","100%",,"$5,000","$0","$1,600","$60","$5,000","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090008","Sanford Simplicity $2,700 HSA/HDHP","31195SD009",,"SDN001","SDS001","SDF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090008-00","Sanford Simplicity $2,700 HSA/HDHP","Standard Silver Off Exchange Plan",,"0.703127193341871","Yes","Yes","No","100%",,"$2,700","$0","$1,800","$60","$2,700","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_simplicity_2700.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090008","Sanford Simplicity $2,700 HSA/HDHP","31195SD009",,"SDN001","SDS001","SDF009","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090008-01","Sanford Simplicity $2,700 HSA/HDHP","Standard Silver On Exchange Plan",,"0.703127193341871","Yes","Yes","No","100%",,"$2,700","$0","$1,800","$60","$2,700","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_simplicity_2700.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080009","Sanford TRUE $5,000 HSA/HDHP","31195SD008",,"SDN002","SDS002","SDF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080009-01","Sanford TRUE $5,000 HSA/HDHP","Standard Bronze On Exchange Plan",,"0.612130834321578","Yes","Yes","No","100%",,"$5,000","$0","$1,600","$60","$5,000","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080009","Sanford TRUE $5,000 HSA/HDHP","31195SD008",,"SDN002","SDS002","SDF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080009-02","Sanford TRUE $5,000 HSA/HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_5000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090009","Sanford Simplicity $2,250","31195SD009",,"SDN001","SDS001","SDF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090009-00","Sanford Simplicity $2,250","Standard Silver Off Exchange Plan",,"0.718187645415684","Yes","Yes","No","100%",,"$2,250","$40","$2,700","$60","$100","$1,900","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","40.00%",,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_simplicity_2250.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090009","Sanford Simplicity $2,250","31195SD009",,"SDN001","SDS001","SDF006","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090009-01","Sanford Simplicity $2,250","Standard Silver On Exchange Plan",,"0.718187645415684","Yes","Yes","No","100%",,"$2,250","$40","$2,700","$60","$100","$1,900","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","40.00%",,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_simplicity_2250.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080011","Sanford Simplicity $4,000 HSA/HDHP","31195SD008",,"SDN001","SDS001","SDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080011-03","Sanford Simplicity $4,000 HSA/HDHP","Limited Cost Sharing Plan Variation",,"0.700980885295207","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$16,000","$16000 per person","$32000 per group","$16,000","$16000 per person","$32000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_4000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080011","Sanford Simplicity $4,000 HSA/HDHP","31195SD008",,"SDN001","SDS001","SDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080011-04","Sanford Simplicity $4,000 HSA/HDHP","73% AV Level Silver Plan",,"0.722667595838822","Yes","Yes","No","100%",,"$3,550","$0","$0","$60","$3,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$16,000","$16000 per person","$32000 per group","$16,000","$16000 per person","$32000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0.00%",,,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_4000_73.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090012","Sanford TRUE $2,700 HSA/HDHP","31195SD009",,"SDN002","SDS002","SDF028","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090012-00","Sanford TRUE $2,700 HSA/HDHP","Standard Silver Off Exchange Plan",,"0.703127193341871","Yes","Yes","No","100%",,"$2,700","$0","$1,800","$60","$2,700","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,700","$2700 per person","$5400 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_true_2700.pdf","http://www.sanfordhealthplan.com/policy/HP-1602-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090012","Sanford TRUE $2,700 HSA/HDHP","31195SD009",,"SDN002","SDS002","SDF028","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090012-01","Sanford TRUE $2,700 HSA/HDHP","Standard Silver On Exchange Plan",,"0.703127193341871","Yes","Yes","No","100%",,"$2,700","$0","$1,800","$60","$2,700","$0","$1,300","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,700","$2700 per person","$5400 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_true_2700.pdf","http://www.sanfordhealthplan.com/policy/HP-1602-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080011","Sanford Simplicity $4,000 HSA/HDHP","31195SD008",,"SDN001","SDS001","SDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080011-05","Sanford Simplicity $4,000","87% AV Level Silver Plan",,"0.862986553804247","Yes","Yes","No","100%",,"$1,250","$0","$0","$60","$1,250","$0","$0","$60","$1,250","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$16,000","$16000 per person","$32000 per group","$16,000","$16000 per person","$32000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0.00%",,,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_4000_87.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080011","Sanford Simplicity $4,000 HSA/HDHP","31195SD008",,"SDN001","SDS001","SDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080011-06","Sanford Simplicity $4,000","94% AV Level Silver Plan",,"0.932658390774855","Yes","Yes","No","100%",,"$550","$0","$0","$60","$550","$0","$0","$60","$550","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$16,000","$16000 per person","$32000 per group","$16,000","$16000 per person","$32000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0.00%",,,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_4000_94.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-00","Sanford Simplicity $3,500","Standard Silver Off Exchange Plan",,"0.719799914352739","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$100","$1,800","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14000 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080009","Sanford TRUE $5,000 HSA/HDHP","31195SD008",,"SDN002","SDS002","SDF004","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080009-03","Sanford TRUE $5,000 HSA/HDHP","Limited Cost Sharing Plan Variation",,"0.612130834321578","Yes","Yes","No","100%",,"$5,000","$0","$1,600","$60","$5,000","$0","$800","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_5000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $4,000 HSA/HDHP","31195SD008",,"SDN002","SDS002","SDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-00","Sanford TRUE $4,000 HSA/HDHP","Standard Silver Off Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_4000.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $4,000 HSA/HDHP","31195SD008",,"SDN002","SDS002","SDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-01","Sanford TRUE $4,000 HSA/HDHP","Standard Silver On Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_4000.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $4,000 HSA/HDHP","31195SD008",,"SDN002","SDS002","SDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-02","Sanford TRUE $4,000 HSA/HDHP","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_4000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $4,000 HSA/HDHP","31195SD008",,"SDN002","SDS002","SDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-06","Sanford TRUE $4,000 HSA/HDHP","94% AV Level Silver Plan",,"0.932658386848586","Yes","Yes","No","100%",,"$550","$0","$0","$60","$550","$0","$0","$60","$550","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$550","$550 per person","$1100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$550","$550 per person","$1100 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_4000_94.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080011","Sanford Simplicity $4,000 HSA/HDHP","31195SD008",,"SDN001","SDS001","SDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080011-00","Sanford Simplicity $4,000 HSA/HDHP","Standard Silver Off Exchange Plan",,"0.700980885295207","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$16,000","$16000 per person","$32000 per group","$16,000","$16000 per person","$32000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_4000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090016","Sanford TRUE $5,000","31195SD009",,"SDN002","SDS002","SDF026","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090016-00","Sanford TRUE $5,000","Standard Bronze Off Exchange Plan",,"0.649614631115679","Yes","Yes","No","100%",,"$5,000","$40","$1,600","$60","$300","$2,600","$0","$60","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_true_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-1602-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090016","Sanford TRUE $5,000","31195SD009",,"SDN002","SDS002","SDF026","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090016-01","Sanford TRUE $5,000","Standard Bronze On Exchange Plan",,"0.649614631115679","Yes","Yes","No","100%",,"$5,000","$40","$1,600","$60","$300","$2,600","$0","$60","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_true_5000.pdf","http://www.sanfordhealthplan.com/policy/HP-1602-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080011","Sanford Simplicity $4,000 HSA/HDHP","31195SD008",,"SDN001","SDS001","SDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080011-01","Sanford Simplicity $4,000 HSA/HDHP","Standard Silver On Exchange Plan",,"0.700980885295207","Yes","Yes","No","100%",,"$4,000","$0","$0","$60","$4,000","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$16,000","$16000 per person","$32000 per group","$16,000","$16000 per person","$32000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_4000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080011","Sanford Simplicity $4,000 HSA/HDHP","31195SD008",,"SDN001","SDS001","SDF001","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080011-02","Sanford Simplicity $4,000","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_4000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090014","Sanford TRUE $4,500 HSA/HDHP","31195SD009",,"SDN002","SDS002","SDF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090014-00","Sanford TRUE $4,500 HSA/HDHP","Standard Silver Off Exchange Plan",,"0.681162826616788","Yes","Yes","No","100%",,"$4,500","$0","$0","$60","$4,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_true_4500.pdf","http://www.sanfordhealthplan.com/policy/HP-1602-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090014","Sanford TRUE $4,500 HSA/HDHP","31195SD009",,"SDN002","SDS002","SDF001","New","HMO","Silver","Not Applicable","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090014-01","Sanford TRUE $4,500 HSA/HDHP","Standard Silver On Exchange Plan",,"0.681162826616788","Yes","Yes","No","100%",,"$4,500","$0","$0","$60","$4,500","$0","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_true_4500.pdf","http://www.sanfordhealthplan.com/policy/HP-1602-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-01","Sanford Simplicity $3,500","Standard Silver On Exchange Plan",,"0.719799914352739","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$100","$1,800","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-02","Sanford Simplicity $3,500","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$60","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_3500_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-03","Sanford Simplicity $3,500","Limited Cost Sharing Plan Variation",,"0.719799914352739","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$100","$1,800","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_3500_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-04","Sanford Simplicity $3,500","73% AV Level Silver Plan",,"0.73990964325953","Yes","Yes","No","100%",,"$3,000","$40","$1,200","$60","$100","$1,800","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_3500_73.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-05","Sanford Simplicity $3,500","87% AV Level Silver Plan",,"0.875826844445005","Yes","Yes","No","100%",,"$700","$0","$1,550","$60","$100","$1,100","$0","$60","$700","$100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_3500_87.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF006","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org/","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-06","Sanford Simplicity $3,500","94% AV Level Silver Plan",,"0.943571701124884","Yes","Yes","No","100%",,"$250","$10","$400","$60","$100","$300","$0","$60","$250","$70","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_3500_94.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080013","Sanford Simplicity $4,750","31195SD008",,"SDN001","SDS001","SDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080013-00","Sanford Simplicity $4,750","Standard Silver Off Exchange Plan",,"0.661646433637623","Yes","Yes","No","100%",,"$4,750","$40","$2,100","$60","$3,800","$1,100","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","50.00%",,,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_4750.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090013","Sanford TRUE $3,500","31195SD009",,"SDN002","SDS002","SDF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090013-00","Sanford TRUE $3,500","Standard Silver Off Exchange Plan","70.80%","0.727926104913845","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$20","$2,400","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_true_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-1602-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090013","Sanford TRUE $3,500","31195SD009",,"SDN002","SDS002","SDF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090013-01","Sanford TRUE $3,500","Standard Silver On Exchange Plan","70.80%","0.727926104913845","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$20","$2,400","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_true_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-1602-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080013","Sanford Simplicity $4,750","31195SD008",,"SDN001","SDS001","SDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080013-01","Sanford Simplicity $4,750","Standard Silver On Exchange Plan",,"0.661646433637623","Yes","Yes","No","100%",,"$4,750","$40","$2,100","$60","$3,800","$1,100","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","50.00%",,,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_4750.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080013","Sanford Simplicity $4,750","31195SD008",,"SDN001","SDS001","SDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080013-02","Sanford Simplicity $4,750","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_4750_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090015","Sanford TRUE $2,250","31195SD009",,"SDN002","SDS002","SDF017","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090015-00","Sanford TRUE $2,250","Standard Silver Off Exchange Plan","71.10%","0.728852107025107","Yes","Yes","No","100%",,"$2,250","$40","$2,700","$60","$20","$2,400","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_true_2250.pdf","http://www.sanfordhealthplan.com/policy/HP-1602-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080014","Sanford Simplicity $2,800","31195SD008",,"SDN001","SDS001","SDF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080014-06","Sanford Simplicity $2,800","94% AV Level Silver Plan",,"0.933389292001607","Yes","Yes","No","100%",,"$300","$0","$700","$60","$100","$600","$0","$60","$300","$90","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%",,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_2800_94.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080001","Sanford Simplicity $1,250","31195SD008",,"SDN001","SDS001","SDF008","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080001-00","Sanford Simplicity $1,250","Standard Gold Off Exchange Plan",,"0.812484821028003","Yes","Yes","No","100%",,"$1,250","$30","$1,500","$60","$100","$1,300","$0","$60","$1,250","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090005","Sanford Simplicity $6,000","31195SD009",,"SDN001","SDS001","SDF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090005-00","Sanford Simplicity $6,000","Standard Bronze Off Exchange Plan","61.00%","0.606846570796385","Yes","Yes","No","100%",,"$6,000","$0","$1,150","$60","$4,400","$700","$0","$60","$1,800","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090005","Sanford Simplicity $6,000","31195SD009",,"SDN001","SDS001","SDF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090005-01","Sanford Simplicity $6,000","Standard Bronze On Exchange Plan","61.00%","0.606846570796385","Yes","Yes","No","100%",,"$6,000","$0","$1,150","$60","$4,400","$700","$0","$60","$1,800","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0340-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090015","Sanford TRUE $2,250","31195SD009",,"SDN002","SDS002","SDF017","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090015-01","Sanford TRUE $2,250","Standard Silver On Exchange Plan","71.10%","0.728852107025107","Yes","Yes","No","100%",,"$2,250","$40","$2,700","$60","$20","$2,400","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_true_2250.pdf","http://www.sanfordhealthplan.com/policy/HP-1602-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080013","Sanford Simplicity $4,750","31195SD008",,"SDN001","SDS001","SDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080013-03","Sanford Simplicity $4,750","Limited Cost Sharing Plan Variation",,"0.661646433637623","Yes","Yes","No","100%",,"$4,750","$40","$2,100","$60","$3,800","$1,100","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","50.00%",,,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_4750_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080013","Sanford Simplicity $4,750","31195SD008",,"SDN001","SDS001","SDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080013-04","Sanford Simplicity $4,750","73% AV Level Silver Plan",,"0.723222611219259","Yes","Yes","No","100%",,"$3,750","$0","$1,250","$60","$3,750","$900","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","40.00%",,,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_4750_73.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090017","Sanford TRUE $1,250","31195SD009",,"SDN002","SDS002","SDF019","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090017-00","Sanford TRUE $1,250","Standard Gold Off Exchange Plan","81.20%","0.824805976190172","Yes","Yes","No","100%",,"$1,250","$30","$1,500","$60","$20","$1,500","$0","$60","$1,250","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_true_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-1602-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090017","Sanford TRUE $1,250","31195SD009",,"SDN002","SDS002","SDF019","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090017-01","Sanford TRUE $1,250","Standard Gold On Exchange Plan","81.20%","0.824805976190172","Yes","Yes","No","100%",,"$1,250","$30","$1,500","$60","$20","$1,500","$0","$60","$1,250","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_true_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-1602-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080013","Sanford Simplicity $4,750","31195SD008",,"SDN001","SDS001","SDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080013-05","Sanford Simplicity $4,750","87% AV Level Silver Plan",,"0.861133278352851","Yes","Yes","No","100%",,"$900","$0","$1,100","$60","$900","$500","$600","$60","$900","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","25.00%",,,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_4750_87.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080013","Sanford Simplicity $4,750","31195SD008",,"SDN001","SDS001","SDF005","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080013-06","Sanford Simplicity $4,750","94% AV Level Silver Plan",,"0.934247757278915","Yes","Yes","No","100%",,"$200","$0","$800","$60","$200","$300","$400","$60","$200","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%",,,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_4750_94.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090018","Sanford TRUE $500","31195SD009",,"SDN002","SDS002","SDF029","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090018-00","Sanford TRUE $500","Standard Platinum Off Exchange Plan","91.30%","0.914372609982335","Yes","Yes","No","100%",,"$500","$0","$600","$60","$10","$1,100","$0","$60","$500","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,100","$1100 per person","$2200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_true_500.pdf","http://www.sanfordhealthplan.com/policy/HP-1602-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090018","Sanford TRUE $500","31195SD009",,"SDN002","SDS002","SDF029","New","HMO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090018-01","Sanford TRUE $500","Standard Platinum On Exchange Plan","91.30%","0.914372609982335","Yes","Yes","No","100%",,"$500","$0","$600","$60","$10","$1,100","$0","$60","$500","$200","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,100","$1100 per person","$2200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_true_500.pdf","http://www.sanfordhealthplan.com/policy/HP-1602-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080014","Sanford Simplicity $2,800","31195SD008",,"SDN001","SDS001","SDF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080014-00","Sanford Simplicity $2,800","Standard Silver Off Exchange Plan",,"0.71898686127187","Yes","Yes","No","100%",,"$2,800","$40","$2,500","$60","$100","$1,800","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","40.00%",,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_2800.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080017","Sanford TRUE $2,800","31195SD008",,"SDN002","SDS002","SDF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080017-03","Sanford TRUE $2,800","Limited Cost Sharing Plan Variation","71.00%","0.729621951902622","Yes","Yes","No","100%",,"$2,800","$40","$2,500","$60","$20","$2,400","$0","$60","$1,400","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_2800_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080017","Sanford TRUE $2,800","31195SD008",,"SDN002","SDS002","SDF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080017-04","Sanford TRUE $2,800","73% AV Level Silver Plan","73.30%","0.750766297888302","Yes","Yes","No","100%",,"$2,750","$40","$2,500","$60","$20","$2,200","$0","$60","$1,400","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_2800_73.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020023","Avera 5500","60536SD002","7942203176","SDN001","SDS001","SDF012","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020023-03","Avera 5500 Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.610060990993953","No","Yes","No","100%",,"$2,390","$0","$4,960","$0","$1,331","$1,915","$854","$0","$1,003","$200","$669","$0","$250","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","40.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70930/2018-avera-5500-limited-cost-share.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","Individual","Yes","95-6042390","61214SD0020003","BESTOne Advantage Gold","61214SD002",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020003-00","BESTOne Advantage Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","SHOP (Small Group)","Yes","95-6042390","61214SD0010007","BESTDental Premium","61214SD001",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010007-00","BESTDental Premium","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTDental_Premium_Plan.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","SHOP (Small Group)","Yes","95-6042390","61214SD0010007","BESTDental Premium","61214SD001",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010007-01","BESTDental Premium","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTDental_Premium_Plan.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","Individual","Yes","95-6042390","61214SD0020003","BESTOne Advantage Gold","61214SD002",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020003-01","BESTOne Advantage Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTOne_Dental_Advantage-Gold_Plan.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","Individual","Yes","95-6042390","61214SD0020004","BESTOne Plus Gold","61214SD002",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020004-00","BESTOne Plus Gold","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","SHOP (Small Group)","Yes","95-6042390","61214SD0010008","BESTDental Standard - H","61214SD001",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTDental_Standard-H_Plan.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080014","Sanford Simplicity $2,800","31195SD008",,"SDN001","SDS001","SDF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080014-01","Sanford Simplicity $2,800","Standard Silver On Exchange Plan",,"0.71898686127187","Yes","Yes","No","100%",,"$2,800","$40","$2,500","$60","$100","$1,800","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","40.00%",,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_2800.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080014","Sanford Simplicity $2,800","31195SD008",,"SDN001","SDS001","SDF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080014-02","Sanford Simplicity $2,800","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_2800_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080014","Sanford Simplicity $2,800","31195SD008",,"SDN001","SDS001","SDF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080014-03","Sanford Simplicity $2,800","Limited Cost Sharing Plan Variation",,"0.71898686127187","Yes","Yes","No","100%",,"$2,800","$40","$2,500","$60","$100","$1,800","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","40.00%",,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_2800_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080014","Sanford Simplicity $2,800","31195SD008",,"SDN001","SDS001","SDF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080014-04","Sanford Simplicity $2,800","73% AV Level Silver Plan",,"0.739524284866079","Yes","Yes","No","100%",,"$2,600","$40","$2,500","$60","$100","$1,800","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","40.00%",,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_2800_73.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080014","Sanford Simplicity $2,800","31195SD008",,"SDN001","SDS001","SDF007","New","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080014-05","Sanford Simplicity $2,800","87% AV Level Silver Plan",,"0.862491517978656","Yes","Yes","No","100%",,"$700","$0","$1,600","$60","$100","$1,200","$0","$60","$700","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_2800_87.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080001","Sanford Simplicity $1,250","31195SD008",,"SDN001","SDS001","SDF008","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080001-01","Sanford Simplicity $1,250","Standard Gold On Exchange Plan",,"0.812484821028003","Yes","Yes","No","100%",,"$1,250","$30","$1,500","$60","$100","$1,300","$0","$60","$1,250","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080001","Sanford Simplicity $1,250","31195SD008",,"SDN001","SDS001","SDF008","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080001-02","Sanford Simplicity $1,250","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_1250_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090011","Sanford TRUE $6,000","31195SD009",,"SDN002","SDS002","SDF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090011-00","Sanford TRUE $6,000","Standard Bronze Off Exchange Plan","61.00%","0.606846570796385","Yes","Yes","No","100%",,"$6,000","$0","$1,550","$60","$4,400","$1,600","$0","$60","$1,800","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_true_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-1602-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","SHOP (Small Group)","No","91-1842494","31195SD0090011","Sanford TRUE $6,000","31195SD009",,"SDN002","SDS002","SDF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090011-01","Sanford TRUE $6,000","Standard Bronze On Exchange Plan","61.00%","0.606846570796385","Yes","Yes","No","100%",,"$6,000","$0","$1,550","$60","$4,400","$1,600","$0","$60","$1,800","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/sg_sd_true_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-1602-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080001","Sanford Simplicity $1,250","31195SD008",,"SDN001","SDS001","SDF008","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080001-03","Sanford Simplicity $1,250","Limited Cost Sharing Plan Variation",,"0.812484821028003","Yes","Yes","No","100%",,"$1,250","$30","$1,500","$60","$100","$1,300","$0","$60","$1,250","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","$9,500","$9500 per person","$19000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_1250_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080012","Sanford Simplicity SIMPLE CHOICE $6,650","31195SD008",,"SDN001","SDS001","SDF002","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080012-00","Sanford Simplicity SIMPLE CHOICE $6,650","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$700","$60","$3,800","$1,700","$0","$60","$1,400","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","$13,300","$13300 per person","$26600 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_6650.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080012","Sanford Simplicity SIMPLE CHOICE $6,650","31195SD008",,"SDN001","SDS001","SDF002","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080012-01","Sanford Simplicity SIMPLE CHOICE $6,650","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$700","$60","$3,800","$1,700","$0","$60","$1,400","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","$13,300","$13300 per person","$26600 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_6650.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080012","Sanford Simplicity SIMPLE CHOICE $6,650","31195SD008",,"SDN001","SDS001","SDF002","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080012-02","Sanford Simplicity SIMPLE CHOICE $6,650","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_6650_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080012","Sanford Simplicity SIMPLE CHOICE $6,650","31195SD008",,"SDN001","SDS001","SDF002","New","HMO","Expanded Bronze","Design 1","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080012-03","Sanford Simplicity SIMPLE CHOICE $6,650","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$700","$60","$3,800","$1,700","$0","$60","$1,400","$400","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","$14,700","$14700 per person","$29400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","$13,300","$13300 per person","$26600 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_6650_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-00","Sanford TRUE $3,500","Standard Silver Off Exchange Plan","70.80%","0.727926104913845","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$20","$2,400","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-01","Sanford TRUE $3,500","Standard Silver On Exchange Plan","70.80%","0.727926104913845","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$20","$2,400","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-02","Sanford TRUE $3,500","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_3500_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-03","Sanford TRUE $3,500","Limited Cost Sharing Plan Variation","70.80%","0.727926104913845","Yes","Yes","No","100%",,"$3,500","$40","$1,100","$60","$20","$2,400","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_3500_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-04","Sanford TRUE $3,500","73% AV Level Silver Plan","73.10%","0.749800953308837","Yes","Yes","No","100%",,"$3,000","$40","$1,200","$60","$20","$2,400","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_3500_73.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-05","Sanford TRUE $3,500","87% AV Level Silver Plan","86.50%","0.873041883221702","Yes","Yes","No","100%",,"$700","$0","$1,550","$60","$20","$1,600","$0","$60","$700","$100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_3500_87.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080018","Sanford TRUE $1,250","31195SD008",,"SDN002","SDS002","SDF019","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080018-00","Sanford TRUE $1,250","Standard Gold Off Exchange Plan","81.20%","0.824805976190172","Yes","Yes","No","100%",,"$1,250","$30","$1,500","$60","$20","$1,500","$0","$60","$1,250","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF017","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-06","Sanford TRUE $3,500","94% AV Level Silver Plan","94.30%","0.946469799559918","Yes","Yes","No","100%",,"$250","$10","$400","$60","$20","$400","$0","$60","$250","$70","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_3500_94.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080016","Sanford TRUE $4,750","31195SD008",,"SDN002","SDS002","SDF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080016-00","Sanford TRUE $4,750","Standard Silver Off Exchange Plan","67.60%","0.684924064961709","Yes","Yes","No","100%",,"$4,750","$40","$2,100","$60","$3,700","$1,200","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_4750.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080016","Sanford TRUE $4,750","31195SD008",,"SDN002","SDS002","SDF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080016-01","Sanford TRUE $4,750","Standard Silver On Exchange Plan","67.60%","0.684924064961709","Yes","Yes","No","100%",,"$4,750","$40","$2,100","$60","$3,700","$1,200","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_4750.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080016","Sanford TRUE $4,750","31195SD008",,"SDN002","SDS002","SDF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080016-02","Sanford TRUE $4,750","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_4750_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080016","Sanford TRUE $4,750","31195SD008",,"SDN002","SDS002","SDF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080016-03","Sanford TRUE $4,750","Limited Cost Sharing Plan Variation","67.60%","0.684924064961709","Yes","Yes","No","100%",,"$4,750","$40","$2,100","$60","$3,700","$1,200","$0","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_4750_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080016","Sanford TRUE $4,750","31195SD008",,"SDN002","SDS002","SDF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080016-04","Sanford TRUE $4,750","73% AV Level Silver Plan","72.20%","0.728063519552374","Yes","Yes","No","100%",,"$3,500","$30","$2,200","$60","$3,500","$1,000","$60","$60","$1,400","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_4750_73.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080016","Sanford TRUE $4,750","31195SD008",,"SDN002","SDS002","SDF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080016-05","Sanford TRUE $4,750","87% AV Level Silver Plan","86.20%","0.864299158266428","Yes","Yes","No","100%",,"$1,000","$0","$1,000","$60","$1,000","$400","$600","$60","$1,000","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_4750_87.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080016","Sanford TRUE $4,750","31195SD008",,"SDN002","SDS002","SDF005","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080016-06","Sanford TRUE $4,750","94% AV Level Silver Plan","93.20%","0.932961278163279","Yes","Yes","No","100%",,"$200","$0","$800","$60","$200","$300","$500","$60","$200","$100","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_4750_94.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080017","Sanford TRUE $2,800","31195SD008",,"SDN002","SDS002","SDF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080017-00","Sanford TRUE $2,800","Standard Silver Off Exchange Plan","71.00%","0.729621951902622","Yes","Yes","No","100%",,"$2,800","$40","$2,500","$60","$20","$2,400","$0","$60","$1,400","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_2800.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080017","Sanford TRUE $2,800","31195SD008",,"SDN002","SDS002","SDF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080017-01","Sanford TRUE $2,800","Standard Silver On Exchange Plan","71.00%","0.729621951902622","Yes","Yes","No","100%",,"$2,800","$40","$2,500","$60","$20","$2,400","$0","$60","$1,400","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_2800.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080017","Sanford TRUE $2,800","31195SD008",,"SDN002","SDS002","SDF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080017-02","Sanford TRUE $2,800","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_2800_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080017","Sanford TRUE $2,800","31195SD008",,"SDN002","SDS002","SDF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080017-05","Sanford TRUE $2,800","87% AV Level Silver Plan","86.20%","0.870176781566599","Yes","Yes","No","100%",,"$750","$0","$1,500","$60","$20","$1,500","$0","$60","$750","$200","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_2800_87.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080017","Sanford TRUE $2,800","31195SD008",,"SDN002","SDS002","SDF018","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080017-06","Sanford TRUE $2,800","94% AV Level Silver Plan","93.50%","0.939116656567483","Yes","Yes","No","100%",,"$300","$0","$700","$60","$20","$600","$0","$60","$300","$70","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_2800_94.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080018","Sanford TRUE $1,250","31195SD008",,"SDN002","SDS002","SDF019","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080018-01","Sanford TRUE $1,250","Standard Gold On Exchange Plan","81.20%","0.824805976190172","Yes","Yes","No","100%",,"$1,250","$30","$1,500","$60","$20","$1,500","$0","$60","$1,250","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_1250.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080018","Sanford TRUE $1,250","31195SD008",,"SDN002","SDS002","SDF019","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080018-02","Sanford TRUE $1,250","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_1250_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080018","Sanford TRUE $1,250","31195SD008",,"SDN002","SDS002","SDF019","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080018-03","Sanford TRUE $1,250","Limited Cost Sharing Plan Variation","81.20%","0.824805976190172","Yes","Yes","No","100%",,"$1,250","$30","$1,500","$60","$20","$1,500","$0","$60","$1,250","$200","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_1250_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080005","Sanford Simplicity $6,000","31195SD008",,"SDN001","SDS001","SDF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080005-00","Sanford Simplicity $6,000","Standard Bronze Off Exchange Plan","61.00%","0.606846570796385","Yes","Yes","No","100%",,"$6,000","$0","$1,200","$60","$4,400","$1,600","$0","$60","$1,800","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080005","Sanford Simplicity $6,000","31195SD008",,"SDN001","SDS001","SDF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080005-01","Sanford Simplicity $6,000","Standard Bronze On Exchange Plan","61.00%","0.606846570796385","Yes","Yes","No","100%",,"$6,000","$0","$1,200","$60","$4,400","$1,600","$0","$60","$1,800","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080005","Sanford Simplicity $6,000","31195SD008",,"SDN001","SDS001","SDF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080005-02","Sanford Simplicity $6,000","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_6000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080005","Sanford Simplicity $6,000","31195SD008",,"SDN001","SDS001","SDF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080005-03","Sanford Simplicity $6,000","Limited Cost Sharing Plan Variation","61.00%","0.606846570796385","Yes","Yes","No","100%",,"$6,000","$0","$1,200","$60","$4,400","$1,600","$0","$60","$1,800","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"$14,300","$14300 per person","$28600 per group","$14,300","$14300 per person","$28600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"$12,000","$12000 per person","$24000 per group","$12,000","$12000 per person","$24000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_simplicity_6000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080007","Sanford TRUE $6,000","31195SD008",,"SDN002","SDS002","SDF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080007-00","Sanford TRUE $6,000","Standard Bronze Off Exchange Plan","61.00%","0.606846570796385","Yes","Yes","No","100%",,"$6,000","$0","$1,150","$60","$4,400","$1,600","$0","$60","$1,800","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080007","Sanford TRUE $6,000","31195SD008",,"SDN002","SDS002","SDF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080007-01","Sanford TRUE $6,000","Standard Bronze On Exchange Plan","61.00%","0.606846570796385","Yes","Yes","No","100%",,"$6,000","$0","$1,150","$60","$4,400","$1,600","$0","$60","$1,800","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080007","Sanford TRUE $6,000","31195SD008",,"SDN002","SDS002","SDF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080007-02","Sanford TRUE $6,000","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$60","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_6000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","31195","SERFF","2017-10-17 20:15:27","Individual","No","91-1842494","31195SD0080007","Sanford TRUE $6,000","31195SD008",,"SDN002","SDS002","SDF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No","Emergency Only","No","Emergency or Urgent Care Only or With Plan Certification","No","https://hix.sanfordhealthplan.org","https://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080007-03","Sanford TRUE $6,000","Limited Cost Sharing Plan Variation","61.00%","0.606846570796385","Yes","Yes","No","100%",,"$6,000","$0","$1,150","$60","$4,400","$1,600","$0","$60","$1,800","$100","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,150","$7150 per person","$14300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/2018/i_sd_true_6000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-1600-2018.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020024","Avera 6550","60536SD002","7942203176","SDN001","SDS001","SDF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020024-01","Avera 6550","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$6,550","$0","$0","$0","$6,550","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.avera.org/app/files/public/70933/2018-avera-6550.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020024","Avera 6550","60536SD002","7942203176","SDN001","SDS001","SDF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020024-02","Avera 6550 Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.avera.org/app/files/public/70935/2018-avera-6550-zero-cost-share.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020024","Avera 6550","60536SD002","7942203176","SDN001","SDS001","SDF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020024-03","Avera 6550 Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$6,550","$0","$0","$0","$6,550","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.avera.org/app/files/public/70934/2018-avera-6550-limited-cost-share.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020029","Avera 2750","60536SD002","7942203176","SDN001","SDS001","SDF015","New","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020029-00","Avera 2750","Standard Silver Off Exchange Plan",,"0.661469611284515","Yes","Yes","No","100%",,"$2,750","$0","$3,790","$0","$2,750","$0","$2,155","$0","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/70913/2018-avera-2750.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020029","Avera 2750","60536SD002","7942203176","SDN001","SDS001","SDF015","New","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020029-01","Avera 2750","Standard Silver On Exchange Plan",,"0.661469611284515","Yes","Yes","No","100%",,"$2,750","$0","$3,790","$0","$2,750","$0","$2,155","$0","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/70913/2018-avera-2750.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020011","Avera 4000","60536SD002","7942203176","SDN001","SDS001","SDF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-00","Avera 4000","Standard Silver Off Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.avera.org/app/files/public/70925/2018-avera-4000.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020011","Avera 4000","60536SD002","7942203176","SDN001","SDS001","SDF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-01","Avera 4000","Standard Silver On Exchange Plan",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.avera.org/app/files/public/70925/2018-avera-4000.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020011","Avera 4000","60536SD002","7942203176","SDN001","SDS001","SDF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-02","Avera 4000 Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.avera.org/app/files/public/70927/2018-avera-4000-zero-cost-share.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020011","Avera 4000","60536SD002","7942203176","SDN001","SDS001","SDF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-03","Avera 4000 Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.700980890927353","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.avera.org/app/files/public/70926/2018-avera-4000-limited-cost-share.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020011","Avera 4000","60536SD002","7942203176","SDN001","SDS001","SDF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-04","Avera 3200","73% AV Level Silver Plan",,"0.736771900647582","Yes","Yes","No","100%",,"$3,200","$0","$0","$0","$3,200","$0","$0","$0","$1,925","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.avera.org/app/files/public/70921/2018-avera-3200.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020011","Avera 4000","60536SD002","7942203176","SDN001","SDS001","SDF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-05","Avera 1100","87% AV Level Silver Plan",,"0.875613200854952","Yes","Yes","No","100%",,"$1,100","$0","$0","$0","$1,100","$0","$0","$0","$1,100","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/70905/2018-avera-1100.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020011","Avera 4000","60536SD002","7942203176","SDN001","SDS001","SDF006","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-06","Avera 500","94% AV Level Silver Plan",,"0.937977329745955","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$0","$500","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/70902/2018-avera-500.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020024","Avera 6550","60536SD002","7942203176","SDN001","SDS001","SDF006","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020024-00","Avera 6550","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$6,550","$0","$0","$0","$6,550","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.avera.org/app/files/public/70933/2018-avera-6550.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020029","Avera 2750","60536SD002","7942203176","SDN001","SDS001","SDF015","New","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020029-02","Avera 2750 Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.avera.org/app/files/public/70915/2018-avera-2750-zero-cost-share.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020022","Avera 3500","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-05","Avera 1150","87% AV Level Silver Plan",,"0.861082185421461","No","Yes","No","100%",,"$1,150","$0","$1,050","$0","$1,007","$522","$671","$0","$827","$110","$552","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70906/2018-avera-1150.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","UT","14948","SERFF","2017-08-16 20:15:58","Individual","Yes","86-0672505","14948UT0010004","DeltaCare USA Pediatric Preferred Plan","14948UT001",,"UTN001","UTS001",,"New","HMO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","14948UT0010004-00","DeltaCare USA Pediatric Preferred Plan","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/14948ut0010004-18"
"2018","UT","14948","SERFF","2017-08-16 20:15:58","Individual","Yes","86-0672505","14948UT0010003","DeltaCare USA Pediatric Basic Plan","14948UT001",,"UTN001","UTS001",,"New","HMO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","14948UT0010003-00","DeltaCare USA Pediatric Basic Plan","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/14948ut0010003-18"
"2018","UT","14948","SERFF","2017-08-16 20:15:58","Individual","Yes","86-0672505","14948UT0040004","DeltaCare USA Preferred Plan for Families","14948UT004",,"UTN001","UTS001",,"New","HMO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","14948UT0040004-01","DeltaCare USA Preferred Plan for Families","Standard High On Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/14948ut0040004-18"
"2018","UT","14948","SERFF","2017-08-16 20:15:58","Individual","Yes","86-0672505","14948UT0040003","DeltaCare USA Basic Plan for Families","14948UT004",,"UTN001","UTS001",,"New","HMO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","14948UT0040003-01","DeltaCare USA Basic Plan for Families","Standard Low On Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/14948ut0040003-18"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020029","Avera 2750","60536SD002","7942203176","SDN001","SDS001","SDF015","New","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020029-03","Avera 2750 Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.661469611284515","Yes","Yes","No","100%",,"$2,750","$0","$3,790","$0","$2,750","$0","$2,155","$0","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,100","$7100 per person","$14200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/70914/2018-avera-2750-limited-cost-share.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020029","Avera 2750","60536SD002","7942203176","SDN001","SDS001","SDF015","New","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020029-04","Avera 1400","73% AV Level Silver Plan",,"0.737026070507767","Yes","Yes","No","100%",,"$1,400","$0","$3,600","$0","$1,400","$0","$2,155","$0","$1,348","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/70907/2018-avera-1400.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020029","Avera 2750","60536SD002","7942203176","SDN001","SDS001","SDF015","New","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020029-05","Avera 550","87% AV Level Silver Plan",,"0.865249319898317","Yes","Yes","No","100%",,"$550","$0","$985","$0","$550","$0","$950","$0","$550","$0","$578","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/70903/2018-avera-550.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020029","Avera 2750","60536SD002","7942203176","SDN001","SDS001","SDF015","New","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020029-06","Avera 200","94% AV Level Silver Plan",,"0.935516961509925","Yes","Yes","No","100%",,"$125","$0","$475","$0","$200","$0","$400","$0","$200","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/70899/2018-avera-200.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020018","Avera 7350","60536SD002","7942203176","SDN001","SDS001","SDF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020018-00","Avera 7350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$7,184","$0","$0","$0","$1,925","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/70936/2018-avera-7350.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020018","Avera 7350","60536SD002","7942203176","SDN001","SDS001","SDF006","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020018-01","Avera 7350","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$7,184","$0","$0","$0","$1,925","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/70936/2018-avera-7350.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020007","Avera 1500","60536SD002","7942203176","SDN001","SDS001","SDF009","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020007-00","Avera 1500","Standard Gold Off Exchange Plan",,"0.805629307539761","No","Yes","No","100%",,"$1,500","$0","$2,000","$0","$1,270","$1,675","$555","$0","$991","$250","$425","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70908/2018-avera-1500.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020007","Avera 1500","60536SD002","7942203176","SDN001","SDS001","SDF009","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020007-01","Avera 1500","Standard Gold On Exchange Plan",,"0.805629307539761","No","Yes","No","100%",,"$1,500","$0","$2,000","$0","$1,270","$1,675","$555","$0","$991","$250","$425","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70908/2018-avera-1500.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020007","Avera 1500","60536SD002","7942203176","SDN001","SDS001","SDF009","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020007-02","Avera 1500 Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70910/2018-avera-1500-zero-cost-share.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020007","Avera 1500","60536SD002","7942203176","SDN001","SDS001","SDF009","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020007-03","Avera 1500 Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.805629307539761","No","Yes","No","100%",,"$1,500","$0","$2,000","$0","$1,270","$1,675","$555","$0","$991","$250","$425","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70909/2018-avera-1500-limited-cost-share.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020022","Avera 3500","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-00","Avera 3500","Standard Silver Off Exchange Plan",,"0.696260414334462","No","Yes","No","100%",,"$2,190","$0","$4,960","$0","$1,117","$1,905","$745","$0","$827","$440","$552","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70922/2018-avera-3500.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020022","Avera 3500","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-01","Avera 3500","Standard Silver On Exchange Plan",,"0.696260414334462","No","Yes","No","100%",,"$2,190","$0","$4,960","$0","$1,117","$1,985","$745","$0","$827","$490","$552","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70922/2018-avera-3500.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020022","Avera 3500","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-02","Avera 3500 Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70924/2018-avera-3500-zero-cost-share.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020022","Avera 3500","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-03","Avera 3500 Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.696260414334462","No","Yes","No","100%",,"$2,190","$0","$4,960","$0","$1,117","$1,985","$745","$0","$827","$490","$552","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70923/2018-avera-3500-limited-cost-share.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020022","Avera 3500","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-04","Avera 2850","73% AV Level Silver Plan",,"0.732826728717569","No","Yes","No","100%",,"$2,064","$0","$3,536","$0","$1,117","$1,255","$745","$0","$827","$330","$552","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,850","$2850 per person","$5700 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70919/2018-avera-2850.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020022","Avera 3500","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-06","Avera 400","94% AV Level Silver Plan",,"0.933560413877234","No","Yes","No","100%",,"$107","$0","$693","$0","$400","$82","$318","$0","$400","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70901/2018-avera-400.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020010","Avera 2800","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-00","Avera 2800","Standard Silver Off Exchange Plan",,"0.714572050164313","No","Yes","No","100%",,"$2,140","$0","$4,960","$0","$1,117","$1,950","$745","$0","$827","$450","$552","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70916/2018-avera-2800.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020010","Avera 2800","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-01","Avera 2800","Standard Silver On Exchange Plan",,"0.714572050164313","No","Yes","No","100%",,"$2,140","$0","$4,960","$0","$1,117","$1,950","$745","$0","$827","$450","$552","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70916/2018-avera-2800.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020010","Avera 2800","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-02","Avera 2800 Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70918/2018-avera-2800-zero-cost-share.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020010","Avera 2800","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-03","Avera 2800 Limited Cost Share","Limited Cost Sharing Plan Variation",,"0.714572050164313","No","Yes","No","100%",,"$2,140","$0","$4,960","$0","$1,117","$1,950","$745","$0","$827","$450","$552","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70917/2018-avera-2800-limited-cost-share.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020010","Avera 2800","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-04","Avera 2700","73% AV Level Silver Plan",,"0.737773055001993","No","Yes","No","100%",,"$2,064","$0","$336","$0","$1,117","$1,255","$745","$0","$827","$330","$552","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,700","$2700 per person","$5400 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70912/2018-avera-2700.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020010","Avera 2800","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-05","Avera 1000","87% AV Level Silver Plan",,"0.864283381272558","No","Yes","No","100%",,"$1,000","$0","$1,200","$0","$1,000","$525","$675","$0","$827","$110","$552","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70904/2018-avera-1000.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020010","Avera 2800","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-06","Avera 300","94% AV Level Silver Plan",,"0.940649329512161","No","Yes","No","100%",,"$107","$0","$593","$0","$300","$82","$318","$0","$300","$0","$400","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40.00%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70900/2018-avera-300.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020023","Avera 5500","60536SD002","7942203176","SDN001","SDS001","SDF012","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020023-00","Avera 5500","Standard Bronze Off Exchange Plan",,"0.610060990993953","No","Yes","No","100%",,"$2,390","$0","$4,960","$0","$1,331","$1,915","$854","$0","$1,003","$200","$669","$0","$250","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","40.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70929/2018-avera-5500.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020023","Avera 5500","60536SD002","7942203176","SDN001","SDS001","SDF012","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020023-01","Avera 5500","Standard Bronze On Exchange Plan",,"0.610060990993953","No","Yes","No","100%",,"$2,390","$0","$4,960","$0","$1,331","$1,915","$854","$0","$1,003","$200","$669","$0","$250","0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","40.00%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70929/2018-avera-5500.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","60536","SERFF","2017-10-17 20:15:27","Individual","No","46-0451539","60536SD0020023","Avera 5500","60536SD002","7942203176","SDN001","SDS001","SDF012","Existing","PPO","Bronze","Not Applicable","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=avera@instamed.net&ssoAlias=AVERASSO&id=AVERA.FFM","http://www.avera.org/marketplace/drug-formulary/","60536SD0020023-02","Avera 5500 Zero Cost Share","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/70931/2018-avera-5500-zero-cost-share.pdf","https://www.avera.org/app/files/public/70982/2018-ind-brochure-avhp.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","SHOP (Small Group)","Yes","95-6042390","61214SD0010008","BESTDental Standard - H","61214SD001",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTDental_Standard-H_Plan.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","Individual","Yes","95-6042390","61214SD0020004","BESTOne Plus Gold","61214SD002",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020004-01","BESTOne Plus Gold","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTOne_Dental_Plus-Gold_Plan.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","SHOP (Small Group)","Yes","95-6042390","61214SD0010010","BESTDental Choice - H","61214SD001",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTDental_Choice-H_Plan.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","SHOP (Small Group)","Yes","95-6042390","61214SD0010010","BESTDental Choice - H","61214SD001",,"SDN001","SDS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTDental_Choice-H_Plan.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","Individual","Yes","95-6042390","61214SD0020005","BESTOne Plus Silver","61214SD002",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020005-00","BESTOne Plus Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","SHOP (Small Group)","Yes","95-6042390","61214SD0010009","BESTDental Standard - L","61214SD001",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTDental_Standard-L_Plan.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","SHOP (Small Group)","Yes","95-6042390","61214SD0010009","BESTDental Standard - L","61214SD001",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTDental_Standard-L_Plan.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","Individual","Yes","95-6042390","61214SD0020005","BESTOne Plus Silver","61214SD002",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020005-01","BESTOne Plus Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTOne_Dental_Plus-Silver_Plan.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","SHOP (Small Group)","Yes","95-6042390","61214SD0010011","BESTDental Choice - L","61214SD001",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTDental_Choice-L_Plan.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","Individual","Yes","95-6042390","61214SD0020006","BESTOne Basic Silver","61214SD002",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020006-00","BESTOne Basic Silver","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","Individual","Yes","95-6042390","61214SD0020006","BESTOne Basic Silver","61214SD002",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020006-01","BESTOne Basic Silver","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTOne_Dental_Basic-Silver_Plan.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","SHOP (Small Group)","Yes","95-6042390","61214SD0010011","BESTDental Choice - L","61214SD001",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTDental_Choice-L_Plan.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","SHOP (Small Group)","Yes","95-6042390","61214SD0010012","BESTDental Value","61214SD001",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTDental_Value_Plan.pdf"
"2018","SD","61214","SERFF","2017-06-22 20:15:42","SHOP (Small Group)","Yes","95-6042390","61214SD0010012","BESTDental Value","61214SD001",,"SDN001","SDS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/current/SD_BESTDental_Value_Plan.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060001","Healthy Premier Gold Copay","42261UT006",,"UTN001","UTS001","UTF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060001-03","Healthy Premier Gold Copay","Limited Cost Sharing Plan Variation",,"0.763810881549805","No","Yes","No","100%",,"$1,500","$100","$1,600","$60","$2,000","$700","$800","$50","$1,500","$100","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypremier-goldcopaylimited.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypremier-goldcopaylimited.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060002","Healthy Premier Silver Copay","42261UT006",,"UTN001","UTS001","UTF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060002-00","Healthy Premier Silver Copay","Standard Silver Off Exchange Plan",,"0.663899431843566","No","Yes","No","100%",,"$4,500","$0","$2,800","$50","$3,100","$900","$600","$50","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypremier-silvercopay.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypremier-silvercopay.pdf"
"2018","UT","40335","SERFF","2017-09-21 20:16:21","Individual","Yes","20-4023720","40335UT0010001","EMI Health Choice PPO (High)","40335UT001",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.5636","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0010001-01","PPO High","Standard High On Exchange Plan","85.05%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/ut-federal-marketplace-dental.aspx"
"2018","UT","40335","SERFF","2017-09-21 20:16:21","SHOP (Small Group)","Yes","20-4023720","40335UT0040001","EMI Health Choice Indemnity","40335UT004",,"UTN001","UTS001",,"Existing","Indemnity","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.4539","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","Indemnity network or out-of-network coverage at R&C fee","Yes",,"","40335UT0040001-01","EMI Health Choice Indemnity","Standard High On Exchange Plan","83.09%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/group-products/shop-dental.aspx"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060004","Healthy Preferred Gold Copay","42261UT006",,"UTN002","UTS002","UTF001","New","EPO","Gold","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060004-02","Healthy Preferred Gold Copay","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypreferred-goldcopayzero.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypreferred-goldcopayzero.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060005","Healthy Preferred Silver Copay","42261UT006",,"UTN002","UTS002","UTF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060005-06","Healthy Preferred Silver Copay","94% AV Level Silver Plan",,"0.934574250481174","No","Yes","No","100%",,"$0","$20","$1,200","$60","$0","$200","$500","$50","$0","$800","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypreferred-silvercsr94.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypreferred-silvercsr94.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060006","Healthy Preferred Bronze HSA","42261UT006",,"UTN002","UTS002","UTF003","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060006-00","Healthy Preferred Bronze HSA","Standard Bronze Off Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$50","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypreferred-bronzehsa.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypreferred-bronzehsa.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060006","Healthy Preferred Bronze HSA","42261UT006",,"UTN002","UTS002","UTF003","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060006-01","Healthy Preferred Bronze HSA","Standard Bronze On Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$50","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypreferred-bronzehsa.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypreferred-bronzehsa.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060006","Healthy Preferred Bronze HSA","42261UT006",,"UTN002","UTS002","UTF003","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060006-02","Healthy Preferred Bronze HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypreferred-bronzehsazero.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypreferred-bronzehsazero.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060006","Healthy Preferred Bronze HSA","42261UT006",,"UTN002","UTS002","UTF003","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060006-03","Healthy Preferred Bronze HSA","Limited Cost Sharing Plan Variation",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$50","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypreferred-bronzehsalimited.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypreferred-bronzehsalimited.pdf"
"2018","UT","40335","SERFF","2017-09-21 20:16:21","SHOP (Small Group)","Yes","20-4023720","40335UT0060001","EMI Health Choice PPO","40335UT006",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.3059","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0060001-01","EMI Health Choice PPO","Standard High On Exchange Plan","83.09%",,,,"Yes","50%","50%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/group-products/shop-dental.aspx"
"2018","UT","40335","SERFF","2017-09-21 20:16:21","SHOP (Small Group)","Yes","20-4023720","40335UT0060002","EMI Health Advantage Plus PPO","40335UT006",,"UTN002","UTS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.3675","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0060002-01","EMI Health Advantage Plus PPO","Standard High On Exchange Plan","85.59%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$20","$20 per person","$60 per group",,,,,,"$20","$20 per person","$60 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/group-products/shop-dental.aspx"
"2018","UT","40335","SERFF","2017-09-21 20:16:21","SHOP (Small Group)","Yes","20-4023720","40335UT0050001","EMI Health Advantage Co-Pay","40335UT005",,"UTN002","UTS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.7572","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0050001-01","EMI Health Advantage Co-Pay","Standard High On Exchange Plan","86.47%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/group-products/shop-dental.aspx"
"2018","UT","40335","SERFF","2017-09-21 20:16:21","Individual","Yes","20-4023720","40335UT0020001","EMI Health Advantage Co-Pay","40335UT002",,"UTN002","UTS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.6935","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0020001-01","EMI Health Advantage Co-Pay","Standard High On Exchange Plan","83.42%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/ut-federal-marketplace-dental.aspx"
"2018","UT","40335","SERFF","2017-09-21 20:16:21","SHOP (Small Group)","Yes","20-4023720","40335UT0050002","EMI Health Premier Co-Pay","40335UT005",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.7368","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0050002-01","EMI Health Premier Co-Pay","Standard High On Exchange Plan","86.47%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/group-products/shop-dental.aspx"
"2018","UT","40335","SERFF","2017-09-21 20:16:21","Individual","Yes","20-4023720","40335UT0020002","EMI Health Choice PPO","40335UT002",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.509","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0020002-01","EMI Health Choice PPO","Standard High On Exchange Plan","85.05%",,,,"Yes","65%","35%",,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/ut-federal-marketplace-dental.aspx"
"2018","UT","40335","SERFF","2017-09-21 20:16:21","SHOP (Small Group)","Yes","20-4023720","40335UT0100001","EMI Health Premier PPO 100/80","40335UT010",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.5441","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0100001-01","EMI Health Premier PPO 100/80","Standard High On Exchange Plan","86.47%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/group-products/shop-dental.aspx"
"2018","UT","40335","SERFF","2017-09-21 20:16:21","Individual","Yes","20-4023720","40335UT0110001","EMI Health EHB Pediatric Plan – Advantage Network","40335UT011",,"UTN002","UTS001",,"Existing","EPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0110001-01","EMI Health EHB Pediatric Plan – Advantage Network","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/ut-federal-marketplace-dental.aspx"
"2018","UT","40335","SERFF","2017-09-21 20:16:21","Individual","Yes","20-4023720","40335UT0110002","EMI Health EHB Pediatric Plan – Premier Network","40335UT011",,"UTN001","UTS001",,"Existing","EPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0110002-01","EMI Health EHB Pediatric Plan – Premier Network","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://emihealth.com/emi/products/federal-marketplace/ut-federal-marketplace-dental.aspx"
"2018","UT","40335","SERFF","2017-09-21 20:16:21","SHOP (Small Group)","Yes","20-4023720","40335UT0080001","EMI Health Premier PPO 100","40335UT008",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.","Yes","PPO network or out-of-network coverage at PPO fee","Yes",,"","40335UT0080001-01","EMI Health Premier PPO 100","Standard High On Exchange Plan","86.47%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/group-products/shop-dental.aspx"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060001","Healthy Premier Gold Copay","42261UT006",,"UTN001","UTS001","UTF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060001-00","Healthy Premier Gold Copay","Standard Gold Off Exchange Plan",,"0.763810881549805","No","Yes","No","100%",,"$1,500","$100","$1,600","$60","$2,000","$700","$800","$50","$1,500","$100","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypremier-goldcopay.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypremier-goldcopay.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060001","Healthy Premier Gold Copay","42261UT006",,"UTN001","UTS001","UTF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060001-01","Healthy Premier Gold Copay","Standard Gold On Exchange Plan",,"0.763810881549805","No","Yes","No","100%",,"$1,500","$100","$1,600","$60","$2,000","$700","$800","$50","$1,500","$100","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypremier-goldcopay.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypremier-goldcopay.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060001","Healthy Premier Gold Copay","42261UT006",,"UTN001","UTS001","UTF001","Existing","EPO","Gold","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060001-02","Healthy Premier Gold Copay","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypremier-goldcopayzero.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypremier-goldcopayzero.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060002","Healthy Premier Silver Copay","42261UT006",,"UTN001","UTS001","UTF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060002-01","Healthy Premier Silver Copay","Standard Silver On Exchange Plan",,"0.663899431843566","No","Yes","No","100%",,"$4,500","$0","$2,800","$50","$3,100","$900","$600","$50","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypremier-silvercopay.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypremier-silvercopay.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060002","Healthy Premier Silver Copay","42261UT006",,"UTN001","UTS001","UTF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060002-02","Healthy Premier Silver Copay","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypremier-silvercopayzero.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypremier-silvercopayzero.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060002","Healthy Premier Silver Copay","42261UT006",,"UTN001","UTS001","UTF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060002-03","Healthy Premier Silver Copay","Limited Cost Sharing Plan Variation",,"0.663899431843566","No","Yes","No","100%",,"$4,500","$0","$2,800","$50","$3,100","$900","$600","$50","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypremier-silvercopaylimited.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypremier-silvercopaylimited.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060002","Healthy Premier Silver Copay","42261UT006",,"UTN001","UTS001","UTF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060002-04","Healthy Premier Silver Copay","73% AV Level Silver Plan",,"0.72371968797111","No","Yes","No","100%",,"$3,000","$0","$2,800","$50","$2,200","$800","$800","$50","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypremier-silvercsr73.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypremier-silvercsr73.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060002","Healthy Premier Silver Copay","42261UT006",,"UTN001","UTS001","UTF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060002-05","Healthy Premier Silver Copay","87% AV Level Silver Plan",,"0.866659966751569","No","Yes","No","100%",,"$400","$0","$2,000","$50","$600","$500","$1,200","$50","$400","$1,100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypremier-silvercsr87.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypremier-silvercsr87.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060002","Healthy Premier Silver Copay","42261UT006",,"UTN001","UTS001","UTF001","Existing","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060002-06","Healthy Premier Silver Copay","94% AV Level Silver Plan",,"0.934574250481174","No","Yes","No","100%",,"$0","$20","$1,200","$60","$0","$200","$500","$50","$0","$800","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypremier-silvercsr94.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypremier-silvercsr94.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060003","Healthy Premier Bronze HSA","42261UT006",,"UTN001","UTS001","UTF003","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060003-00","Healthy Premier Bronze HSA","Standard Bronze Off Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$50","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypremier-bronzehsa.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypremier-bronzehsa.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060003","Healthy Premier Bronze HSA","42261UT006",,"UTN001","UTS001","UTF003","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060003-01","Healthy Premier Bronze HSA","Standard Bronze On Exchange Plan",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$50","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypremier-bronzehsa.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypremier-bronzehsa.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060003","Healthy Premier Bronze HSA","42261UT006",,"UTN001","UTS001","UTF003","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060003-02","Healthy Premier Bronze HSA","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypremier-bronzehsazero.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypremier-bronzehsazero.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060003","Healthy Premier Bronze HSA","42261UT006",,"UTN001","UTS001","UTF003","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060003-03","Healthy Premier Bronze HSA","Limited Cost Sharing Plan Variation",,"0.602242888854189","Yes","Yes","No","100%",,"$6,650","$0","$0","$60","$6,650","$0","$0","$50","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypremier-bronzehsalimited.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypremier-bronzehsalimited.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0070001","Healthy Premier Bronze w/3 Copays before Deductible","42261UT007",,"UTN001","UTS001","UTF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0070001-00","Healthy Premier Bronze w/3 Copays before Deductible","Standard Bronze Off Exchange Plan",,"0.606372876058882","Yes","Yes","No","100%",,"6550","0","750","60","6200","1150","0","50","1900","0","0","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypremier-bronze3copays.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypremier-bronze3copays.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0070001","Healthy Premier Bronze w/3 Copays before Deductible","42261UT007",,"UTN001","UTS001","UTF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0070001-01","Healthy Premier Bronze w/3 Copays before Deductible","Standard Bronze On Exchange Plan",,"0.606372876058882","Yes","Yes","No","100%",,"6550","0","750","60","6200","1150","0","50","1900","0","0","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypremier-bronze3copays.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypremier-bronze3copays.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0070001","Healthy Premier Bronze w/3 Copays before Deductible","42261UT007",,"UTN001","UTS001","UTF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0070001-02","Healthy Premier Bronze w/3 Copays before Deductible","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"0","0","0","0","0","0","0","0","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"0","$0 per person","$0 per group","0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypremier-bronzecopayzero.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypremier-bronzecopayzero.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0070001","Healthy Premier Bronze w/3 Copays before Deductible","42261UT007",,"UTN001","UTS001","UTF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0070001-03","Healthy Premier Bronze w/3 Copays before Deductible","Limited Cost Sharing Plan Variation",,"0.606372876058882","Yes","Yes","No","100%",,"6550","0","750","60","6200","1150","0","50","1900","0","0","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypremier-bronzecopaylimited.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypremier-bronzecopaylimited.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060004","Healthy Preferred Gold Copay","42261UT006",,"UTN002","UTS002","UTF001","New","EPO","Gold","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060004-00","Healthy Preferred Gold Copay","Standard Gold Off Exchange Plan",,"0.763810881549805","No","Yes","No","100%",,"$1,500","$100","$1,600","$60","$2,000","$700","$800","$50","$1,500","$100","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypreferred-goldcopay.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypreferred-goldcopay.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060004","Healthy Preferred Gold Copay","42261UT006",,"UTN002","UTS002","UTF001","New","EPO","Gold","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060004-01","Healthy Preferred Gold Copay","Standard Gold On Exchange Plan",,"0.763810881549805","No","Yes","No","100%",,"$1,500","$100","$1,600","$60","$2,000","$700","$800","$50","$1,500","$100","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypreferred-goldcopay.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypreferred-goldcopay.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0070002","Healthy Preferred Bronze w/3 Copays before Deductible","42261UT007",,"UTN002","UTS002","UTF002","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0070002-00","Healthy Preferred Bronze w/3 Copays before Deductible","Standard Bronze Off Exchange Plan",,"0.606372876058882","Yes","Yes","No","100%",,"6550","0","750","60","6200","1150","0","50","1900","0","0","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypreferred-bronze3copays.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypreferred-bronze3copays.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0070002","Healthy Preferred Bronze w/3 Copays before Deductible","42261UT007",,"UTN002","UTS002","UTF002","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0070002-01","Healthy Preferred Bronze w/3 Copays before Deductible","Standard Bronze On Exchange Plan",,"0.606372876058882","Yes","Yes","No","100%",,"6550","0","750","60","6200","1150","0","50","1900","0","0","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypreferred-bronze3copays.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypreferred-bronze3copays.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060004","Healthy Preferred Gold Copay","42261UT006",,"UTN002","UTS002","UTF001","New","EPO","Gold","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060004-03","Healthy Preferred Gold Copay","Limited Cost Sharing Plan Variation",,"0.763810881549805","No","Yes","No","100%",,"$1,500","$100","$1,600","$60","$2,000","$700","$800","$50","$1,500","$100","$20","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypreferred-goldcopaylimited.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypreferred-goldcopaylimited.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060005","Healthy Preferred Silver Copay","42261UT006",,"UTN002","UTS002","UTF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060005-00","Healthy Preferred Silver Copay","Standard Silver Off Exchange Plan",,"0.663899431843566","No","Yes","No","100%",,"$4,500","$0","$2,800","$50","$3,100","$900","$600","$50","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypreferred-silvercopay.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypreferred-silvercopay.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060005","Healthy Preferred Silver Copay","42261UT006",,"UTN002","UTS002","UTF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060005-01","Healthy Preferred Silver Copay","Standard Silver On Exchange Plan",,"0.663899431843566","No","Yes","No","100%",,"$4,500","$0","$2,800","$50","$3,100","$900","$600","$50","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypreferred-silvercopay.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypreferred-silvercopay.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060005","Healthy Preferred Silver Copay","42261UT006",,"UTN002","UTS002","UTF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060005-02","Healthy Preferred Silver Copay","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypreferred-silvercopayzero.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypreferred-silvercopayzero.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060005","Healthy Preferred Silver Copay","42261UT006",,"UTN002","UTS002","UTF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060005-03","Healthy Preferred Silver Copay","Limited Cost Sharing Plan Variation",,"0.663899431843566","No","Yes","No","100%",,"$4,500","$0","$2,800","$50","$3,100","$900","$600","$50","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypreferred-silvercopaylimited.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypreferred-silvercopaylimited.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060005","Healthy Preferred Silver Copay","42261UT006",,"UTN002","UTS002","UTF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060005-04","Healthy Preferred Silver Copay","73% AV Level Silver Plan",,"0.72371968797111","No","Yes","No","100%",,"$3,000","$0","$2,800","$50","$2,200","$800","$800","$50","$1,600","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypreferred-silvercsr73.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypreferred-silvercsr73.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0060005","Healthy Preferred Silver Copay","42261UT006",,"UTN002","UTS002","UTF001","New","EPO","Silver","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0060005-05","Healthy Preferred Silver Copay","87% AV Level Silver Plan",,"0.866659966751569","No","Yes","No","100%",,"$400","$0","$2,000","$50","$600","$500","$1,200","$50","$400","$1,100","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypreferred-silvercsr87.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypreferred-silvercsr87.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0070002","Healthy Preferred Bronze w/3 Copays before Deductible","42261UT007",,"UTN002","UTS002","UTF002","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0070002-02","Healthy Preferred Bronze w/3 Copays before Deductible","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"0","0","0","0","0","0","0","0","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"0","$0 per person","$0 per group","0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypreferred-bronzecopayzero.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypreferred-bronzecopayzero.pdf"
"2018","UT","42261","SERFF","2017-09-21 20:16:21","Individual","No","47-2293857","42261UT0070002","Healthy Preferred Bronze w/3 Copays before Deductible","42261UT007",,"UTN002","UTS002","UTF002","New","EPO","Bronze","Not Applicable","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9947",,,"2018-01-01","2018-12-31","No","Emergent Only","Yes","Services at In-Network providers and emergency services are covered out of service area","No","https://enroll.uhealthplan.utah.edu/ehp/eapp/samlpaymentacs","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0070002-03","Healthy Preferred Bronze w/3 Copays before Deductible","Limited Cost Sharing Plan Variation",,"0.606372876058882","Yes","Yes","No","100%",,"6550","0","750","60","6200","1150","0","50","1900","0","0","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://uhealthplan.utah.edu/individual/pdf/2018/sbc/healthypreferred-bronzecopaylimited.pdf","http://uhealthplan.utah.edu/individual/pdf/2018/plan-brochure/healthypreferred-bronzecopaylimited.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","42757UT0020003","BESTOne Advantage High","42757UT002",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020003-00","BESTOne Advantage High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/current/UT_BESTOne_Dental_Advantage-High_Plan.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","42757UT0010007","BESTDental Premium","42757UT001",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/exchange/paybill.html","","42757UT0010007-00","BESTDental Premium","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2017/UT_BESTDental_Premium_Plan.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","42757UT0010007","BESTDental Premium","42757UT001",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/exchange/paybill.html","","42757UT0010007-01","BESTDental Premium","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2017/UT_BESTDental_Premium_Plan.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","42757UT0020003","BESTOne Advantage High","42757UT002",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020003-01","BESTOne Advantage High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/current/UT_BESTOne_Dental_Advantage-High_Plan.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","42757UT0020004","BESTOne Plus High","42757UT002",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020004-00","BESTOne Plus High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/current/UT_BESTOne_Dental_Plus-High_Plan.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","42757UT0010008","BESTDental Standard - H","42757UT001",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/exchange/paybill.html","","42757UT0010008-00","BESTDental Standard - H","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2017/UT_BESTDental_Standard-H_Plan.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","42757UT0010008","BESTDental Standard - H","42757UT001",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/exchange/paybill.html","","42757UT0010008-01","BESTDental Standard - H","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2017/UT_BESTDental_Standard-H_Plan.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","42757UT0020004","BESTOne Plus High","42757UT002",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020004-01","BESTOne Plus High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/current/UT_BESTOne_Dental_Plus-High_Plan.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","42757UT0010010","BESTDental Choice - H","42757UT001",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/exchange/paybill.html","","42757UT0010010-00","BESTDental Choice - H","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2017/UT_BESTDental_Choice-H_Plan.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","42757UT0010010","BESTDental Choice - H","42757UT001",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","https://www.bestlife.com/exchange/paybill.html","","42757UT0010010-01","BESTDental Choice - H","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2017/UT_BESTDental_Choice-H_Plan.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","42757UT0020005","BESTOne Plus","42757UT002",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020005-00","BESTOne Plus","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/current/UT_BESTOne_Dental_Plus-Low_Plan.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","42757UT0010009","BESTDental Standard - L","42757UT001",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0010009-00","BESTDental Standard - L","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/current/UT_BESTDental_Standard-L_Plan.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","42757UT0010009","BESTDental Standard - L","42757UT001",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0010009-01","BESTDental Standard - L","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/current/UT_BESTDental_Standard-L_Plan.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","42757UT0020005","BESTOne Plus","42757UT002",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020005-01","BESTOne Plus","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/current/UT_BESTOne_Dental_Plus-Low_Plan.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","42757UT0010011","BESTDental Choice - L","42757UT001",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0010011-00","BESTDental Choice - L","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/current/UT_BESTDental_Choice-L_Plan.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","42757UT0020006","BESTOne Basic","42757UT002",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020006-00","BESTOne Basic","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/current/UT_BESTOne_Dental_Basic-Low_Plan.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","Individual","Yes","95-6042390","42757UT0020006","BESTOne Basic","42757UT002",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Estimated Rate","2018-01-01","2018-12-31","No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020006-01","BESTOne Basic","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/current/UT_BESTOne_Dental_Basic-Low_Plan.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","42757UT0010011","BESTDental Choice - L","42757UT001",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0010011-01","BESTDental Choice - L","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/current/UT_BESTDental_Choice-L_Plan.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","42757UT0010012","BESTDental Value","42757UT001",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0010012-00","BESTDental Value","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/current/UT_BESTDental_Value_Plan.pdf"
"2018","UT","42757","SERFF","2017-08-16 20:15:58","SHOP (Small Group)","Yes","95-6042390","42757UT0010012","BESTDental Value","42757UT001",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.98","Guaranteed Rate","2018-01-01",,"No",,"Yes","Full","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0010012-01","BESTDental Value","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/current/UT_BESTDental_Value_Plan.pdf"
"2018","VA","10207","SERFF","2017-09-22 20:15:56","Individual","No","52-1358219","10207VA0380003","HealthyBlue HMO Gold $1,000","10207VA038",,"VAN002","VAS001","VAF011","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994536054211409",,,"2018-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://carefirst.com/acarx","10207VA0380003-02","HealthyBlue HMO Gold $1,000","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/HENVCN7LRXXVCN7DN012018.pdf",
"2018","VA","10207","SERFF","2017-09-22 20:15:56","Individual","No","52-1358219","10207VA0380003","HealthyBlue HMO Gold $1,000","10207VA038",,"VAN002","VAS001","VAF011","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994536054211409",,,"2018-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://carefirst.com/acarx","10207VA0380003-03","HealthyBlue HMO Gold $1,000","Limited Cost Sharing Plan Variation","78.54%",,"No","Yes","No","100%",,"$1,000","$990","$0","$10","$1,000","$675","$198","$0","$1,000","$230","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/HENVCN7MRXXVCN7BN012018.pdf",
"2018","VA","10207","SERFF","2017-09-22 20:15:56","Individual","No","52-1358219","10207VA0380004","BlueChoice HMO Young Adult $7,350","10207VA038",,"VAN001","VAS001","VAF009","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994536054211409",,,"2018-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://carefirst.com/acarx","10207VA0380004-00","BlueChoice HMO Young Adult $7,350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$7,200","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://content.carefirst.com/sbc/AHHVCN9JRXCVCN9DN012018.pdf",
"2018","UT","46958","SERFF","2017-08-16 20:15:58","Individual","Yes","39-1263473","46958UT0470002","Humana Dental Smart Choice Basic","46958UT047",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Members can go to any in-network provider nationwide and receive the in-network level of benefits; however, if using out-of-network providers, the covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.  In-network providers are included in the nationwide network and should be used if at all possible.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","46958UT0470002-01","Humana Dental Smart Choice Basic","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$45","$45 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=3110471"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020023","Select Value Gold 1500 - no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF009","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020023-00","Select Value Gold 1500 - no deductible for office visits","Standard Gold Off Exchange Plan",,"0.776671148801871","No","Yes","No","100%",,"$1,500","$110","$2,304","$60","$1,882","$745","$1,241","$55","$687","$1,330","$172","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1095","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_gold_1500_-_no_deductible_for_office_visits&csr=standard_gold_off_exchange_plan&id=I40A1095"
"2018","VA","10207","SERFF","2017-09-22 20:15:56","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $3,500","10207VA038",,"VAN001","VAS001","VAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994536054211409",,,"2018-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://carefirst.com/acarx","10207VA0380001-02","BlueChoice HMO Silver $3,500","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/AHAVCN6QRXXVCN6BN012018.pdf",
"2018","VA","10207","SERFF","2017-09-22 20:15:56","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $3,500","10207VA038",,"VAN001","VAS001","VAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994536054211409",,,"2018-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://carefirst.com/acarx","10207VA0380001-03","BlueChoice HMO Silver $3,500","Limited Cost Sharing Plan Variation","70.70%",,"No","Yes","No","100%",,"$3,500","$1,120","$0","$10","$3,090","$930","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/AHNVCN6MRXXVCN6HN012018.pdf",
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020023","Select Value Gold 1500 - no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF009","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020023-01","Select Value Gold 1500 - no deductible for office visits","Standard Gold On Exchange Plan",,"0.776671148801871","No","Yes","No","100%",,"$1,500","$110","$2,304","$60","$1,882","$745","$1,241","$55","$687","$1,330","$172","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1096","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_gold_1500_-_no_deductible_for_office_visits&csr=standard_gold_on_exchange_plan&id=I40A1096"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020023","Select Value Gold 1500 - no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF009","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020023-02","Select Value Gold 1500 - no deductible for office visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1097","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_gold_1500_-_no_deductible_for_office_visits&csr=zero_cost_sharing_plan_variation&id=I40A1097"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020023","Select Value Gold 1500 - no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF009","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020023-03","Select Value Gold 1500 - no deductible for office visits","Limited Cost Sharing Plan Variation",,"0.776671148801871","No","Yes","No","100%",,"$1,500","$110","$2,304","$60","$1,882","$745","$1,241","$55","$687","$1,330","$172","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1098","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_gold_1500_-_no_deductible_for_office_visits&csr=limited_cost_sharing_plan_variationn&id=I40A1098"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020007","Select Med Gold 1500 - no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF009","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020007-00","Select Med Gold 1500 - no deductible for office visits","Standard Gold Off Exchange Plan",,"0.776671148801871","No","Yes","No","100%",,"$1,500","$110","$2,304","$60","$1,882","$745","$1,241","$55","$687","$1,330","$172","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0969","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_gold_1500_-_no_deductible_for_office_visits&csr=standard_gold_off_exchange_plan&id=I30A0969"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020007","Select Med Gold 1500 - no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF009","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020007-01","Select Med Gold 1500 - no deductible for office visits","Standard Gold On Exchange Plan",,"0.776671148801871","No","Yes","No","100%",,"$1,500","$110","$2,304","$60","$1,882","$745","$1,241","$55","$687","$1,330","$172","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0970","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_gold_1500_-_no_deductible_for_office_visits&csr=standard_gold_on_exchange_plan&id=I30A0970"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020007","Select Med Gold 1500 - no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF009","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020007-02","Select Med Gold 1500 - no deductible for office visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$60","$0","$0","$0","$55","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0971","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_gold_1500_-_no_deductible_for_office_visits&csr=zero_cost_sharing_plan_variation&id=I30A0971"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020007","Select Med Gold 1500 - no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF009","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020007-03","Select Med Gold 1500 - no deductible for office visits","Limited Cost Sharing Plan Variation",,"0.776671148801871","No","Yes","No","100%",,"$1,500","$110","$2,304","$60","$1,882","$745","$1,241","$55","$687","$1,330","$172","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0972","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_gold_1500_-_no_deductible_for_office_visits&csr=limited_cost_sharing_plan_variationn&id=I30A0972"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020024","Select Value Silver 1800","68781UT002",,"UTN002","UTS002","UTF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020024-00","Select Value Silver 1800","Standard Silver Off Exchange Plan",,"0.671755756506191","No","Yes","No","100%",,"1,800","0","5,550","60","2,662","865","1,759","55","558","2,220","429","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1099","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_1800&csr=standard_silver_off_exchange_plan&id=I40A1099"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020024","Select Value Silver 1800","68781UT002",,"UTN002","UTS002","UTF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020024-01","Select Value Silver 1800","Standard Silver On Exchange Plan",,"0.671755756506191","No","Yes","No","100%",,"1,800","0","5,550","60","2,662","865","1,759","55","558","2,220","429","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1100","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_1800&csr=standard_silver_on_exchange_plan&id=I40A1100"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020024","Select Value Silver 1800","68781UT002",,"UTN002","UTS002","UTF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020024-02","Select Value Silver 1800","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1101","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_1800&csr=zero_cost_sharing_plan_variation&id=I40A1101"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020024","Select Value Silver 1800","68781UT002",,"UTN002","UTS002","UTF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020024-03","Select Value Silver 1800","Limited Cost Sharing Plan Variation",,"0.671755756506191","No","Yes","No","100%",,"1,800","0","5,550","60","2,662","865","1,759","55","558","2,220","429","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1102","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_1800&csr=limited_cost_sharing_plan_variation&id=I40A1102"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020024","Select Value Silver 1800","68781UT002",,"UTN002","UTS002","UTF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020024-04","Select Value Silver 1800","73% AV Level Silver Plan",,"0.735427898454652","No","Yes","No","100%",,"1,300","130","3,455","60","1,800","865","1,414","55","729","1,920","258","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1103","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_1800&csr=73_av_level_silver_plan&id=I40A1103"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020024","Select Value Silver 1800","68781UT002",,"UTN002","UTS002","UTF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020024-05","Select Value Silver 1800","87% AV Level Silver Plan",,"0.876941892716151","No","Yes","No","100%",,"300","0","1,450","60","450","545","755","55","300","925","172","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1104","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_1800&csr=87_av_level_silver_plan&id=I40A1104"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020024","Select Value Silver 1800","68781UT002",,"UTN002","UTS002","UTF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020024-06","Select Value Silver 1800","94% AV Level Silver Plan",,"0.948356849623209","No","Yes","No","100%",,"0","60","576","60","0","420","265","55","0","405","43","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1105","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_1800&csr=94_av_level_silver_plan&id=I40A1105"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020005","Select Med Silver 1800","68781UT002",,"UTN001","UTS001","UTF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-00","Select Med Silver 1800","Standard Silver Off Exchange Plan",,"0.671755756506191","No","Yes","No","100%",,"1,800","0","5,550","60","2,662","865","1,759","55","558","2,220","429","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0962","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_1800&csr=standard_silver_off_exchange_plan&id=I30A0962"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020005","Select Med Silver 1800","68781UT002",,"UTN001","UTS001","UTF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-01","Select Med Silver 1800","Standard Silver On Exchange Plan",,"0.671755756506191","No","Yes","No","100%",,"1,800","0","5,550","60","2,662","865","1,759","55","558","2,220","429","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0963","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_1800&csr=standard_silver_on_exchange_plan&id=I30A0963"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020005","Select Med Silver 1800","68781UT002",,"UTN001","UTS001","UTF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-02","Select Med Silver 1800","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0964","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_1800&csr=zero_cost_sharing_plan_variation&id=I30A0964"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020005","Select Med Silver 1800","68781UT002",,"UTN001","UTS001","UTF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-03","Select Med Silver 1800","Limited Cost Sharing Plan Variation",,"0.671755756506191","No","Yes","No","100%",,"1,800","0","5,550","60","2,662","865","1,759","55","558","2,220","429","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0965","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_1800&csr=limited_cost_sharing_plan_variation&id=I30A0965"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020005","Select Med Silver 1800","68781UT002",,"UTN001","UTS001","UTF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-04","Select Med Silver 1800","73% AV Level Silver Plan",,"0.735427898454652","No","Yes","No","100%",,"1,300","130","3,455","60","1,800","865","1,414","55","729","1,920","258","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0966","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_1800&csr=73_av_level_silver_plan&id=I30A0966"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020005","Select Med Silver 1800","68781UT002",,"UTN001","UTS001","UTF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-05","Select Med Silver 1800","87% AV Level Silver Plan",,"0.876941892716151","No","Yes","No","100%",,"300","0","1,450","60","450","545","755","55","300","925","172","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0967","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_1800&csr=87_av_level_silver_plan&id=I30A0967"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020005","Select Med Silver 1800","68781UT002",,"UTN001","UTS001","UTF010","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-06","Select Med Silver 1800","94% AV Level Silver Plan",,"0.948356849623209","No","Yes","No","100%",,"0","60","576","60","0","420","265","55","0","405","43","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0968","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_1800&csr=94_av_level_silver_plan&id=I30A0968"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020025","Select Value Bronze 6700 - limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020025-00","Select Value  Bronze 6700 - limited office visit waiver","Standard Bronze Off Exchange Plan",,"0.616760000915613","No","Yes","No","100%",,"2,743","0","4,607","60","2,955","1,150","1,766","55","623","2,255","343","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,700","$6700 per person","$13400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1106","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_bronze_6700_-_limited_office_visit_waiver&csr=standard_bronze_off_exchange_plan&id=I40A1106"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020025","Select Value Bronze 6700 - limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020025-01","Select Value  Bronze 6700 - limited office visit waiver","Standard Bronze On Exchange Plan",,"0.616760000915613","No","Yes","No","100%",,"2,743","0","4,607","60","2,955","1,150","1,766","55","623","2,255","343","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,700","$6700 per person","$13400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1107","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_bronze_6700_-_limited_office_visit_waiver&csr=standard_bronze_on_exchange_plan&id=I40A1107"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020025","Select Value Bronze 6700 - limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020025-02","Select Value  Bronze 6700 - limited office visit waiver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1108","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_bronze_6700_-_limited_office_visit_waiver&csr=zero_cost_sharing_plan_variation&id=I40A1108"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020025","Select Value Bronze 6700 - limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020025-03","Select Value Bronze 6700 - limited office visit waiver","Limited Cost Sharing Plan Variation",,"0.616760000915613","No","Yes","No","100%",,"2,743","0","4,607","60","2,955","1,150","1,766","55","623","2,255","343","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,700","$6700 per person","$13400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1109","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_bronze_6700_-_limited_office_visit_waiver&csr=limited_cost_sharing_plan_variation&id=I40A1109"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020011","Select Med  Bronze 6700 - limited office visit waiver","68781UT002",,"UTN001","UTS001","UTF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020011-00","Select Med Bronze 6700 - limited office visit waiver","Standard Bronze Off Exchange Plan",,"0.616760000915613","No","Yes","No","100%",,"2,743","0","4,607","60","2,955","1,150","1,766","55","623","2,255","343","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,700","$6700 per person","$13400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0973","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_bronze_6700_-_limited_office_visit_waiver&csr=standard_bronze_off_exchange_plan&id=I30A0973"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020011","Select Med  Bronze 6700 - limited office visit waiver","68781UT002",,"UTN001","UTS001","UTF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020011-01","Select Med Bronze 6700 - limited office visit waiver","Standard Bronze On Exchange Plan",,"0.616760000915613","No","Yes","No","100%",,"2,743","0","4,607","60","2,955","1,150","1,766","55","623","2,255","343","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,700","$6700 per person","$13400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0974","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_bronze_6700_-_limited_office_visit_waiver&csr=standard_bronze_on_exchange_plan&id=I30A0974"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020011","Select Med  Bronze 6700 - limited office visit waiver","68781UT002",,"UTN001","UTS001","UTF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020011-02","Select Med Bronze 6700 - limited office visit waiver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0975","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_bronze_6700_-_limited_office_visit_waiver&csr=zero_cost_sharing_plan_variation&id=I30A0975"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020011","Select Med  Bronze 6700 - limited office visit waiver","68781UT002",,"UTN001","UTS001","UTF011","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020011-03","Select Med Bronze 6700 - limited office visit waiver","Limited Cost Sharing Plan Variation",,"0.616760000915613","No","Yes","No","100%",,"2,743","0","4,607","60","2,955","1,150","1,766","55","623","2,255","343","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,700","$6700 per person","$13400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0976","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_bronze_6700_-_limited_office_visit_waiver&csr=limited_cost_sharing_plan_variation&id=I30A0976"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020027","Select Value HealthSave Bronze 6650 (HSA qualified) – Rewards","68781UT002",,"UTN002","UTS002","UTF012","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020027-00","Select Value HealthSave Bronze 6650 (HSA qualified) – Rewards","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"6,650","0","0","60","6,650","0","0","55","1,925","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","per person not applicable","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1117","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_bronze_6650_(hsa_qualified)_-_rewards&csr=standard_bronze_off_exchange_plan&id=I40A1117"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020027","Select Value HealthSave Bronze 6650 (HSA qualified) – Rewards","68781UT002",,"UTN002","UTS002","UTF012","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020027-01","Select Value HealthSave Bronze 6650 (HSA qualified) – Rewards","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"6,650","0","0","60","6,650","0","0","55","1,925","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","per person not applicable","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1119","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_bronze_6650_(hsa_qualified)_-_rewards&csr=standard_bronze_on_exchange_plan&id=I40A1119"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020027","Select Value HealthSave Bronze 6650 (HSA qualified) – Rewards","68781UT002",,"UTN002","UTS002","UTF012","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020027-02","Select Value HealthSave Bronze 6650 (not HSA qualified) – Rewards","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1121","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_bronze_6650_(not_hsa_qualified)_-_rewards&csr=zero_cost_sharing_plan_variation&id=I40A1121"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020027","Select Value HealthSave Bronze 6650 (HSA qualified) – Rewards","68781UT002",,"UTN002","UTS002","UTF012","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020027-03","Select Value HealthSave Bronze 6650 (HSA qualified) – Rewards","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"6,650","0","0","60","6,650","0","0","55","1,925","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","per person not applicable","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1123","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_bronze_6650_(hsa_qualified)_-_rewards&csr=limited_cost_sharing_plan_variation&id=I40A1123"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020016","Select Med HealthSave Bronze 6650 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF012","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020016-00","Select Med HealthSave Bronze 6650 (HSA Qualified)","Standard Bronze Off Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"6650","0","0","60","6650","0","0","55","1925","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","per person not applicable","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0984","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_bronze_6650_(hsa_qualified)&csr=standard_bronze_off_exchange_plan&id=I30A0984"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020016","Select Med HealthSave Bronze 6650 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF012","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020016-01","Select Med HealthSave Bronze 6650 (HSA Qualified)","Standard Bronze On Exchange Plan",,"0.602242886076114","Yes","Yes","No","100%",,"6650","0","0","60","6650","0","0","55","1925","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","per person not applicable","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0986","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_bronze_6650_(hsa_qualified)&csr=standard_bronze_on_exchange_plan&id=I30A0986"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020016","Select Med HealthSave Bronze 6650 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF012","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020016-02","Select Med HealthSave Bronze 6650 (not HSA Qualified)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0988","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_bronze_6650_(not_hsa_qualified)&csr=zero_cost_sharing_plan_variation&id=I30A0988"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020016","Select Med HealthSave Bronze 6650 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF012","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020016-03","Select Med HealthSave Bronze 6650 (HSA Qualified)","Limited Cost Sharing Plan Variation",,"0.602242886076114","Yes","Yes","No","100%",,"6,650","0","0","60","6,650","0","0","55","1,925","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","per person not applicable","$13300 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0990","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_bronze_6650_(hsa_qualified)&csr=limited_cost_sharing_plan_variation&id=I30A0990"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020028","Select Value HealthSave Silver 3100 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020028-00","Select Value HealthSave Silver 3100 (HSA Qualified)","Standard Silver Off Exchange Plan",,"0.666144781947605","Yes","Yes","No","100%",,"3,100","110","2,304","60","3,100","745","1,241","55","916","2,080","172","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","per person not applicable","$6200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1125","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_3100_(hsa_qualified)&csr=standard_silver_off_exchange_plan&id=I40A1125"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020028","Select Value HealthSave Silver 3100 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020028-01","Select Value HealthSave Silver 3100 (HSA Qualified)","Standard Silver On Exchange Plan",,"0.666144781947605","Yes","Yes","No","100%",,"3,100","110","2,304","60","3,100","745","1,241","55","916","2,080","172","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","per person not applicable","$6200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1127","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_3100_(hsa_qualified)&csr=standard_silver_on_exchange_plan&id=I40A1127"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020028","Select Value HealthSave Silver 3100 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020028-02","Select Value HealthSave Silver 3100 (not HSA Qualified)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1129","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_sliver_3100_(not_hsa_qualified)&csr=zero_cost_sharing_plan_variation&id=I40A1129"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020028","Select Value HealthSave Silver 3100 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020028-03","Select Value HealthSave Silver 3100 (HSA Qualified)","Limited Cost Sharing Plan Variation",,"0.666144781947605","Yes","Yes","No","100%",,"3,100","110","2,304","60","3,100","745","1,241","55","916","2,080","172","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","per person not applicable","$6200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1131","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_3100_(hsa_qualified)&csr=limited_cost_sharing_plan_variation&id=I40A1131"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020028","Select Value HealthSave Silver 3100 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020028-04","Select Value HealthSave Silver 3100 (HSA Qualified)","73% AV Level Silver Plan",,"0.736758824169822","Yes","Yes","No","100%",,"1,500","110","2,304","60","1,500","745","1,241","55","916","1,780","172","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1133","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_3100_(hsa_qualified)&csr=73_av_level_silver_plan&id=I40A1133"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020028","Select Value HealthSave Silver 3100 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020028-05","Select Value HealthSave Silver 3100 (not HSA Qualified)","87% AV Level Silver Plan",,"0.871518563577593","Yes","Yes","No","100%",,"400","0","1,800","60","400","440","883","55","400","925","172","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","per person not applicable","$800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1135","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_3100_(not_hsa_qualified)&csr=87_av_level_silver_plan&id=I40A1135"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020028","Select Value HealthSave Silver 3100 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020028-06","Select Value HealthSave Silver 3100 (not HSA Qualified)","94% AV Level Silver Plan",,"0.94592176155711","Yes","Yes","No","100%",,"100","30","576","60","100","225","265","55","100","405","43","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1137","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_3100_(not_hsa_qualified)&csr=94_av_level_silver_plan&id=I40A1137"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020020","Select Med HealthSave Silver 3100 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020020-00","Select Med HealthSave Silver 3100 (HSA Qualified)","Standard Silver Off Exchange Plan",,"0.666144781947605","Yes","Yes","No","100%",,"3,100","110","2,304","60","3,100","745","1,241","55","916","2,080","172","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","per person not applicable","$6200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0996","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_3100_(hsa_qualified)&csr=standard_silver_off_exchange_plan&id=I30A0996"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020020","Select Med HealthSave Silver 3100 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020020-01","Select Med HealthSave Silver 3100 (HSA Qualified)","Standard Silver On Exchange Plan",,"0.666144781947605","Yes","Yes","No","100%",,"3,100","110","2,304","60","3,100","745","1,241","55","916","2,080","172","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","per person not applicable","$6200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0998","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_3100_(hsa_qualified)&csr=standard_silver_on_exchange_plan&id=I30A0998"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020020","Select Med HealthSave Silver 3100 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020020-02","Select Med HealthSave Silver 3100 (not HSA Qualified)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1000","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_3100_(not_hsa_qualified)&csr=zero_cost_sharing_plan_variation&id=I30A1000"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020020","Select Med HealthSave Silver 3100 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020020-03","Select Med HealthSave Silver 3100 (HSA Qualified)","Limited Cost Sharing Plan Variation",,"0.666144781947605","Yes","Yes","No","100%",,"3,100","110","2,304","60","3,100","745","1,241","55","916","2,080","172","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","per person not applicable","$6200 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1002","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_3100_(hsa_qualified)&csr=limited_cost_sharing_plan_variation&id=I30A1002"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020020","Select Med HealthSave Silver 3100 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020020-04","Select Med HealthSave Silver 3100 (HSA Qualified)","73% AV Level Silver Plan",,"0.736758824169822","Yes","Yes","No","100%",,"1,500","110","2,304","60","1,500","745","1,241","55","916","1,780","172","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1004","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_3100_(hsa_qualified)&csr=73_av_level_silver_plan&id=I30A1004"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020020","Select Med HealthSave Silver 3100 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020020-05","Select Med HealthSave Silver 3100 (not HSA Qualified)","87% AV Level Silver Plan",,"0.871518563577593","Yes","Yes","No","100%",,"400","0","1,800","60","400","440","883","55","400","925","172","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","per person not applicable","$800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1006","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_3100_(not_hsa_qualified)&csr=87_av_level_silver_plan&id=I30A1006"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020020","Select Med HealthSave Silver 3100 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF017","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020020-06","Select Med HealthSave Silver 3100 (not HSA Qualified)","94% AV Level Silver Plan",,"0.94592176155711","Yes","Yes","No","100%",,"100","30","576","60","100","225","265","55","100","405","43","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1008","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_3100_(not_hsa_qualified)&csr=94_av_level_silver_plan&id=I30A1008"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020040","Select Value HealthSave Expanded Bronze 3175 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF013","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020040-00","Select Value HealthSave Expanded Bronze 3175 (HSA Qualified)","Standard Bronze Off Exchange Plan",,"0.64943872634281","Yes","Yes","No","100%",,"3,175","20","3,455","60","3,175","745","1,414","55","830","2,080","258","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,175","per person not applicable","$6350 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1154","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_expanded_bronze_3175_(hsa_qualified)&csr=standard_bronze_off_exchange_plan&id=I40A1154"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020040","Select Value HealthSave Expanded Bronze 3175 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF013","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020040-01","Select Value HealthSave Expanded Bronze 3175 (HSA Qualified)","Standard Bronze On Exchange Plan",,"0.64943872634281","Yes","Yes","No","100%",,"3,175","20","3,455","60","3,175","745","1,414","55","830","2,080","258","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,175","per person not applicable","$6350 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1156","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_expanded_bronze_3175_(hsa_qualified)&csr=standard_bronze_on_exchange_plan&id=I40A1156"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020040","Select Value HealthSave Expanded Bronze 3175 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF013","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020040-02","Select Value HealthSave Expanded Bronze 3175 (not HSA Qualified)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1158","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_expanded_bronze_3175_(not_hsa_qualified)&csr=zero_cost_sharing_plan_variation&id=I40A1158"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020040","Select Value HealthSave Expanded Bronze 3175 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF013","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020040-03","Select Value HealthSave Expanded Bronze 3175 (HSA Qualified)","Limited Cost Sharing Plan Variation",,"0.64943872634281","Yes","Yes","No","100%",,"3,175","20","3,455","60","3,175","745","1,414","55","830","2,080","258","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,175","per person not applicable","$6350 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1160","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_expanded_bronze_3175_(hsa_qualified)&csr=limited_cost_sharing_plan_variation&id=I40A1160"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020041","Select Med HealthSave Expanded Bronze 3175 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF013","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020041-00","Select Med HealthSave Expanded Bronze 3175 (HSA Qualified)","Standard Bronze Off Exchange Plan",,"0.64943872634281","Yes","Yes","No","100%",,"3,175","20","3,455","60","3,175","745","1,414","55","830","2,080","258","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,175","per person not applicable","$6350 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1021","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_expanded_bronze_3175_(hsa_qualified)&csr=standard_bronze_off_exchange_plan&id=I30A1021"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020041","Select Med HealthSave Expanded Bronze 3175 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF013","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020041-01","Select Med HealthSave Expanded Bronze 3175 (HSA Qualified)","Standard Bronze On Exchange Plan",,"0.64943872634281","Yes","Yes","No","100%",,"3,175","20","3,455","60","3,175","745","1,414","55","830","2,080","258","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,175","per person not applicable","$6350 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1023","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_expanded_bronze_3175_(hsa_qualified)&csr=standard_bronze_on_exchange_plan&id=I30A1023"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020041","Select Med HealthSave Expanded Bronze 3175 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF013","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020041-02","Select Med HealthSave Expanded Bronze 3175 (not HSA Qualified)","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1025","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_expanded_bronze_3175_(not_hsa_qualified)&csr=zero_cost_sharing_plan_variation&id=I30A1025"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020041","Select Med HealthSave Expanded Bronze 3175 (HSA Qualified)","68781UT002",,"UTN001","UTS001","UTF013","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020041-03","Select Med HealthSave Expanded Bronze 3175 (HSA Qualified)","Limited Cost Sharing Plan Variation",,"0.64943872634281","Yes","Yes","No","100%",,"3,175","20","3,455","60","3,175","745","1,414","55","830","2,080","258","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,175","per person not applicable","$6350 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1027","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_expanded_bronze_3175_(hsa_qualified)&csr=limited_cost_sharing_plan_variation&id=I30A1027"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020031","Select Value Catastrophic 7350","68781UT002",,"UTN002","UTS002","UTF012","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020031-00","Select Value Catastrophic 7350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"7,350","0","0","60","6,904","280","0","55","1,925","0","0","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1139","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_catastrophic_7350&csr=standard_catastrophic_off_exchange_plan&id=I40A1139"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020031","Select Value Catastrophic 7350","68781UT002",,"UTN002","UTS002","UTF012","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020031-01","Select Value Catastrophic 7350","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"7,350","0","0","60","6,904","280","0","55","1,925","0","0","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1141","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_catastrophic_7350&csr=standard_catastrophic_on_exchange_plan&id=I40A1141"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020019","Select Med Catastrophic 7350","68781UT002",,"UTN001","UTS001","UTF012","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020019-00","Select Med Catastrophic 7350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"7,350","0","0","60","6,904","280","0","55","1,925","0","0","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0992","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_catastrophic_7350&csr=standard_catastrophic_off_exchange_plan&id=I30A0992"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020019","Select Med Catastrophic 7350","68781UT002",,"UTN001","UTS001","UTF012","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020019-01","Select Med Catastrophic 7350","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"7,350","0","0","60","6,904","280","0","55","1,925","0","0","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0994","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_catastrophic_7350&csr=standard_catastrophic_on_exchange_plan&id=I30A0994"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0130011","Select Value Benchmark Bronze 6350","68781UT013",,"UTN002","UTS002","UTF014","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130011-00","Select Value Benchmark Bronze 6350","Standard Bronze Off Exchange Plan",,"0.600736333034893","No","Yes","No","100%",,"2,743","0","4,607","60","2,705","1,150","1,587","55","623","2,255","343","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1174","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_benchmark_bronze_6350&csr=standard_silver_off_exchange_plan&id=I40A1174"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0130011","Select Value Benchmark Bronze 6350","68781UT013",,"UTN002","UTS002","UTF014","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130011-01","Select Value Benchmark Bronze 6350","Standard Bronze On Exchange Plan",,"0.600736333034893","No","Yes","No","100%",,"2,743","0","4,607","60","2,705","1,150","1,587","55","623","2,255","343","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1175","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_benchmark_bronze_6350&csr=standard_silver_on_exchange_plan&id=I40A1175"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0130011","Select Value Benchmark Bronze 6350","68781UT013",,"UTN002","UTS002","UTF014","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130011-02","Select Value Benchmark Bronze 6350","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1176","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_benchmark_bronze_6350&csr=zero_cost_sharing_plan_variation&id=I40A1176"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0130011","Select Value Benchmark Bronze 6350","68781UT013",,"UTN002","UTS002","UTF014","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130011-03","Select Value Benchmark Bronze 6350","Limited Cost Sharing Plan Variation",,"0.600736333034893","No","Yes","No","100%",,"2,743","0","4,607","60","2,705","1,150","1,587","55","623","2,255","343","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1177","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_benchmark_bronze_6350&csr=limited_cost_sharing_plan_variation&id=I40A1177"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0130010","Select Med Benchmark Bronze 6350","68781UT013",,"UTN001","UTS001","UTF014","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130010-00","Select Med Benchmark Bronze 6350","Standard Bronze Off Exchange Plan",,"0.600736333034893","No","Yes","No","100%",,"2,743","0","4,607","60","2,705","1,150","1,587","55","623","2,255","343","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1041","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_benchmark_bronze_6350&csr=standard_bronze_off_exchange_plan&id=I30A1041"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0130010","Select Med Benchmark Bronze 6350","68781UT013",,"UTN001","UTS001","UTF014","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130010-01","Select Med Benchmark Bronze 6350","Standard Bronze On Exchange Plan",,"0.600736333034893","No","Yes","No","100%",,"2,743","0","4,607","60","2,705","1,150","1,587","55","623","2,255","343","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1042","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_benchmark_bronze_6350&csr=standard_bronze_on_exchange_plan&id=I30A1042"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0130010","Select Med Benchmark Bronze 6350","68781UT013",,"UTN001","UTS001","UTF014","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130010-02","Select Med Benchmark Bronze 6350","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1043","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_benchmark_bronze_6350&csr=zero_cost_sharing_plan_variation&id=I30A1043"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0130010","Select Med Benchmark Bronze 6350","68781UT013",,"UTN001","UTS001","UTF014","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130010-03","Select Med Benchmark Bronze 6350","Limited Cost Sharing Plan Variation",,"0.600736333034893","No","Yes","No","100%",,"2,743","0","4,607","60","2,705","1,150","1,587","55","623","2,255","343","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1044","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_benchmark_bronze_6350&csr=limited_cost_sharing_plan_variation&id=I30A1044"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0130012","Select Value Benchmark Expanded Bronze 2450","68781UT013",,"UTN002","UTS002","UTF010","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130012-00","Select Value Benchmark Expanded Bronze 2450","Standard Bronze Off Exchange Plan",,"0.649434762441037","No","Yes","No","100%",,"2,161","0","5,189","60","2,662","865","1,759","55","558","2,220","429","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1178","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_benchmark_expanded_bronze_2450&csr=standard_bronze_off_exchange_plan&id=I40A1178"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0130012","Select Value Benchmark Expanded Bronze 2450","68781UT013",,"UTN002","UTS002","UTF010","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130012-01","Select Value Benchmark Expanded Bronze 2450","Standard Bronze On Exchange Plan",,"0.649434762441037","No","Yes","No","100%",,"2,161","0","5,189","60","2,662","865","1,759","55","558","2,220","429","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1179","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_benchmark_expanded_bronze_2450&csr=standard_bronze_on_exchange_plan&id=I40A1179"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0130012","Select Value Benchmark Expanded Bronze 2450","68781UT013",,"UTN002","UTS002","UTF010","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130012-02","Select Value Benchmark Expanded Bronze 2450","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1180","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_benchmark_expanded_bronze_2450&csr=zero_cost_sharing_plan_variation&id=I40A1180"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0130012","Select Value Benchmark Expanded Bronze 2450","68781UT013",,"UTN002","UTS002","UTF010","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130012-03","Select Value Benchmark Expanded Bronze 2450","Limited Cost Sharing Plan Variation",,"0.649434762441037","No","Yes","No","100%",,"2,161","0","5,189","60","2,662","865","1,759","55","558","2,220","429","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1181","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_benchmark_expanded_bronze_2450&csr=limited_cost_sharing_plan_variation&id=I40A1181"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0130013","Select Med Benchmark Expanded Bronze 2450","68781UT013",,"UTN001","UTS001","UTF010","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130013-00","Select Med Benchmark Expanded Bronze 2450","Standard Bronze Off Exchange Plan",,"0.649434762441037","No","Yes","No","100%",,"2,161","0","5,189","60","2,662","865","1,759","55","558","2,220","429","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1045","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_benchmark_expanded_bronze_2450&csr=standard_bronze_off_exchange_plan&id=I30A1045"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0130013","Select Med Benchmark Expanded Bronze 2450","68781UT013",,"UTN001","UTS001","UTF010","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130013-01","Select Med Benchmark Expanded Bronze 2450","Standard Bronze On Exchange Plan",,"0.649434762441037","No","Yes","No","100%",,"2,161","0","5,189","60","2,662","865","1,759","55","558","2,220","429","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1046","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_benchmark_expanded_bronze_2450&csr=standard_bronze_on_exchange_plan&id=I30A1046"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0130013","Select Med Benchmark Expanded Bronze 2450","68781UT013",,"UTN001","UTS001","UTF010","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130013-02","Select Med Benchmark Expanded Bronze 2450","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1047","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_benchmark_expanded_bronze_2450&csr=zero_cost_sharing_plan_variation&id=I30A1047"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0130013","Select Med Benchmark Expanded Bronze 2450","68781UT013",,"UTN001","UTS001","UTF010","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130013-03","Select Med Benchmark Expanded Bronze 2450","Limited Cost Sharing Plan Variation",,"0.649434762441037","No","Yes","No","100%",,"2,161","0","5,189","60","2,662","865","1,759","55","558","2,220","429","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1048","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_benchmark_expanded_bronze_2450&csr=limited_cost_sharing_plan_variation&id=I30A1048"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020026","Select Value Silver 4000 Copay Plan - no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020026-00","Select Value Silver 4000 Copay Plan - no deductible for office visits","Standard Silver Off Exchange Plan",,"0.680961243448069","No","Yes","No","100%",,"1,858","5,492","0","60","3,710","1,680","518","55","268","3,270","22","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1110","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_4000_copay_plan_-_no_deductible_for_office_visits&csr=standard_silver_off_exchange_plan&id=I40A1110"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020026","Select Value Silver 4000 Copay Plan - no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020026-01","Select Value Silver 4000 Copay Plan - no deductible for office visits","Standard Silver On Exchange Plan",,"0.680961243448069","No","Yes","No","100%",,"1,858","5,492","0","60","3,710","1,680","518","55","268","3,270","22","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1111","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_4000_copay_plan_-_no_deductible_for_office_visits&csr=standard_silver_on_exchange_plan&id=I40A1111"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020026","Select Value Silver 4000 Copay Plan - no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020026-02","Select Value Silver 4000 Copay Plan - no deductible for office visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1112","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_4000_copay_plan_-_no_deductible_for_office_visits&csr=zero_cost_sharing_plan_variation&id=I40A1112"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020026","Select Value Silver 4000 Copay Plan - no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020026-03","Select Value Silver 4000 Copay Plan - no deductible for office visits","Limited Cost Sharing Plan Variation",,"0.680961243448069","No","Yes","No","100%",,"1,858","5,492","0","60","3,710","1,680","518","55","268","3,270","22","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1113","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_4000_copay_plan_-_no_deductible_for_office_visits&csr=limited_cost_sharing_plan_variation&id=I40A1113"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020026","Select Value Silver 4000 Copay Plan - no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020026-04","Select Value Silver 4000 Copay Plan - no deductible for office visits","73% AV Level Silver Plan",,"0.739092739763516","No","Yes","No","100%",,"1,908","3,942","0","60","1,810","1,305","518","55","318","2,820","22","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1114","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_4000_copay_plan_-_no_deductible_for_office_visits&csr=73_av_level_silver_plan&id=I40A1114"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020026","Select Value Silver 4000 Copay Plan - no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020026-05","Select Value Silver 4000 Copay Plan - no deductible for office visits","87% AV Level Silver Plan",,"0.878235743010162","No","Yes","No","100%",,"350","1,650","0","60","650","1,118","232","55","350","1,639","11","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1115","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_4000_copay_plan_-_no_deductible_for_office_visits&csr=87_av_level_silver_plan&id=I40A1115"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020026","Select Value Silver 4000 Copay Plan - no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020026-06","Select Value Silver 4000 Copay Plan - no deductible for office visits","94% AV Level Silver Plan",,"0.947939798188504","No","Yes","No","100%",,"0","1,000","0","60","0","810","86","55","0","955","4","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1116","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_4000_copay_plan_-_no_deductible_for_office_visits&csr=94_av_level_silver_plan&id=I40A1116"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020012","Select Med Silver 4000 Copay Plan - no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-00","Select Med Silver 4000 Copay Plan - no deductible for office visits","Standard Silver Off Exchange Plan",,"0.680961243448069","No","Yes","No","100%",,"1,858","5,492","0","60","3,710","1,680","518","55","268","3,270","22","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0977","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_4000_copay_plan_-_no_deductible_for_office_visits&csr=standard_silver_off_exchange_plan&id=I30A0977"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020012","Select Med Silver 4000 Copay Plan - no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-01","Select Med Silver 4000 Copay Plan - no deductible for office visits","Standard Silver On Exchange Plan",,"0.680961243448069","No","Yes","No","100%",,"1,858","5,492","0","60","3,710","1,680","518","55","268","3,270","22","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0978","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_4000_copay_plan_-_no_deductible_for_office_visits&csr=standard_silver_on_exchange_plan&id=I30A0978"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020012","Select Med Silver 4000 Copay Plan - no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-02","Select Med Silver 4000 Copay Plan - no deductible for office visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0979","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_4000_copay_plan_-_no_deductible_for_office_visits&csr=zero_cost_sharing_plan_variation&id=I30A0979"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020012","Select Med Silver 4000 Copay Plan - no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-03","Select Med Silver 4000 Copay Plan - no deductible for office visits","Limited Cost Sharing Plan Variation",,"0.680961243448069","No","Yes","No","100%",,"1,858","5,492","0","60","3,710","1,680","518","55","268","3,270","22","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0980","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_4000_copay_plan_-_no_deductible_for_office_visits&csr=limited_cost_sharing_plan_variation&id=I30A0980"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020012","Select Med Silver 4000 Copay Plan - no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-04","Select Med Silver 4000 Copay Plan - no deductible for office visits","73% AV Level Silver Plan",,"0.739092739763516","No","Yes","No","100%",,"1,908","3,942","0","60","1,810","1,305","518","55","318","2,820","22","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0981","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_4000_copay_plan_-_no_deductible_for_office_visits&csr=73_av_level_silver_plan&id=I30A0981"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020012","Select Med Silver 4000 Copay Plan - no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-05","Select Med Silver 4000 Copay Plan - no deductible for office visits","87% AV Level Silver Plan",,"0.878235743010162","No","Yes","No","100%",,"350","1,650","0","60","650","1,118","232","55","350","1,639","11","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0982","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_4000_copay_plan_-_no_deductible_for_office_visits&csr=87_av_level_silver_plan&id=I30A0982"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020012","Select Med Silver 4000 Copay Plan - no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF015","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-06","Select Med Silver 4000 Copay Plan - no deductible for office visits","94% AV Level Silver Plan",,"0.947939798188504","No","Yes","No","100%",,"0","1,000","0","60","0","810","86","55","0","955","4","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0983","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_4000_copay_plan_-_no_deductible_for_office_visits&csr=94_av_level_silver_plan&id=I30A0983"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020042","Select Value Expanded Bronze 4600 Copay Plan - limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF016","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020042-00","Select Value Expanded Bronze 4600 Copay Plan - limited office visit waiver","Standard Bronze Off Exchange Plan",,"0.649879000387873","No","Yes","No","100%",,"1,858","5,492","0","60","4,201","1,760","691","55","389","3,270","30","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,600","$4600 per person","$9200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1162","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_expanded_bronze_4600_copay_plan_-_limited_office_visit_waiver&csr=standard_bronze_off_exchange_plan&id=I40A1162"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020042","Select Value Expanded Bronze 4600 Copay Plan - limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF016","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020042-01","Select Value Expanded Bronze 4600 Copay Plan - limited office visit waiver","Standard Bronze On Exchange Plan",,"0.649879000387873","No","Yes","No","100%",,"1,858","5,492","0","60","4,201","1,760","691","55","389","3,270","30","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,600","$4600 per person","$9200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1163","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_expanded_bronze_4600_copay_plan_-_limited_office_visit_waiver&csr=standard_bronze_on_exchange_plan&id=I40A1163"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020042","Select Value Expanded Bronze 4600 Copay Plan - limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF016","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020042-02","Select Value Expanded Bronze 4600 Copay Plan - limited office visit waiver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1164","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_expanded_bronze_4600_copay_plan_-_limited_office_visit_waiver&csr=zero_cost_sharing_plan_variation&id=I40A1164"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020042","Select Value Expanded Bronze 4600 Copay Plan - limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF016","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020042-03","Select Value Expanded Bronze 4600 Copay Plan - limited office visit waiver","Limited Cost Sharing Plan Variation",,"0.649879000387873","No","Yes","No","100%",,"1,858","5,492","0","60","4,201","1,760","691","55","389","3,270","30","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,600","$4600 per person","$9200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1165","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_expanded_bronze_4600_copay_plan_-_limited_office_visit_waiver&csr=limited_cost_sharing_plan_variation&id=I40A1165"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020043","Select Med Expanded Bronze 4600 Copay Plan - limited office visit waiver","68781UT002",,"UTN001","UTS001","UTF016","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020043-00","Select Med Expanded Bronze 4600 Copay Plan - limited office visit waiver","Standard Bronze Off Exchange Plan",,"0.649879000387873","No","Yes","No","100%",,"1,858","5,492","0","60","4,201","1,760","691","55","389","3,270","30","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,600","$4600 per person","$9200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1029","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_expanded_bronze_4600_copay_plan_-_limited_office_visit_waiver&csr=standard_bronze_off_exchange_plan&id=I30A1029"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020043","Select Med Expanded Bronze 4600 Copay Plan - limited office visit waiver","68781UT002",,"UTN001","UTS001","UTF016","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020043-01","Select Med Expanded Bronze 4600 Copay Plan - limited office visit waiver","Standard Bronze On Exchange Plan",,"0.649879000387873","No","Yes","No","100%",,"1,858","5,492","0","60","4,201","1,760","691","55","389","3,270","30","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,600","$4600 per person","$9200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1030","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_expanded_bronze_4600_copay_plan_-_limited_office_visit_waiver&csr=standard_bronze_on_exchange_plan&id=I30A1030"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020043","Select Med Expanded Bronze 4600 Copay Plan - limited office visit waiver","68781UT002",,"UTN001","UTS001","UTF016","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020043-02","Select Med Expanded Bronze 4600 Copay Plan - limited office visit waiver","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1031","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_expanded_bronze_4600_copay_plan_-_limited_office_visit_waiver&csr=zero_cost_sharing_plan_variation&id=I30A1031"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020043","Select Med Expanded Bronze 4600 Copay Plan - limited office visit waiver","68781UT002",,"UTN001","UTS001","UTF016","New","HMO","Expanded Bronze","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020043-03","Select Med Expanded Bronze 4600 Copay Plan - limited office visit waiver","Limited Cost Sharing Plan Variation",,"0.649879000387873","No","Yes","No","100%",,"1,858","5,492","0","60","4,201","1,760","691","55","389","3,270","30","0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,600","$4600 per person","$9200 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1032","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_expanded_bronze_4600_copay_plan_-_limited_office_visit_waiver&csr=limited_cost_sharing_plan_variation&id=I30A1032"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020038","Select Value Silver 2500 - no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF010","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020038-00","Select Value Silver 2500 - no deductible for office visits","Standard Silver Off Exchange Plan",,"0.689488393003886","No","Yes","No","100%",,"2,161","0","5,189","60","1,998","865","1,759","55","429","2,220","429","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1147","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_2500_-_no_deductible_for_office_visits&csr=standard_silver_off_exchange_plan&id=I40A1147"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020038","Select Value Silver 2500 - no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF010","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020038-01","Select Value Silver 2500 - no deductible for office visits","Standard Silver On Exchange Plan",,"0.689488393003886","No","Yes","No","100%",,"2,161","0","5,189","60","1,998","865","1,759","55","429","2,220","429","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1148","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_2500_-_no_deductible_for_office_visits&csr=standard_silver_on_exchange_plan&id=I40A1148"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020038","Select Value Silver 2500 - no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF010","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020038-02","Select Value Silver 2500 - no deductible for office visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1149","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_2500_-_no_deductible_for_office_visits&csr=zero_cost_sharing_plan_variation&id=I40A1149"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020038","Select Value Silver 2500 - no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF010","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020038-03","Select Value Silver 2500 - no deductible for office visits","Limited Cost Sharing Plan Variation",,"0.689488393003886","No","Yes","No","100%",,"2,161","0","5,189","60","1,998","865","1,759","55","429","2,220","429","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1150","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_2500_-_no_deductible_for_office_visits&csr=limited_cost_sharing_plan_variation&id=I40A1150"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020038","Select Value Silver 2500 - no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF010","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020038-04","Select Value Silver 2500 - no deductible for office visits","73% AV Level Silver Plan",,"0.735622765599062","No","Yes","No","100%",,"2,000","110","3,455","60","1,943","785","1,414","55","601","1,920","258","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1151","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_2500_-_no_deductible_for_office_visits&csr=73_av_level_silver_plan&id=I40A1151"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020038","Select Value Silver 2500 - no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF010","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020038-05","Select Value Silver 2500 - no deductible for office visits","87% AV Level Silver Plan",,"0.875605226279568","No","Yes","No","100%",,"350","0","1,650","60","650","605","745","55","350","925","129","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1152","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_2500_-_no_deductible_for_office_visits&csr=87_av_level_silver_plan&id=I40A1152"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020038","Select Value Silver 2500 - no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF010","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020038-06","Select Value Silver 2500 - no deductible for office visits","94% AV Level Silver Plan",,"0.947937571289658","No","Yes","No","100%",,"100","60","576","60","100","420","265","55","100","405","43","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A1153","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_silver_2500_-_no_deductible_for_office_visits&csr=94_av_level_silver_plan&id=I40A1153"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020039","Select Med Silver 2500 - no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF010","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020039-00","Select Med Silver 2500 - no deductible for office visits","Standard Silver Off Exchange Plan",,"0.689488393003886","No","Yes","No","100%",,"2,161","0","5,189","60","1,998","865","1,759","55","429","2,220","429","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1014","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_2500_-_no_deductible_for_office_visits&csr=standard_silver_off_exchange_plan&id=I30A1014"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020039","Select Med Silver 2500 - no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF010","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020039-01","Select Med Silver 2500 - no deductible for office visits","Standard Silver On Exchange Plan",,"0.689488393003886","No","Yes","No","100%",,"2,161","0","5,189","60","1,998","865","1,759","55","429","2,220","429","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1015","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_2500_-_no_deductible_for_office_visits&csr=standard_silver_on_exchange_plan&id=I30A1015"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020039","Select Med Silver 2500 - no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF010","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020039-02","Select Med Silver 2500 - no deductible for office visits","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"0","0","0","60","0","0","0","55","0","0","0","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1016","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_2500_-_no_deductible_for_office_visits&csr=zero_cost_sharing_plan_variation&id=I30A1016"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020039","Select Med Silver 2500 - no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF010","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020039-03","Select Med Silver 2500 - no deductible for office visits","Limited Cost Sharing Plan Variation",,"0.689488393003886","No","Yes","No","100%",,"2,161","0","5,189","60","1,998","865","1,759","55","429","2,220","429","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1017","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_2500_-_no_deductible_for_office_visits&csr=limited_cost_sharing_plan_variation&id=I30A1017"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020039","Select Med Silver 2500 - no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF010","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020039-04","Select Med Silver 2500 - no deductible for office visits","73% AV Level Silver Plan",,"0.735622765599062","No","Yes","No","100%",,"2,000","110","3,455","60","1,943","785","1,414","55","601","1,920","258","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1018","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_2500_-_no_deductible_for_office_visits&csr=73_av_level_silver_plan&id=I30A1018"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020039","Select Med Silver 2500 - no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF010","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020039-05","Select Med Silver 2500 - no deductible for office visits","87% AV Level Silver Plan",,"0.875605226279568","No","Yes","No","100%",,"350","0","1,650","60","650","605","745","55","350","925","129","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1019","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_2500_-_no_deductible_for_office_visits&csr=87_av_level_silver_plan&id=I30A1019"
"2018","UT","68781","SERFF","2017-09-21 20:16:21","Individual","No","87-0409820","68781UT0020039","Select Med Silver 2500 - no deductible for office visits","68781UT002",,"UTN001","UTS001","UTF010","New","HMO","Silver","Not Applicable","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.978",,,"2018-01-01","2018-12-31","No","Urgent or emergency care only","No","Urgent or emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020039-06","Select Med Silver 2500 - no deductible for office visits","94% AV Level Silver Plan",,"0.947937571289658","No","Yes","No","100%",,"100","60","576","60","100","420","265","55","100","405","43","0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A1020","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_silver_2500_-_no_deductible_for_office_visits&csr=94_av_level_silver_plan&id=I30A1020"
"2018","UT","68809","SERFF","2017-08-16 20:15:58","Individual","Yes","91-1857813","68809UT0010009","Guardian Choice","68809UT001",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.56","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSExchangePayment.aspx","","68809UT0010009-00","Guardian Choice","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/utah/","https://dentalexchange.guardianlife.com/our-plans/utah/"
"2018","UT","68809","SERFF","2017-08-16 20:15:58","Individual","Yes","91-1857813","68809UT0010009","Guardian Choice","68809UT001",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.56","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSExchangePayment.aspx","","68809UT0010009-01","Guardian Choice","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/utah/","https://dentalexchange.guardianlife.com/our-plans/utah/"
"2018","UT","71246","SERFF","2017-08-16 20:15:58","Individual","Yes","94-2761537","71246UT0010004","Delta Dental PPO Pediatric Preferred Plan","71246UT001",,"UTN001","UTS001",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","71246UT0010004-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","per group not applicable",,,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/71246ut0010004-18"
"2018","UT","71246","SERFF","2017-08-16 20:15:58","Individual","Yes","94-2761537","71246UT0010003","Delta Dental PPO Pediatric Basic Plan","71246UT001",,"UTN001","UTS001",,"New","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","71246UT0010003-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","per group not applicable",,,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/71246ut0010003-18"
"2018","UT","71246","SERFF","2017-08-16 20:15:58","Individual","Yes","94-2761537","71246UT0030002","Delta Dental PPO Basic Plan for Families","71246UT003",,"UTN001","UTS001",,"New","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","71246UT0030002-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","per group not applicable",,,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/71246ut0030002-18"
"2018","UT","71246","SERFF","2017-08-16 20:15:58","Individual","Yes","94-2761537","71246UT0040002","Delta Dental PPO Preferred Plan for Families","71246UT004",,"UTN001","UTS001",,"New","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","71246UT0040002-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","per group not applicable",,,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/71246ut0040002-18"
"2018","UT","87169","SERFF","2017-08-16 20:15:58","Individual","Yes","47-0397286","87169UT0040001","Renaissance Individual Dental PPO, EHB Certified High (Exchange)","87169UT004",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.682","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level.","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/87169","","87169UT0040001-00","Renaissance Individual Dental PPO, EHB Certified High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","UT","87169","SERFF","2017-08-16 20:15:58","Individual","Yes","47-0397286","87169UT0040001","Renaissance Individual Dental PPO, EHB Certified High (Exchange)","87169UT004",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.682","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level.","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/87169","","87169UT0040001-01","Renaissance Individual Dental PPO, EHB Certified High (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/UT_EHB_High_2018","http://www.renaissancedental.com/UT_EHB_High_2018"
"2018","UT","87169","SERFF","2017-08-16 20:15:58","Individual","Yes","47-0397286","87169UT0040002","Renaissance Individual Dental PPO, EHB Certified Low (Exchange)","87169UT004",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.83","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level.","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/87169","","87169UT0040002-00","Renaissance Individual Dental PPO, EHB Certified Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","UT","87169","SERFF","2017-08-16 20:15:58","Individual","Yes","47-0397286","87169UT0040002","Renaissance Individual Dental PPO, EHB Certified Low (Exchange)","87169UT004",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"0.83","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level.","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/87169","","87169UT0040002-01","Renaissance Individual Dental PPO, EHB Certified Low (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/UT_EHB_Low_2018","http://www.renaissancedental.com/UT_EHB_Low_2018"
"2018","UT","87169","SERFF","2017-08-16 20:15:58","Individual","Yes","47-0397286","87169UT0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified High (Exchange)","87169UT005",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level.","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/87169","","87169UT0050001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified High","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","UT","87169","SERFF","2017-08-16 20:15:58","Individual","Yes","47-0397286","87169UT0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified High (Exchange)","87169UT005",,"UTN001","UTS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level.","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/87169","","87169UT0050001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified High (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/UT_Ped_High_2018","http://www.renaissancedental.com/UT_Ped_High_2018"
"2018","UT","87169","SERFF","2017-08-16 20:15:58","Individual","Yes","47-0397286","87169UT0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified Low (Exchange)","87169UT005",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level.","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/87169","","87169UT0050002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified Low","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","UT","87169","SERFF","2017-08-16 20:15:58","Individual","Yes","47-0397286","87169UT0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified Low (Exchange)","87169UT005",,"UTN001","UTS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level.","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/87169","","87169UT0050002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified Low (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/UT_Ped_Low_2018","http://www.renaissancedental.com/UT_Ped_Low_2018"
"2018","VA","10207","SERFF","2017-09-22 20:15:56","SHOP (Small Group)","No","52-1358219","10207VA0430003","BlueChoice HMO 1000","10207VA043",,"VAN001","VAS001","VAF007","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993919349318366",,,"2018-01-01","2018-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://carefirst.com/acarx","10207VA0430003-00","BlueChoice HMO 1000","Standard Gold Off Exchange Plan","80.95%",,"Yes","Yes","No","100%",,"$1,000","$40","$1,854","$10","$1,000","$270","$1,150","$0","$1,000","$0","$180","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$2000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$2000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://content.carefirst.com/sbc/AHHVC87ARXCVCJ7AN012018.pdf",
"2018","VA","10207","SERFF","2017-09-22 20:15:56","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $3,500","10207VA038",,"VAN001","VAS001","VAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994536054211409",,,"2018-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://carefirst.com/acarx","10207VA0380001-00","BlueChoice HMO Silver $3,500","Standard Silver Off Exchange Plan","70.70%",,"No","Yes","No","100%",,"$3,500","$1,120","$0","$10","$3,090","$930","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/AHNVCN6JRXXVCN6HN012018.pdf",
"2018","VA","10207","SERFF","2017-09-22 20:15:56","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $3,500","10207VA038",,"VAN001","VAS001","VAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994536054211409",,,"2018-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://carefirst.com/acarx","10207VA0380001-01","BlueChoice HMO Silver $3,500","Standard Silver On Exchange Plan","70.70%",,"No","Yes","No","100%",,"$3,500","$1,120","$0","$10","$3,090","$930","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/AHNVCN6JRXXVCN6HN012018.pdf",
"2018","VA","10207","SERFF","2017-09-22 20:15:56","SHOP (Small Group)","No","52-1358219","10207VA0430003","BlueChoice HMO 1000","10207VA043",,"VAN001","VAS001","VAF007","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993919349318366",,,"2018-01-01","2018-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://carefirst.com/acarx","10207VA0430003-01","BlueChoice HMO 1000","Standard Gold On Exchange Plan","80.95%",,"Yes","Yes","No","100%",,"$1,000","$40","$1,854","$10","$1,000","$270","$1,150","$0","$1,000","$0","$180","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$2000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$2000 per person","$2000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://content.carefirst.com/sbc/AHHVC87ARXCVCJ7AN012018.pdf",
"2018","VA","10207","SERFF","2017-09-22 20:15:56","SHOP (Small Group)","No","52-1358219","10207VA0430006","BlueChoice HMO HSA/HRA 2000","10207VA043",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993919349318366",,,"2018-01-01","2018-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://carefirst.com/acarx","10207VA0430006-00","BlueChoice HMO HSA/HRA 2000","Standard Silver Off Exchange Plan","71.35%",,"Yes","Yes","No","100%",,"$2,000","$40","$1,654","$10","$2,000","$250","$956","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://content.carefirst.com/sbc/AHHVC86ARXCVCJ6BN012018.pdf",
"2018","VA","10207","SERFF","2017-09-22 20:15:56","SHOP (Small Group)","No","52-1358219","10207VA0430006","BlueChoice HMO HSA/HRA 2000","10207VA043",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993919349318366",,,"2018-01-01","2018-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://carefirst.com/acarx","10207VA0430006-01","BlueChoice HMO HSA/HRA 2000","Standard Silver On Exchange Plan","71.35%",,"Yes","Yes","No","100%",,"$2,000","$40","$1,654","$10","$2,000","$250","$956","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://content.carefirst.com/sbc/AHHVC86ARXCVCJ6BN012018.pdf",
"2018","VA","10207","SERFF","2017-09-22 20:15:56","SHOP (Small Group)","No","52-1358219","10207VA0440004","BlueChoice Advantage 90%/70%","10207VA044",,"VAN002","VAS001","VAF008","Existing","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993919349318366",,,"2018-01-01","2018-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"https://carefirst.com/acarx","10207VA0440004-00","BlueChoice Advantage 90%/70%","Standard Platinum Off Exchange Plan","91.73%",,"Yes","Yes","No","100%",,"$0","$40","$1,027","$10","$0","$310","$1,039","$0","$0","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group",,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$2,000","$4000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://content.carefirst.com/sbc/AAVVB88BRXXVBJ8CN012018.pdf",
"2018","VA","10207","SERFF","2017-09-22 20:15:56","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $3,500","10207VA038",,"VAN001","VAS001","VAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994536054211409",,,"2018-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://carefirst.com/acarx","10207VA0380001-04","BlueChoice HMO Silver $3,500","73% AV Level Silver Plan","73.29%",,"No","Yes","No","100%",,"$3,000","$1,120","$0","$10","$3,000","$930","$18","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/AHNVCN6LRXXVCN6JN012018.pdf",
"2018","VA","10207","SERFF","2017-09-22 20:15:56","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $3,500","10207VA038",,"VAN001","VAS001","VAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994536054211409",,,"2018-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://carefirst.com/acarx","10207VA0380001-05","BlueChoice HMO Silver $3,500","87% AV Level Silver Plan","86.63%",,"No","Yes","No","100%",,"$0","$520","$0","$10","$0","$1,100","$296","$0","$0","$480","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/AHAVCN6NRXXVCN6WN012018.pdf",
"2018","VA","10207","SERFF","2017-09-22 20:15:56","SHOP (Small Group)","No","52-1358219","10207VA0440004","BlueChoice Advantage 90%/70%","10207VA044",,"VAN002","VAS001","VAF008","Existing","POS","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993919349318366",,,"2018-01-01","2018-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"https://carefirst.com/acarx","10207VA0440004-01","BlueChoice Advantage 90%/70%","Standard Platinum On Exchange Plan","91.73%",,"Yes","Yes","No","100%",,"$0","$40","$1,027","$10","$0","$310","$1,039","$0","$0","$0","$190","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group",,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10.00%",,,,,"$2,000","$4000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://content.carefirst.com/sbc/AAVVB88BRXXVBJ8CN012018.pdf",
"2018","VA","10207","SERFF","2017-09-22 20:15:56","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $3,500","10207VA038",,"VAN001","VAS001","VAF010","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994536054211409",,,"2018-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://carefirst.com/acarx","10207VA0380001-06","BlueChoice HMO Silver $3,500","94% AV Level Silver Plan","93.09%",,"No","Yes","No","100%",,"$0","$230","$0","$10","$0","$220","$296","$0","$0","$205","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/AHAVCN6PRXXVCN6GN012018.pdf",
"2018","VA","10207","SERFF","2017-09-22 20:15:56","Individual","No","52-1358219","10207VA0380003","HealthyBlue HMO Gold $1,000","10207VA038",,"VAN002","VAS001","VAF011","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994536054211409",,,"2018-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://carefirst.com/acarx","10207VA0380003-00","HealthyBlue HMO Gold $1,000","Standard Gold Off Exchange Plan","78.54%",,"No","Yes","No","100%",,"$1,000","$990","$0","$10","$1,000","$675","$198","$0","$1,000","$230","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/HENVCN7JRXXVCN7BN012018.pdf",
"2018","VA","10207","SERFF","2017-09-22 20:15:56","Individual","No","52-1358219","10207VA0380003","HealthyBlue HMO Gold $1,000","10207VA038",,"VAN002","VAS001","VAF011","Existing","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994536054211409",,,"2018-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://carefirst.com/acarx","10207VA0380003-01","HealthyBlue HMO Gold $1,000","Standard Gold On Exchange Plan","78.54%",,"No","Yes","No","100%",,"$1,000","$990","$0","$10","$1,000","$675","$198","$0","$1,000","$230","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/HENVCN7JRXXVCN7BN012018.pdf",
"2018","VA","10207","SERFF","2017-09-22 20:15:56","Individual","No","52-1358219","10207VA0380004","BlueChoice HMO Young Adult $7,350","10207VA038",,"VAN001","VAS001","VAF009","Existing","HMO","Catastrophic","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994536054211409",,,"2018-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://carefirst.com/acarx","10207VA0380004-01","BlueChoice HMO Young Adult $7,350","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$10","$7,200","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://content.carefirst.com/sbc/AHHVCN9JRXCVCN9DN012018.pdf",
"2018","VA","16064","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","54-0357120","16064VA1300003","Anthem Dental Family","16064VA130",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Annual Benefit Maximum (applies to Adult Dental Benefits): $750",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","16064VA1300003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e214303.pdf",
"2018","VA","16064","SERFF","2017-08-13 20:16:00","Individual","Yes","54-0357120","16064VA1270005","Anthem Dental Family Value","16064VA127",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,"Annual Benefit Maximum (applies to Adult Dental Benefits): $750",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","16064VA1270005-01","Anthem Dental Family Value","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e214305.pdf",
"2018","VA","16064","SERFF","2017-08-13 20:16:00","Individual","Yes","54-0357120","16064VA1330005","Anthem Dental Family Value","16064VA133",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Annual Benefit Maximum (applies to Adult Dental Benefits): $750",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","16064VA1330005-00","Anthem Dental Family Value","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e214305.pdf",
"2018","VA","16064","SERFF","2017-08-13 20:16:00","Individual","Yes","54-0357120","16064VA1270003","Anthem Dental Family","16064VA127",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,"Annual Benefit Maximum (applies to Adult Dental Benefits): $750",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","16064VA1270003-01","Anthem Dental Family","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e214303.pdf",
"2018","VA","16064","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","54-0357120","16064VA1300004","Anthem Dental Family Enhanced","16064VA130",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Annual Benefit Maximum (applies to Adult Dental Benefits): $1,000",,"No","Allows Adult and Child-Only",,,,,"0.844","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","16064VA1300004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e214304.pdf",
"2018","VA","16064","SERFF","2017-08-13 20:16:00","Individual","Yes","54-0357120","16064VA1330003","Anthem Dental Family","16064VA133",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Annual Benefit Maximum (applies to Adult Dental Benefits): $750",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","16064VA1330003-00","Anthem Dental Family","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e214303.pdf",
"2018","VA","16064","SERFF","2017-08-13 20:16:00","Individual","Yes","54-0357120","16064VA1270004","Anthem Dental Family Enhanced","16064VA127",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,"Annual Benefit Maximum (applies to Adult Dental Benefits): $1,000",,"No","Allows Adult and Child-Only",,,,,"0.844","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","16064VA1270004-01","Anthem Dental Family Enhanced","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e214304.pdf",
"2018","VA","16064","SERFF","2017-08-13 20:16:00","Individual","Yes","54-0357120","16064VA1330004","Anthem Dental Family Enhanced","16064VA133",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Annual Benefit Maximum (applies to Adult Dental Benefits): $1,000",,"No","Allows Adult and Child-Only",,,,,"0.844","Guaranteed Rate","2018-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","16064VA1330004-00","Anthem Dental Family Enhanced","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e214304.pdf",
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410015","OptimaFit Gold 1500 M","20507VA141","7487657612","VAN001","VAS001","VAF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410015-00","OptimaFit Gold 1500","Standard Gold Off Exchange Plan",,"0.761157671912107","Yes","Yes","No","100%",,"$1,500","$30","$1,100","$0","$200","$1,300","$0","$0","$1,500","$0","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3406|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410015","OptimaFit Gold 1500 M","20507VA141","7487657612","VAN001","VAS001","VAF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410015-01","OptimaFit Gold 1500 M","Standard Gold On Exchange Plan",,"0.761157671912107","Yes","Yes","No","100%",,"$1,500","$30","$1,100","$0","$200","$1,300","$0","$0","$1,500","$0","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3365|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410015","OptimaFit Gold 1500 M","20507VA141","7487657612","VAN001","VAS001","VAF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410015-02","OptimaFit Gold 1500 ZCS","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3380|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410015","OptimaFit Gold 1500 M","20507VA141","7487657612","VAN001","VAS001","VAF001","Existing","HMO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410015-03","OptimaFit Gold 1500 LCS","Limited Cost Sharing Plan Variation",,"0.761157671912107","Yes","Yes","No","100%",,"$1,500","$30","$1,100","$0","$200","$1,300","$0","$0","$1,500","$0","$40","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3389|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410017","OptimaFit Silver 4600 20% M","20507VA141","7487657612","VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410017-00","OptimaFit Silver 4600 20%","Standard Silver Off Exchange Plan",,"0.697652467748894","No","Yes","No","100%",,"$4,600","$30","$1,600","$0","$400","$1,100","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,600","$4600 per person","$9200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3409|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410017","OptimaFit Silver 4600 20% M","20507VA141","7487657612","VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410017-01","OptimaFit Silver 4600 20% M","Standard Silver On Exchange Plan",,"0.697652467748894","No","Yes","No","100%",,"$4,600","$30","$1,600","$0","$400","$1,100","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,600","$4600 per person","$9200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3367|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410017","OptimaFit Silver 4600 20% M","20507VA141","7487657612","VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410017-02","OptimaFit Silver 4600 20% ZCS","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3383|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410017","OptimaFit Silver 4600 20% M","20507VA141","7487657612","VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410017-03","OptimaFit Silver 4600 20% LCS","Limited Cost Sharing Plan Variation",,"0.697652467748894","No","Yes","No","100%",,"$4,600","$30","$1,600","$0","$400","$1,100","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,600","$4600 per person","$9200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3390|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410017","OptimaFit Silver 4600 20% M","20507VA141","7487657612","VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410017-04","OptimaFit Silver 2900 (04) M","73% AV Level Silver Plan",,"0.739265794957695","No","Yes","No","100%",,"$2,900","$30","$1,900","$0","$300","$1,100","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3373|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP3.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410017","OptimaFit Silver 4600 20% M","20507VA141","7487657612","VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410017-05","OptimaFit Silver 600 (05) M","87% AV Level Silver Plan",,"0.870845145126612","No","Yes","No","100%",,"$600","$30","$1,200","$0","$200","$1,000","$0","$0","$600","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3375|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP3.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410017","OptimaFit Silver 4600 20% M","20507VA141","7487657612","VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9975",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410017-06","OptimaFit Silver 150 (06) M","94% AV Level Silver Plan",,"0.933998618102333","No","Yes","No","100%",,"$150","$30","$700","$0","$150","$800","$0","$0","$150","$60","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3377|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP3.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410018","OptimaFit Silver 2850 20% HSA M","20507VA141","7487657612","VAN001","VAS001","VAF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9963",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410018-00","OptimaFit Silver 2850 20% HSA","Standard Silver Off Exchange Plan",,"0.681725064115197","Yes","Yes","No","100%",,"$2,850","$20","$1,900","$0","$2,850","$200","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3481|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410018","OptimaFit Silver 2850 20% HSA M","20507VA141","7487657612","VAN001","VAS001","VAF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9963",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410018-01","OptimaFit Silver 2850 20% HSA M","Standard Silver On Exchange Plan",,"0.681725064115197","Yes","Yes","No","100%",,"$2,850","$20","$1,900","$0","$2,850","$200","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3368|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410018","OptimaFit Silver 2850 20% HSA M","20507VA141","7487657612","VAN001","VAS001","VAF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9963",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410018-02","OptimaFit Silver 2850 20% ZCS","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3384|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410018","OptimaFit Silver 2850 20% HSA M","20507VA141","7487657612","VAN001","VAS001","VAF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9963",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410018-03","OptimaFit Silver 2850 20% LCS","Limited Cost Sharing Plan Variation",,"0.681725064115197","Yes","Yes","No","100%",,"$2,850","$20","$1,900","$0","$2,850","$200","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3480|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410018","OptimaFit Silver 2850 20% HSA M","20507VA141","7487657612","VAN001","VAS001","VAF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9963",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410018-04","OptimaFit Silver 1600 20% (04) M","73% AV Level Silver Plan",,"0.739277732016743","Yes","Yes","No","100%",,"$1,600","$20","$2,200","$0","$900","$900","$0","$0","$1,600","$0","$70","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3374|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP3.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410018","OptimaFit Silver 2850 20% HSA M","20507VA141","7487657612","VAN001","VAS001","VAF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9963",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410018-05","OptimaFit Silver 500 10% (05) M","87% AV Level Silver Plan",,"0.864612017807579","Yes","Yes","No","100%",,"$500","$20","$1,200","$0","$500","$800","$40","$0","$500","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3376|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP3.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410018","OptimaFit Silver 2850 20% HSA M","20507VA141","7487657612","VAN001","VAS001","VAF005","Existing","HMO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9963",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410018-06","OptimaFit Silver 100 5% (06) M","94% AV Level Silver Plan",,"0.931646563339635","Yes","Yes","No","100%",,"$100","$20","$600","$0","$100","$600","$40","$0","$100","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3378|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP3.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410019","OptimaFit Bronze 7200 20% M","20507VA141","7487657612","VAN001","VAS001","VAF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410019-00","OptimaFit Bronze 7200 20%","Standard Bronze Off Exchange Plan",,"0.587140257012401","Yes","Yes","No","100%",,"$7,200","$20","$200","$0","$900","$1,000","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3410|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410019","OptimaFit Bronze 7200 20% M","20507VA141","7487657612","VAN001","VAS001","VAF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410019-01","OptimaFit Bronze 7200 20% M","Standard Bronze On Exchange Plan",,"0.587140257012401","Yes","Yes","No","100%",,"$7,200","$20","$200","$0","$900","$1,000","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3369|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410019","OptimaFit Bronze 7200 20% M","20507VA141","7487657612","VAN001","VAS001","VAF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410019-02","OptimaFit Bronze 7200 20% ZCS","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3385|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410019","OptimaFit Bronze 7200 20% M","20507VA141","7487657612","VAN001","VAS001","VAF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410019-03","OptimaFit Bronze 7200 20% LCS","Limited Cost Sharing Plan Variation",,"0.587140257012401","Yes","Yes","No","100%",,"$7,200","$20","$200","$0","$900","$1,000","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3392|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410009","OptimaFit Catastrophic 7350 M","20507VA141","7487657612","VAN001","VAS001","VAF002","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410009-00","OptimaFit Catastrophic 7350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$10","$0","$0","$300","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3413|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410009","OptimaFit Catastrophic 7350 M","20507VA141","7487657612","VAN001","VAS001","VAF002","New","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410009-01","OptimaFit Catastrophic 7350 M","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$10","$0","$0","$300","$100","$0","$0","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3379|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410008","OptimaFit Bronze 6000 HSA M","20507VA141","7487657612","VAN001","VAS001","VAF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410008-00","OptimaFit Bronze 6000 HSA","Standard Bronze Off Exchange Plan",,"0.607976310324391","Yes","Yes","No","100%",,"$6,000","$20","$600","$0","$3,200","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3412|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410008","OptimaFit Bronze 6000 HSA M","20507VA141","7487657612","VAN001","VAS001","VAF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410008-01","OptimaFit Bronze 6000 HSA M","Standard Bronze On Exchange Plan",,"0.607976310324391","Yes","Yes","No","100%",,"$6,000","$20","$600","$0","$3,200","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3372|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410008","OptimaFit Bronze 6000 HSA M","20507VA141","7487657612","VAN001","VAS001","VAF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410008-02","OptimaFit Bronze 6000 ZCS","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3388|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410008","OptimaFit Bronze 6000 HSA M","20507VA141","7487657612","VAN001","VAS001","VAF003","New","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410008-03","OptimaFit Bronze 6000 LCS","Limited Cost Sharing Plan Variation",,"0.607976310324391","Yes","Yes","No","100%",,"$6,000","$20","$600","$0","$3,200","$0","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3395|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410022","OptimaFit Bronze 7200 20% M Select","20507VA141","7487657612","VAN003","VAS003","VAF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410022-00","OptimaFit Bronze 7200 20%  Select","Standard Bronze Off Exchange Plan",,"0.587140257012401","Yes","Yes","No","100%",,"$7,200","$20","$200","$0","$900","$1,000","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3486|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1SelectHR.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410022","OptimaFit Bronze 7200 20% M Select","20507VA141","7487657612","VAN003","VAS003","VAF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410022-01","OptimaFit Bronze 7200 20% M Select","Standard Bronze On Exchange Plan",,"0.587140257012401","Yes","Yes","No","100%",,"$7,200","$20","$200","$0","$900","$1,000","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3399|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1SelectHR.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410022","OptimaFit Bronze 7200 20% M Select","20507VA141","7487657612","VAN003","VAS003","VAF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410022-02","OptimaFit Bronze 7200 20% Select ZCS","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3400|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1SelectHR.aspx"
"2018","VA","20507","SERFF","2017-10-31 20:15:29","Individual","No","54-1283337","20507VA1410022","OptimaFit Bronze 7200 20% M Select","20507VA141","7487657612","VAN003","VAS003","VAF007","Existing","HMO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9965",,,"2018-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://ww2.e-billexpress.com/ebpp/OptimaSHO/OnExchange.aspx","https://www.optimahealth.com/exchangesbc/HIX4TierClosedIGformulary2018.pdf","20507VA1410022-03","OptimaFit Bronze 7200 20% Select LCS","Limited Cost Sharing Plan Variation",,"0.587140257012401","Yes","Yes","No","100%",,"$7,200","$20","$200","$0","$900","$1,000","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,200","$7200 per person","$14400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=3401|False|1","https://www.optimahealth.com/vendor/exchange/012018HIXBrochureIFP1SelectHR.aspx"
"2018","VA","24832","SERFF","2017-08-13 20:16:00","Individual","Yes","47-0397286","24832VA0020003","Renaissance Individual Dental PPO, EHB Certified","24832VA002",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","24832VA0020003-00","Renaissance Individual Dental PPO, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","VA","24832","SERFF","2017-08-13 20:16:00","Individual","Yes","47-0397286","24832VA0020004","Renaissance Individual Dental PPO, EHB Certified","24832VA002",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","24832VA0020004-00","Renaissance Individual Dental PPO, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","VA","24832","SERFF","2017-08-13 20:16:00","Individual","Yes","47-0397286","24832VA0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","24832VA004",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/24832","","24832VA0040001-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/VA_EHB_High_2018","http://www.renaissancedental.com/VA_EHB_High_2018"
"2018","VA","24832","SERFF","2017-08-13 20:16:00","Individual","Yes","47-0397286","24832VA0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","24832VA004",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/24832","","24832VA0040002-01","Renaissance Individual Dental PPO, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/VA_EHB_Low_2018","http://www.renaissancedental.com/VA_EHB_Low_2018"
"2018","VA","24832","SERFF","2017-08-13 20:16:00","Individual","Yes","47-0397286","24832VA0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","24832VA005",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/24832","","24832VA0050001-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/VA_Ped_High_2018","http://www.renaissancedental.com/VA_Ped_High_2018"
"2018","VA","24832","SERFF","2017-08-13 20:16:00","Individual","Yes","47-0397286","24832VA0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","24832VA005",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/24832","","24832VA0050002-01","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/VA_Ped_Low_2018","http://www.renaissancedental.com/VA_Ped_Low_2018"
"2018","VA","24832","SERFF","2017-08-13 20:16:00","Individual","Yes","47-0397286","24832VA0060001","Renaissance Individual Dental Pediatric-Only, EHB Certified","24832VA006",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","24832VA0060001-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","VA","24832","SERFF","2017-08-13 20:16:00","Individual","Yes","47-0397286","24832VA0060002","Renaissance Individual Dental Pediatric-Only, EHB Certified","24832VA006",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01",,"Yes","Benefits paid at the Out of Network Level","Yes","Same Benefit Level","Yes",,"","24832VA0060002-00","Renaissance Individual Dental Pediatric-Only, EHB Certified","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","VA","31319","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","54-0844477","31319VA0020015","Delta Dental Small Group Family Exchange Dental Plan","31319VA002",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes",,"","31319VA0020015-00","Delta Dental Small Group Family Exchange Dental Plan","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","VA","31319","SERFF","2017-08-13 20:16:00","Individual","Yes","54-0844477","31319VA0010004","Delta Dental Individual and Family Basic plus Major Plan","31319VA001",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.657","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","31319VA0010004-01","Delta Dental Individual and Family Basic plus Major Plan","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/DDVA_Individual_Basic_Plus_Major_Plan.pdf",
"2018","VA","31319","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","54-0844477","31319VA0020016","Delta Dental Small Group Family Exchange Dental Plan","31319VA002",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes",,"","31319VA0020016-00","Delta Dental Small Group Family Exchange Dental Plan","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","VA","31319","SERFF","2017-08-13 20:16:00","Individual","Yes","54-0844477","31319VA0010003","Delta Dental Individual and Family Basic Plan","31319VA001",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"0.481","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","31319VA0010003-01","Delta Dental Individual and Family Basic Plan","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/DDVA_Individual_Basic_Plan.pdf",
"2018","VA","31319","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","54-0844477","31319VA0020017","Delta Dental Small Group Family Exchange Dental Plan","31319VA002",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes",,"","31319VA0020017-00","Delta Dental Small Group Family Exchange Dental Plan","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","VA","31319","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","54-0844477","31319VA0020018","Delta Dental Small Group Family Exchange Dental Plan","31319VA002",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes",,"","31319VA0020018-00","Delta Dental Small Group Family Exchange Dental Plan","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030002","Gold 1500/30/50 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF001","New","POS","Gold","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030002-00","Gold 1500/30/50 POS HMO","Standard Gold Off Exchange Plan",,"0.76118684913539","Yes","Yes","No","100%",,"$1,500","$40","$2,800","$60","$1,400","$2,000","$0","$60","$1,500","$250","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","30.00%",,,,,"$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030002-00-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030009","Bronze HSA 6000 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF006","New","POS","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030009-01","Bronze HSA 6000 POS HMO","Standard Bronze On Exchange Plan",,"0.606610143328799","Yes","Yes","No","100%",,"$6,000","$0","$550","$60","$6,000","$250","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","25.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0030009-01-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030002","Gold 1500/30/50 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF001","New","POS","Gold","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030002-01","Gold 1500/30/50 POS HMO","Standard Gold On Exchange Plan",,"0.76118684913539","Yes","Yes","No","100%",,"$1,500","$40","$2,800","$60","$1,400","$2,000","$0","$60","$1,500","$250","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","30.00%",,,,,"$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030002-01-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030008","Bronze HSA 5000 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF004","New","POS","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030008-02","Bronze HSA 5000 Native American Zero Cost Share POS HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/37204va0030008-02-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030008","Bronze HSA 5000 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF004","New","POS","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030008-03","Bronze HSA 5000 Native American Limited Cost Share POS HMO","Limited Cost Sharing Plan Variation",,"0.612289288368638","Yes","Yes","No","100%",,"$5,000","$0","$1,550","$60","$5,000","$1,100","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0030008-03-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","40308","SERFF","2017-09-22 20:15:56","Individual","No","53-0078070","40308VA0240008","BluePreferred Silver $3,500","40308VA024",,"VAN002","VAS001","VAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995681245122489",,,"2018-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,"https://carefirst.com/acarx","40308VA0240008-06","BluePreferred Silver $3,500","94% AV Level Silver Plan","93.09%",,"No","Yes","No","100%",,"$0","$230","$0","$10","$0","$220","$296","$0","$0","$205","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/APPVBN6JRXXVBN6VN012018.pdf",
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030002","Gold 1500/30/50 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF001","New","POS","Gold","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030002-02","Gold 1500/30/50 Native American Zero Cost Share POS HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/37204va0030002-02-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030002","Gold 1500/30/50 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF001","New","POS","Gold","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030002-03","Gold 1500/30/50 Native American Limited Cost Share POS HMO","Limited Cost Sharing Plan Variation",,"0.76118684913539","Yes","Yes","No","100%",,"$1,500","$40","$2,800","$60","$1,400","$2,000","$0","$60","$1,500","$250","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","30.00%",,,,,"$3,000","$3000 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030002-03-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030003","Silver 6000/20% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF002","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030003-00","Silver 6000/20% POS HMO","Standard Silver Off Exchange Plan",,"0.660387714554012","Yes","Yes","No","100%",,"$6,000","$30","$900","$60","$2,000","$1,700","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030003-00-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030003","Silver 6000/20% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF002","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030003-01","Silver 6000/20% POS HMO","Standard Silver On Exchange Plan",,"0.660387714554012","Yes","Yes","No","100%",,"$6,000","$30","$900","$60","$2,000","$1,700","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030003-01-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030003","Silver 6000/20% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF002","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030003-02","Silver 6000/20% Native American Zero Cost Share POS HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/37204va0030003-02-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030003","Silver 6000/20% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF002","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030003-03","Silver 6000/20% Native American Limited Cost Share POS HMO","Limited Cost Sharing Plan Variation",,"0.660387714554012","Yes","Yes","No","100%",,"$6,000","$30","$900","$60","$2,000","$1,700","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030003-03-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030003","Silver 6000/20% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF002","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030003-04","Silver 6000/20% (CSR 73%) POS HMO","73% AV Level Silver Plan",,"0.738945883803472","Yes","Yes","No","100%",,"$3,000","$0","$1,500","$60","$2,000","$1,600","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030003-04-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030003","Silver 6000/20% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF002","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030003-05","Silver 6000/20% (CSR 87%) POS HMO","87% AV Level Silver Plan",,"0.878544853759075","Yes","Yes","No","100%",,"$700","$0","$700","$60","$700","$700","$0","$60","$700","$0","$250","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030003-05-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030003","Silver 6000/20% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF002","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030003-06","Silver 6000/20% (CSR 94%) POS HMO","94% AV Level Silver Plan",,"0.942711922715422","Yes","Yes","No","100%",,"$200","$0","$400","$60","$200","$400","$0","$60","$200","$0","$350","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030003-06-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030004","Silver 4000/40/20% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF003","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030004-00","Silver 4000/40/20% POS HMO","Standard Silver Off Exchange Plan",,"0.683544454357668","Yes","Yes","No","100%",,"$4,000","$30","$1,300","$60","$1,800","$2,000","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030004-00-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030004","Silver 4000/40/20% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF003","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030004-01","Silver 4000/40/20% POS HMO","Standard Silver On Exchange Plan",,"0.683544454357668","Yes","Yes","No","100%",,"$4,000","$30","$1,300","$60","$1,800","$2,000","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030004-01-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030004","Silver 4000/40/20% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF003","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030004-02","Silver 4000/40/20% Native American Zero Cost Share POS HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/37204va0030004-02-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030004","Silver 4000/40/20% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF003","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030004-03","Silver 4000/40/20% Native American Limited Cost Share POS HMO","Limited Cost Sharing Plan Variation",,"0.683544454357668","Yes","Yes","No","100%",,"$4,000","$30","$1,300","$60","$1,800","$2,000","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,000","$7000 per person","$14000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030004-03-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030004","Silver 4000/40/20% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF003","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030004-04","Silver 4000/40/20% (CSR 73%) POS HMO","73% AV Level Silver Plan",,"0.736281949458175","Yes","Yes","No","100%",,"$2,600","$30","$1,600","$60","$1,500","$1,800","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030004-04-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030004","Silver 4000/40/20% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF003","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030004-05","Silver 4000/40/20% (CSR 87%) POS HMO","87% AV Level Silver Plan",,"0.875592948498063","Yes","Yes","No","100%",,"$700","$0","$800","$60","$700","$800","$0","$60","$700","$0","$250","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030004-05-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030004","Silver 4000/40/20% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF003","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030004-06","Silver 4000/40/20% (CSR 94%) POS HMO","94% AV Level Silver Plan",,"0.942753610200312","Yes","Yes","No","100%",,"$200","$0","$400","$60","$200","$400","$0","$60","$200","$0","$350","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20.00%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030004-06-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030005","Silver 3000/25% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF003","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030005-00","Silver 3000/25% POS HMO","Standard Silver Off Exchange Plan",,"0.684819066390553","Yes","Yes","No","100%",,"$3,000","$30","$1,900","$60","$2,000","$1,900","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030005-00-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030005","Silver 3000/25% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF003","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030005-01","Silver 3000/25% POS HMO","Standard Silver On Exchange Plan",,"0.684819066390553","Yes","Yes","No","100%",,"$3,000","$30","$1,900","$60","$2,000","$1,900","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030005-01-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030005","Silver 3000/25% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF003","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030005-02","Silver 3000/25% Native American Zero Cost Share POS HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/37204va0030005-02-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030005","Silver 3000/25% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF003","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030005-03","Silver 3000/25% Native American Limited Cost Share POS HMO","Limited Cost Sharing Plan Variation",,"0.684819066390553","Yes","Yes","No","100%",,"$3,000","$30","$1,900","$60","$2,000","$1,900","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030005-03-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030005","Silver 3000/25% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF003","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030005-04","Silver 3000/25% (CSR 73%) POS HMO","73% AV Level Silver Plan",,"0.736619469006343","Yes","Yes","No","100%",,"$2,500","$30","$2,000","$60","$2,000","$1,700","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030005-04-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030005","Silver 3000/25% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF003","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030005-05","Silver 3000/25% (CSR 87%) POS HMO","87% AV Level Silver Plan",,"0.877532463688723","Yes","Yes","No","100%",,"$700","$0","$700","$60","$700","$700","$0","$60","$700","$0","$300","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030005-05-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030005","Silver 3000/25% POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF003","New","POS","Silver","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030005-06","Silver 3000/25% (CSR 94%) POS HMO","94% AV Level Silver Plan",,"0.941703599092696","Yes","Yes","No","100%",,"$200","$0","$400","$60","$200","$400","$0","$60","$200","$0","$400","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030005-06-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030006","Bronze 5400 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF004","New","POS","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030006-00","Bronze 5400 POS HMO","Standard Bronze Off Exchange Plan",,"0.612979773732105","Yes","Yes","No","100%",,"$5,400","$30","$1,800","$60","$5,400","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","35.00%",,,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030006-00-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030006","Bronze 5400 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF004","New","POS","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030006-01","Bronze 5400 POS HMO","Standard Bronze On Exchange Plan",,"0.612979773732105","Yes","Yes","No","100%",,"$5,400","$30","$1,800","$60","$5,400","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","35.00%",,,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030006-01-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030006","Bronze 5400 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF004","New","POS","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030006-02","Bronze 5400 Native American Zero Cost Share POS HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/37204va0030006-02-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030006","Bronze 5400 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF004","New","POS","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030006-03","Bronze 5400 Native American Limited Cost Share POS HMO","Limited Cost Sharing Plan Variation",,"0.612979773732105","Yes","Yes","No","100%",,"$5,400","$30","$1,800","$60","$5,400","$600","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","35.00%",,,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030006-03-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030007","Bronze 6200 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF005","New","POS","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030007-00","Bronze 6200 POS HMO","Standard Bronze Off Exchange Plan",,"0.606688841328093","Yes","Yes","No","100%",,"$6,200","$0","$1,150","$60","$6,200","$300","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","30.00%",,,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030007-00-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030007","Bronze 6200 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF005","New","POS","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030007-01","Bronze 6200 POS HMO","Standard Bronze On Exchange Plan",,"0.606688841328093","Yes","Yes","No","100%",,"$6,200","$0","$1,150","$60","$6,200","$300","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","30.00%",,,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030007-01-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030007","Bronze 6200 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF005","New","POS","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030007-02","Bronze 6200 Native American Zero Cost Share POS HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/37204va0030007-02-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030007","Bronze 6200 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF005","New","POS","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030007-03","Bronze 6200 Native American Limited Cost Share POS HMO","Limited Cost Sharing Plan Variation",,"0.606688841328093","Yes","Yes","No","100%",,"$6,200","$0","$1,150","$60","$6,200","$300","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","30.00%",,,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030007-03-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030008","Bronze HSA 5000 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF004","New","POS","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030008-00","Bronze HSA 5000 POS HMO","Standard Bronze Off Exchange Plan",,"0.612289288368638","Yes","Yes","No","100%",,"$5,000","$0","$1,550","$60","$5,000","$1,100","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0030008-00-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030008","Bronze HSA 5000 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF004","New","POS","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030008-01","Bronze HSA 5000 POS HMO","Standard Bronze On Exchange Plan",,"0.612289288368638","Yes","Yes","No","100%",,"$5,000","$0","$1,550","$60","$5,000","$1,100","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","35.00%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0030008-01-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030009","Bronze HSA 6000 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF006","New","POS","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030009-00","Bronze HSA 6000 POS HMO","Standard Bronze Off Exchange Plan",,"0.606610143328799","Yes","Yes","No","100%",,"$6,000","$0","$550","$60","$6,000","$250","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","25.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0030009-00-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030009","Bronze HSA 6000 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF006","New","POS","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030009-02","Bronze HSA 6000 Native American Zero Cost Share POS HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/37204va0030009-02-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030009","Bronze HSA 6000 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF006","New","POS","Bronze","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030009-03","Bronze HSA 6000 Native American Limited Cost Share POS HMO","Limited Cost Sharing Plan Variation",,"0.606610143328799","Yes","Yes","No","100%",,"$6,000","$0","$550","$60","$6,000","$250","$0","$60","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","25.00%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0030009-03-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030010","Catastrophic 7350 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF007","New","POS","Catastrophic","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030010-00","Catastrophic 7350 POS HMO","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,700","$120","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030010-00-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030010","Catastrophic 7350 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF007","New","POS","Catastrophic","Not Applicable","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030010-01","Catastrophic 7350 POS HMO","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$60","$6,700","$120","$0","$60","$1,900","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030010-01-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020011","Cigna Connect 6400","41921VA002","7730182962","VAN001","VAS002","VAF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020011-01","Cigna Connect 6400","Standard Bronze On Exchange Plan",,"0.587146438886356","Yes","Yes","No","100%",,"$6,400","$0","$1,000","$10","$6,400","$0","$300","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6400-nova-va","http://www.cigna.com/2018/sob/cigna-connect-6400-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020011","Cigna Connect 6400","41921VA002","7730182962","VAN001","VAS002","VAF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020011-02","Cigna Connect-0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-nova-va","http://www.cigna.com/2018/sob/cigna-connect-0-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020011","Cigna Connect 6400","41921VA002","7730182962","VAN001","VAS002","VAF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020011-03","Cigna Connect 6400-1","Limited Cost Sharing Plan Variation",,"0.587146438886356","Yes","Yes","No","100%",,"$6,400","$0","$1,000","$10","$6,400","$0","$300","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6400-1-nova-va","http://www.cigna.com/2018/sob/cigna-connect-6400-1-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020003","Cigna Connect 6000","41921VA002","7730182962","VAN001","VAS001","VAF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020003-00","Cigna Connect 6000","Standard Bronze Off Exchange Plan","61.89%","0.638254319676626","Yes","Yes","No","100%",,"$6,000","$20","$1,300","$10","$650","$400","$0","$200","$1,590","$40","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6000-rich-va","http://www.cigna.com/2018/sob/cigna-connect-6000-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020003","Cigna Connect 6000","41921VA002","7730182962","VAN001","VAS001","VAF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020003-01","Cigna Connect 6000","Standard Bronze On Exchange Plan","61.89%","0.638254319676626","Yes","Yes","No","100%",,"$6,000","$20","$1,300","$10","$650","$400","$0","$200","$1,590","$40","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6000-rich-va","http://www.cigna.com/2018/sob/cigna-connect-6000-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020003","Cigna Connect 6000","41921VA002","7730182962","VAN001","VAS001","VAF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020003-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-rich-va","http://www.cigna.com/2018/sob/cigna-connect-0-rich-va"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030011","Bronze Standard 6650 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF008","New","POS","Expanded Bronze","Design 1","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030011-00","Bronze Standard 6650 POS HMO","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$700","$60","$5,700","$800","$0","$60","$1,600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030011-00-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030011","Bronze Standard 6650 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF008","New","POS","Expanded Bronze","Design 1","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030011-01","Bronze Standard 6650 POS HMO","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$700","$60","$5,700","$800","$0","$60","$1,600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030011-01-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030011","Bronze Standard 6650 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF008","New","POS","Expanded Bronze","Design 1","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030011-02","Bronze Standard 6650 POS HMO","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/37204va0030011-02-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","37204","SERFF","2017-09-22 20:15:56","Individual","No","47-3163409","37204VA0030011","Bronze Standard 6650 POS HMO","37204VA003","7407850644","VAN001","VAS001","VAF008","New","POS","Expanded Bronze","Design 1","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes","0.9988",,,"2018-01-01","2018-12-31","No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits.","No","https://pchp.insxcloud.com/payment","http://www.pchp.net/index.php/prescription-drug-formulary-hmo-2018.html","37204VA0030011-03","Bronze Standard 6650 POS HMO","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$6,650","$0","$700","$60","$5,700","$800","$0","$60","$1,600","$300","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0030011-03-2018.html","http://www.pchp.net/index.php/plan-brochure-hmo-2018.html"
"2018","VA","40198","SERFF","2017-08-14 20:15:51","Individual","Yes","59-0397210","40198VA0020002","DentaQuest EPO  Pediatric High","40198VA002",,"VAN003","VAS002",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","40198VA0020002-00","DentaQuest EPO  Pediatric High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/"
"2018","VA","40198","SERFF","2017-08-14 20:15:51","Individual","Yes","59-0397210","40198VA0020002","DentaQuest EPO  Pediatric High","40198VA002",,"VAN003","VAS002",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","40198VA0020002-01","DentaQuest EPO  Pediatric High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/"
"2018","VA","40198","SERFF","2017-08-14 20:15:51","Individual","Yes","59-0397210","40198VA0020003","DentaQuest EPO Family High","40198VA002",,"VAN003","VAS002",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","40198VA0020003-00","DentaQuest EPO Family High","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/"
"2018","VA","40198","SERFF","2017-08-14 20:15:51","Individual","Yes","59-0397210","40198VA0020003","DentaQuest EPO Family High","40198VA002",,"VAN003","VAS002",,"Existing","EPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","40198VA0020003-01","DentaQuest EPO Family High","Standard High On Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/"
"2018","VA","40198","SERFF","2017-08-14 20:15:51","Individual","Yes","59-0397210","40198VA0020004","DentaQuest EPO Family Low","40198VA002",,"VAN003","VAS002",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","40198VA0020004-00","DentaQuest EPO Family Low","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/"
"2018","VA","40198","SERFF","2017-08-14 20:15:51","Individual","Yes","59-0397210","40198VA0020004","DentaQuest EPO Family Low","40198VA002",,"VAN003","VAS002",,"Existing","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","40198VA0020004-01","DentaQuest EPO Family Low","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/"
"2018","VA","40198","SERFF","2017-08-14 20:15:51","Individual","Yes","59-0397210","40198VA0020005","DentaQuest EPO Family Preventative","40198VA002",,"VAN003","VAS002",,"New","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","40198VA0020005-00","DentaQuest EPO Family Preventative","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/"
"2018","VA","40198","SERFF","2017-08-14 20:15:51","Individual","Yes","59-0397210","40198VA0020005","DentaQuest EPO Family Preventative","40198VA002",,"VAN003","VAS002",,"New","EPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","https://member.dentaquest.com/maintain","","40198VA0020005-01","DentaQuest EPO Family Preventative","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/"
"2018","VA","40308","SERFF","2017-09-22 20:15:56","Individual","No","53-0078070","40308VA0240007","HealthyBlue PPO Gold $1,000","40308VA024",,"VAN001","VAS001","VAF008","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995681245122489",,,"2018-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,"https://carefirst.com/acarx","40308VA0240007-00","HealthyBlue PPO Gold $1,000","Standard Gold Off Exchange Plan","78.54%",,"No","Yes","No","100%",,"$1,000","$990","$0","$10","$1,000","$675","$198","$0","$1,000","$230","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/HFNVBN7ERXXVBN7DN012018.pdf",
"2018","VA","40308","SERFF","2017-09-22 20:15:56","SHOP (Small Group)","No","53-0078070","40308VA0270007","BluePreferred PPO 100%/80%","40308VA027",,"VAN001","VAS001","VAF007","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995591517452603",,,"2018-01-01","2018-12-31","Yes","All covered services","Yes","All covered services","Yes",,"https://carefirst.com/acarx","40308VA0270007-00","BluePreferred PPO 100%/80%","Standard Platinum Off Exchange Plan","91.72%",,"Yes","Yes","No","100%",,"$0","$600","$0","$10","$0","$490","$1,076","$0","$0","$380","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group",,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://content.carefirst.com/sbc/APPVB88ARXXVBJ8CN012018.pdf",
"2018","VA","40308","SERFF","2017-09-22 20:15:56","Individual","Yes","53-0078070","40308VA0320001","BlueDental Preferred High","40308VA032",,"VAN010","VAS002",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,"Annual maximum benefit is $1,000 per member age 19 and over. Frequency and age limitations may apply based on type of service received.",,"No","Allows Adult and Child-Only",,,,,"0.4175","Guaranteed Rate","2018-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,"","40308VA0320001-01","BlueDental Preferred High","Standard High On Exchange Plan","83.85%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","$180 per group",,,,,,"$120","$120 per person","$360 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.carefirst.com/bluedentalpreferredhighoptionva",
"2018","VA","40308","SERFF","2017-09-22 20:15:56","SHOP (Small Group)","Yes","53-0078070","40308VA0330002","BlueDental Preferred High","40308VA033",,"VAN010","VAS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Frequency and age limitations may apply based on type of service received. Annual maximum benefit is $1,000 per member.",,"No","Allows Adult and Child-Only",,,,,"0.239","Guaranteed Rate","2018-01-01",,"Yes","All Covered Services","Yes","All Covered Services","No",,"","40308VA0330002-00","BlueDental Preferred High","Standard High Off Exchange Plan","83.85%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","$180 per group",,,,,,"$120","$120 per person","$360 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","VA","40308","SERFF","2017-09-22 20:15:56","SHOP (Small Group)","Yes","53-0078070","40308VA0340002","BlueDental Traditional","40308VA034",,"VAN011","VAS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Frequency and age limitations may apply based on type of service received. Annual maximum benefit is $1,500 per member.",,"No","Allows Adult and Child-Only",,,,,"0.223","Guaranteed Rate","2018-01-01",,"Yes","All Covered Services","Yes","All Covered Services","No",,"","40308VA0340002-00","BlueDental Traditional","Standard High Off Exchange Plan","83.85%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","$180 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","VA","40308","SERFF","2017-09-22 20:15:56","SHOP (Small Group)","No","53-0078070","40308VA0270007","BluePreferred PPO 100%/80%","40308VA027",,"VAN001","VAS001","VAF007","Existing","PPO","Platinum","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995591517452603",,,"2018-01-01","2018-12-31","Yes","All covered services","Yes","All covered services","Yes",,"https://carefirst.com/acarx","40308VA0270007-01","BluePreferred PPO 100%/80%","Standard Platinum On Exchange Plan","91.72%",,"Yes","Yes","No","100%",,"$0","$600","$0","$10","$0","$490","$1,076","$0","$0","$380","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group",,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://content.carefirst.com/sbc/APPVB88ARXXVBJ8CN012018.pdf",
"2018","VA","40308","SERFF","2017-09-22 20:15:56","Individual","No","53-0078070","40308VA0240007","HealthyBlue PPO Gold $1,000","40308VA024",,"VAN001","VAS001","VAF008","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995681245122489",,,"2018-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,"https://carefirst.com/acarx","40308VA0240007-01","HealthyBlue PPO Gold $1,000","Standard Gold On Exchange Plan","78.54%",,"No","Yes","No","100%",,"$1,000","$990","$0","$10","$1,000","$675","$198","$0","$1,000","$230","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/HFNVBN7ERXXVBN7DN012018.pdf",
"2018","VA","40308","SERFF","2017-09-22 20:15:56","Individual","Yes","53-0078070","40308VA0320002","BlueDental Preferred Low","40308VA032",,"VAN010","VAS002",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,"Annual maximum benefit is $1,000 per member age 19 and over. Frequency and age limitations may apply based on type of service received.",,"No","Allows Adult and Child-Only",,,,,"0.3212","Guaranteed Rate","2018-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,"","40308VA0320002-01","BlueDental Preferred Low","Standard Low On Exchange Plan","68.38%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$200","$200 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.carefirst.com/bluedentalpreferredlowoptionva",
"2018","VA","40308","SERFF","2017-09-22 20:15:56","Individual","No","53-0078070","40308VA0240007","HealthyBlue PPO Gold $1,000","40308VA024",,"VAN001","VAS001","VAF008","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995681245122489",,,"2018-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,"https://carefirst.com/acarx","40308VA0240007-02","HealthyBlue PPO Gold $1,000","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/HFNVBN7GRXXVBN7EN012018.pdf",
"2018","VA","40308","SERFF","2017-09-22 20:15:56","SHOP (Small Group)","No","53-0078070","40308VA0270027","BluePreferred PPO 1000 90%/70%","40308VA027",,"VAN001","VAS001","VAF006","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995591517452603",,,"2018-01-01","2018-12-31","Yes","All covered services","Yes","All covered services","Yes",,"https://carefirst.com/acarx","40308VA0270027-00","BluePreferred PPO 1000 90%/70%","Standard Gold Off Exchange Plan","79.93%",,"Yes","Yes","No","100%",,"$1,000","$40","$927","$10","$1,000","$270","$935","$0","$1,000","$0","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$2000 per person","$2000 per group","0.00%",,,,,"$2,000","$4000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://content.carefirst.com/sbc/APHVB87ARXCVBJ7AN012018.pdf",
"2018","VA","40308","SERFF","2017-09-22 20:15:56","Individual","Yes","53-0078070","40308VA0320003","BlueDental Preferred High","40308VA032",,"VAN010","VAS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Annual maximum benefit is $1,000 per member age 19 and over. Frequency and age limitations may apply based on type of service received.",,"No","Allows Adult and Child-Only",,,,,"0.4175","Guaranteed Rate","2018-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,"","40308VA0320003-00","BlueDental Preferred High","Standard High Off Exchange Plan","83.85%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","$180 per group",,,,,,"$120","$120 per person","$360 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.carefirst.com/bluedentalpreferredhighoptionva",
"2018","VA","40308","SERFF","2017-09-22 20:15:56","Individual","Yes","53-0078070","40308VA0320004","BlueDental Preferred Low","40308VA032",,"VAN010","VAS002",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Annual maximum benefit is $1,000 per member age 19 and over. Frequency and age limitations may apply based on type of service received.",,"No","Allows Adult and Child-Only",,,,,"0.3212","Guaranteed Rate","2018-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,"","40308VA0320004-00","BlueDental Preferred Low","Standard Low Off Exchange Plan","68.38%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$200","$200 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.carefirst.com/bluedentalpreferredlowoptionva",
"2018","VA","40308","SERFF","2017-09-22 20:15:56","SHOP (Small Group)","No","53-0078070","40308VA0270027","BluePreferred PPO 1000 90%/70%","40308VA027",,"VAN001","VAS001","VAF006","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995591517452603",,,"2018-01-01","2018-12-31","Yes","All covered services","Yes","All covered services","Yes",,"https://carefirst.com/acarx","40308VA0270027-01","BluePreferred PPO 1000 90%/70%","Standard Gold On Exchange Plan","79.93%",,"Yes","Yes","No","100%",,"$1,000","$40","$927","$10","$1,000","$270","$935","$0","$1,000","$0","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$2000 per person","$2000 per group","0.00%",,,,,"$2,000","$4000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://content.carefirst.com/sbc/APHVB87ARXCVBJ7AN012018.pdf",
"2018","VA","40308","SERFF","2017-09-22 20:15:56","Individual","No","53-0078070","40308VA0240007","HealthyBlue PPO Gold $1,000","40308VA024",,"VAN001","VAS001","VAF008","Existing","PPO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995681245122489",,,"2018-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,"https://carefirst.com/acarx","40308VA0240007-03","HealthyBlue PPO Gold $1,000","Limited Cost Sharing Plan Variation","78.54%",,"No","Yes","No","100%",,"$1,000","$990","$0","$10","$1,000","$675","$198","$0","$1,000","$230","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/HFNVBN7HRXXVBN7DN012018.pdf",
"2018","VA","40308","SERFF","2017-09-22 20:15:56","Individual","No","53-0078070","40308VA0240008","BluePreferred Silver $3,500","40308VA024",,"VAN002","VAS001","VAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995681245122489",,,"2018-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,"https://carefirst.com/acarx","40308VA0240008-00","BluePreferred Silver $3,500","Standard Silver Off Exchange Plan","70.70%",,"No","Yes","No","100%",,"$3,500","$1,120","$0","$10","$3,090","$930","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$7000 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/APNVBN6ARXXVBN6RN012018.pdf",
"2018","VA","40308","SERFF","2017-09-22 20:15:56","SHOP (Small Group)","No","53-0078070","40308VA0270028","BluePreferred PPO HSA/HRA 2000 80%/60%","40308VA027",,"VAN001","VAS001","VAF006","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995591517452603",,,"2018-01-01","2018-12-31","Yes","All covered services","Yes","All covered services","Yes",,"https://carefirst.com/acarx","40308VA0270028-00","BluePreferred PPO HSA/HRA 2000 80%/60%","Standard Silver Off Exchange Plan","71.35%",,"Yes","Yes","No","100%",,"$2,000","$40","$1,654","$10","$2,000","$250","$956","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://content.carefirst.com/sbc/APHVB86CRXCVBJ6AN012018.pdf",
"2018","VA","40308","SERFF","2017-09-22 20:15:56","SHOP (Small Group)","No","53-0078070","40308VA0270028","BluePreferred PPO HSA/HRA 2000 80%/60%","40308VA027",,"VAN001","VAS001","VAF006","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995591517452603",,,"2018-01-01","2018-12-31","Yes","All covered services","Yes","All covered services","Yes",,"https://carefirst.com/acarx","40308VA0270028-01","BluePreferred PPO HSA/HRA 2000 80%/60%","Standard Silver On Exchange Plan","71.35%",,"Yes","Yes","No","100%",,"$2,000","$40","$1,654","$10","$2,000","$250","$956","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0.00%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://content.carefirst.com/sbc/APHVB86CRXCVBJ6AN012018.pdf",
"2018","VA","40308","SERFF","2017-09-22 20:15:56","Individual","No","53-0078070","40308VA0240008","BluePreferred Silver $3,500","40308VA024",,"VAN002","VAS001","VAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995681245122489",,,"2018-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,"https://carefirst.com/acarx","40308VA0240008-01","BluePreferred Silver $3,500","Standard Silver On Exchange Plan","70.70%",,"No","Yes","No","100%",,"$3,500","$1,120","$0","$10","$3,090","$930","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$7000 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/APNVBN6ARXXVBN6RN012018.pdf",
"2018","VA","40308","SERFF","2017-09-22 20:15:56","Individual","No","53-0078070","40308VA0240008","BluePreferred Silver $3,500","40308VA024",,"VAN002","VAS001","VAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995681245122489",,,"2018-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,"https://carefirst.com/acarx","40308VA0240008-02","BluePreferred Silver $3,500","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/APPVBN6KRXXVBN6SN012018.pdf",
"2018","VA","40308","SERFF","2017-09-22 20:15:56","Individual","No","53-0078070","40308VA0240008","BluePreferred Silver $3,500","40308VA024",,"VAN002","VAS001","VAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995681245122489",,,"2018-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,"https://carefirst.com/acarx","40308VA0240008-03","BluePreferred Silver $3,500","Limited Cost Sharing Plan Variation","70.70%",,"No","Yes","No","100%",,"$3,500","$1,120","$0","$10","$3,090","$930","$0","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$7000 per person","$7000 per group","30.00%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/APNVBN6DRXXVBN6RN012018.pdf",
"2018","VA","40308","SERFF","2017-09-22 20:15:56","Individual","No","53-0078070","40308VA0240008","BluePreferred Silver $3,500","40308VA024",,"VAN002","VAS001","VAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995681245122489",,,"2018-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,"https://carefirst.com/acarx","40308VA0240008-04","BluePreferred Silver $3,500","73% AV Level Silver Plan","73.29%",,"No","Yes","No","100%",,"$3,000","$1,120","$0","$10","$3,000","$930","$18","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"$11,700","$11700 per person","$23400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30.00%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/APNVBN6CRXXVBN6KN012018.pdf",
"2018","VA","40308","SERFF","2017-09-22 20:15:56","Individual","No","53-0078070","40308VA0240008","BluePreferred Silver $3,500","40308VA024",,"VAN002","VAS001","VAF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995681245122489",,,"2018-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,"https://carefirst.com/acarx","40308VA0240008-05","BluePreferred Silver $3,500","87% AV Level Silver Plan","86.63%",,"No","Yes","No","100%",,"$0","$520","$0","$10","$0","$1,100","$296","$0","$0","$480","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://content.carefirst.com/sbc/APPVBN6HRXXVBN6FN012018.pdf",
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","Yes","59-1031071","41921VA0030001","Cigna Dental Pediatric","41921VA003","7730182962","VAN002","VAS003",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Services","Yes",,"","41921VA0030001-00","Cigna Dental Pediatric","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/2018/sob/cigna-dental-pediatric-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020002","Cigna Connect 6400","41921VA002","7730182962","VAN001","VAS001","VAF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020002-00","Cigna Connect 6400","Standard Bronze Off Exchange Plan",,"0.587146438886356","Yes","Yes","No","100%",,"$6,400","$0","$1,000","$10","$6,400","$0","$300","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6400-rich-va","http://www.cigna.com/2018/sob/cigna-connect-6400-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020002","Cigna Connect 6400","41921VA002","7730182962","VAN001","VAS001","VAF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020002-01","Cigna Connect 6400","Standard Bronze On Exchange Plan",,"0.587146438886356","Yes","Yes","No","100%",,"$6,400","$0","$1,000","$10","$6,400","$0","$300","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6400-rich-va","http://www.cigna.com/2018/sob/cigna-connect-6400-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020002","Cigna Connect 6400","41921VA002","7730182962","VAN001","VAS001","VAF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020002-02","Cigna Connect-0","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-rich-va","http://www.cigna.com/2018/sob/cigna-connect-0-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020002","Cigna Connect 6400","41921VA002","7730182962","VAN001","VAS001","VAF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020002-03","Cigna Connect 6400-1","Limited Cost Sharing Plan Variation",,"0.587146438886356","Yes","Yes","No","100%",,"$6,400","$0","$1,000","$10","$6,400","$0","$300","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6400-1-rich-va","http://www.cigna.com/2018/sob/cigna-connect-6400-1-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020011","Cigna Connect 6400","41921VA002","7730182962","VAN001","VAS002","VAF002","Existing","EPO","Bronze","Not Applicable","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020011-00","Cigna Connect 6400","Standard Bronze Off Exchange Plan",,"0.587146438886356","Yes","Yes","No","100%",,"$6,400","$0","$1,000","$10","$6,400","$0","$300","$200","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6400-nova-va","http://www.cigna.com/2018/sob/cigna-connect-6400-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020003","Cigna Connect 6000","41921VA002","7730182962","VAN001","VAS001","VAF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020003-03","Cigna Connect 6000-1","Limited Cost Sharing Plan Variation","61.89%","0.638254319676626","Yes","Yes","No","100%",,"$6,000","$20","$1,300","$10","$650","$400","$0","$200","$1,590","$40","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6000-1-rich-va","http://www.cigna.com/2018/sob/cigna-connect-6000-1-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020012","Cigna Connect 6000","41921VA002","7730182962","VAN001","VAS002","VAF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020012-00","Cigna Connect 6000","Standard Bronze Off Exchange Plan","61.89%","0.638254319676626","Yes","Yes","No","100%",,"$6,000","$20","$1,300","$10","$650","$400","$0","$200","$1,590","$40","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6000-nova-va","http://www.cigna.com/2018/sob/cigna-connect-6000-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020012","Cigna Connect 6000","41921VA002","7730182962","VAN001","VAS002","VAF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020012-01","Cigna Connect 6000","Standard Bronze On Exchange Plan","61.89%","0.638254319676626","Yes","Yes","No","100%",,"$6,000","$20","$1,300","$10","$650","$400","$0","$200","$1,590","$40","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6000-nova-va","http://www.cigna.com/2018/sob/cigna-connect-6000-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020012","Cigna Connect 6000","41921VA002","7730182962","VAN001","VAS002","VAF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020012-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-nova-va","http://www.cigna.com/2018/sob/cigna-connect-0-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020012","Cigna Connect 6000","41921VA002","7730182962","VAN001","VAS002","VAF003","Existing","EPO","Bronze","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020012-03","Cigna Connect 6000-1","Limited Cost Sharing Plan Variation","61.89%","0.638254319676626","Yes","Yes","No","100%",,"$6,000","$20","$1,300","$10","$650","$400","$0","$200","$1,590","$40","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6000-1-nova-va","http://www.cigna.com/2018/sob/cigna-connect-6000-1-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020006","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS001","VAF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020006-00","Cigna Connect 4500","Standard Silver Off Exchange Plan","68.15%","0.691482419643546","Yes","Yes","No","100%",,"$4,500","$30","$1,600","$10","$130","$500","$0","$200","$1,590","$40","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4500-rich-va","http://www.cigna.com/2018/sob/cigna-connect-4500-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020006","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS001","VAF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020006-01","Cigna Connect 4500","Standard Silver On Exchange Plan","68.15%","0.691482419643546","Yes","Yes","No","100%",,"$4,500","$30","$1,600","$10","$130","$500","$0","$200","$1,590","$40","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4500-rich-va","http://www.cigna.com/2018/sob/cigna-connect-4500-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020006","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS001","VAF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020006-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-rich-va","http://www.cigna.com/2018/sob/cigna-connect-0-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020006","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS001","VAF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020006-03","Cigna Connect 4500-1","Limited Cost Sharing Plan Variation","68.15%","0.691482419643546","Yes","Yes","No","100%",,"$4,500","$30","$1,600","$10","$130","$500","$0","$200","$1,590","$40","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4500-1-rich-va","http://www.cigna.com/2018/sob/cigna-connect-4500-1-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020006","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS001","VAF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020006-04","Cigna Connect 3100-2","73% AV Level Silver Plan","72.17%","0.731155884951875","Yes","Yes","No","100%",,"$3,100","$30","$1,900","$10","$130","$500","$0","$200","$1,590","$40","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-3100-2-rich-va","http://www.cigna.com/2018/sob/cigna-connect-3100-2-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020006","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS001","VAF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020006-05","Cigna Connect 800-3","87% AV Level Silver Plan","86.11%","0.863909044150211","Yes","Yes","No","100%",,"$800","$20","$1,200","$10","$130","$400","$0","$200","$800","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-800-3-rich-va","http://www.cigna.com/2018/sob/cigna-connect-800-3-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020006","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS001","VAF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020006-06","Cigna Connect 100-4","94% AV Level Silver Plan","93.13%","0.933939121651426","Yes","Yes","No","100%",,"$100","$10","$1,100","$10","$100","$300","$0","$200","$100","$10","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-100-4-rich-va","http://www.cigna.com/2018/sob/cigna-connect-100-4-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020015","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS002","VAF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020015-00","Cigna Connect 4500","Standard Silver Off Exchange Plan","68.15%","0.691482419643546","Yes","Yes","No","100%",,"$4,500","$30","$1,600","$10","$130","$500","$0","$200","$1,590","$40","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4500-nova-va","http://www.cigna.com/2018/sob/cigna-connect-4500-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020015","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS002","VAF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020015-01","Cigna Connect 4500","Standard Silver On Exchange Plan","68.15%","0.691482419643546","Yes","Yes","No","100%",,"$4,500","$30","$1,600","$10","$130","$500","$0","$200","$1,590","$40","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4500-nova-va","http://www.cigna.com/2018/sob/cigna-connect-4500-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020015","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS002","VAF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020015-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-nova-va","http://www.cigna.com/2018/sob/cigna-connect-0-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020015","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS002","VAF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020015-03","Cigna Connect 4500-1","Limited Cost Sharing Plan Variation","68.15%","0.691482419643546","Yes","Yes","No","100%",,"$4,500","$30","$1,600","$10","$130","$500","$0","$200","$1,590","$40","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-4500-1-nova-va","http://www.cigna.com/2018/sob/cigna-connect-4500-1-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020015","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS002","VAF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020015-04","Cigna Connect 3100-2","73% AV Level Silver Plan","72.17%","0.731155884951875","Yes","Yes","No","100%",,"$3,100","$30","$1,900","$10","$130","$500","$0","$200","$1,590","$40","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-3100-2-nova-va","http://www.cigna.com/2018/sob/cigna-connect-3100-2-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020015","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS002","VAF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020015-05","Cigna Connect 800-3","87% AV Level Silver Plan","86.11%","0.863909044150211","Yes","Yes","No","100%",,"$800","$20","$1,200","$10","$130","$400","$0","$200","$800","$30","$80","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-800-3-nova-va","http://www.cigna.com/2018/sob/cigna-connect-800-3-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020015","Cigna Connect 4500","41921VA002","7730182962","VAN001","VAS002","VAF006","Existing","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020015-06","Cigna Connect 100-4","94% AV Level Silver Plan","93.13%","0.933939121651426","Yes","Yes","No","100%",,"$100","$10","$1,100","$10","$100","$300","$0","$200","$100","$10","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-100-4-nova-va","http://www.cigna.com/2018/sob/cigna-connect-100-4-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020009","Cigna Connect 1200","41921VA002","7730182962","VAN001","VAS001","VAF008","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020009-00","Cigna Connect 1200","Standard Gold Off Exchange Plan","78.15%","0.781302564165379","Yes","Yes","No","100%",,"$1,200","$20","$1,700","$10","$1,200","$200","$700","$200","$1,200","$40","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1200-rich-va","http://www.cigna.com/2018/sob/cigna-connect-1200-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020009","Cigna Connect 1200","41921VA002","7730182962","VAN001","VAS001","VAF008","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020009-01","Cigna Connect 1200","Standard Gold On Exchange Plan","78.15%","0.781302564165379","Yes","Yes","No","100%",,"$1,200","$20","$1,700","$10","$1,200","$200","$700","$200","$1,200","$40","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1200-rich-va","http://www.cigna.com/2018/sob/cigna-connect-1200-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020009","Cigna Connect 1200","41921VA002","7730182962","VAN001","VAS001","VAF008","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020009-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-rich-va","http://www.cigna.com/2018/sob/cigna-connect-0-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020009","Cigna Connect 1200","41921VA002","7730182962","VAN001","VAS001","VAF008","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020009-03","Cigna Connect 1200-1","Limited Cost Sharing Plan Variation","78.15%","0.781302564165379","Yes","Yes","No","100%",,"$1,200","$20","$1,700","$10","$1,200","$200","$700","$200","$1,200","$40","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1200-1-rich-va","http://www.cigna.com/2018/sob/cigna-connect-1200-1-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020018","Cigna Connect 1200","41921VA002","7730182962","VAN001","VAS002","VAF008","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020018-00","Cigna Connect 1200","Standard Gold Off Exchange Plan","78.15%","0.781302564165379","Yes","Yes","No","100%",,"$1,200","$20","$1,700","$10","$1,200","$200","$700","$200","$1,200","$40","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1200-nova-va","http://www.cigna.com/2018/sob/cigna-connect-1200-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020018","Cigna Connect 1200","41921VA002","7730182962","VAN001","VAS002","VAF008","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020018-01","Cigna Connect 1200","Standard Gold On Exchange Plan","78.15%","0.781302564165379","Yes","Yes","No","100%",,"$1,200","$20","$1,700","$10","$1,200","$200","$700","$200","$1,200","$40","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1200-nova-va","http://www.cigna.com/2018/sob/cigna-connect-1200-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020018","Cigna Connect 1200","41921VA002","7730182962","VAN001","VAS002","VAF008","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020018-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-nova-va","http://www.cigna.com/2018/sob/cigna-connect-0-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020018","Cigna Connect 1200","41921VA002","7730182962","VAN001","VAS002","VAF008","Existing","EPO","Gold","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020018-03","Cigna Connect 1200-1","Limited Cost Sharing Plan Variation","78.15%","0.781302564165379","Yes","Yes","No","100%",,"$1,200","$20","$1,700","$10","$1,200","$200","$700","$200","$1,200","$40","$60","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-1200-1-nova-va","http://www.cigna.com/2018/sob/cigna-connect-1200-1-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020029","Cigna Connect 6500","41921VA002","7730182962","VAN001","VAS001","VAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020029-00","Cigna Connect 6500","Standard Silver Off Exchange Plan","66.13%","0.670320264832219","Yes","Yes","No","100%",,"$6,500","$20","$800","$10","$130","$400","$0","$200","$1,590","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6500-rich-va","http://www.cigna.com/2018/sob/cigna-connect-6500-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020029","Cigna Connect 6500","41921VA002","7730182962","VAN001","VAS001","VAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020029-01","Cigna Connect 6500","Standard Silver On Exchange Plan","66.13%","0.670320264832219","Yes","Yes","No","100%",,"$6,500","$20","$800","$10","$130","$400","$0","$200","$1,590","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6500-rich-va","http://www.cigna.com/2018/sob/cigna-connect-6500-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020029","Cigna Connect 6500","41921VA002","7730182962","VAN001","VAS001","VAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020029-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-rich-va","http://www.cigna.com/2018/sob/cigna-connect-0-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020029","Cigna Connect 6500","41921VA002","7730182962","VAN001","VAS001","VAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020029-03","Cigna Connect 6500-1","Limited Cost Sharing Plan Variation","66.13%","0.670320264832219","Yes","Yes","No","100%",,"$6,500","$20","$800","$10","$130","$400","$0","$200","$1,590","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6500-1-rich-va","http://www.cigna.com/2018/sob/cigna-connect-6500-1-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020029","Cigna Connect 6500","41921VA002","7730182962","VAN001","VAS001","VAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020029-04","Cigna Connect 3300-2","73% AV Level Silver Plan","72.04%","0.730162452966339","Yes","Yes","No","100%",,"$3,300","$20","$1,400","$10","$130","$400","$0","$200","$1,590","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-3300-2-rich-va","http://www.cigna.com/2018/sob/cigna-connect-3300-2-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020029","Cigna Connect 6500","41921VA002","7730182962","VAN001","VAS001","VAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020029-05","Cigna Connect 860-3","87% AV Level Silver Plan","86.11%","0.862910664122057","Yes","Yes","No","100%",,"$860","$20","$1,200","$10","$130","$400","$0","$200","$860","$20","$70","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$860","$860 per person","$1720 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-860-3-rich-va","http://www.cigna.com/2018/sob/cigna-connect-860-3-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020029","Cigna Connect 6500","41921VA002","7730182962","VAN001","VAS001","VAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020029-06","Cigna Connect 150-4","94% AV Level Silver Plan","93.06%","0.933770823177549","Yes","Yes","No","100%",,"$150","$20","$200","$10","$130","$400","$40","$200","$150","$30","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-150-4-rich-va","http://www.cigna.com/2018/sob/cigna-connect-150-4-rich-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020030","Cigna Connect 6500","41921VA002","7730182962","VAN001","VAS002","VAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020030-00","Cigna Connect 6500","Standard Silver Off Exchange Plan","66.13%","0.670320264832219","Yes","Yes","No","100%",,"$6,500","$20","$800","$10","$130","$400","$0","$200","$1,590","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6500-nova-va","http://www.cigna.com/2018/sob/cigna-connect-6500-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020030","Cigna Connect 6500","41921VA002","7730182962","VAN001","VAS002","VAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020030-01","Cigna Connect 6500","Standard Silver On Exchange Plan","66.13%","0.670320264832219","Yes","Yes","No","100%",,"$6,500","$20","$800","$10","$130","$400","$0","$200","$1,590","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6500-nova-va","http://www.cigna.com/2018/sob/cigna-connect-6500-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020030","Cigna Connect 6500","41921VA002","7730182962","VAN001","VAS002","VAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020030-02","Cigna Connect-0","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-0-nova-va","http://www.cigna.com/2018/sob/cigna-connect-0-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020030","Cigna Connect 6500","41921VA002","7730182962","VAN001","VAS002","VAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020030-03","Cigna Connect 6500-1","Limited Cost Sharing Plan Variation","66.13%","0.670320264832219","Yes","Yes","No","100%",,"$6,500","$20","$800","$10","$130","$400","$0","$200","$1,590","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-6500-1-nova-va","http://www.cigna.com/2018/sob/cigna-connect-6500-1-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020030","Cigna Connect 6500","41921VA002","7730182962","VAN001","VAS002","VAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020030-04","Cigna Connect 3300-2","73% AV Level Silver Plan","72.04%","0.730162452966339","Yes","Yes","No","100%",,"$3,300","$20","$1,400","$10","$130","$400","$0","$200","$1,590","$30","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-3300-2-nova-va","http://www.cigna.com/2018/sob/cigna-connect-3300-2-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020030","Cigna Connect 6500","41921VA002","7730182962","VAN001","VAS002","VAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020030-05","Cigna Connect 860-3","87% AV Level Silver Plan","86.11%","0.862910664122057","Yes","Yes","No","100%",,"$860","$20","$1,200","$10","$130","$400","$0","$200","$860","$20","$70","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$860","$860 per person","$1720 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-860-3-nova-va","http://www.cigna.com/2018/sob/cigna-connect-860-3-nova-va"
"2018","VA","41921","SERFF","2017-09-25 20:16:04","Individual","No","59-1031071","41921VA0020030","Cigna Connect 6500","41921VA002","7730182962","VAN001","VAS002","VAF007","New","EPO","Silver","Not Applicable","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"2018-01-01","2018-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","41921VA0020030-06","Cigna Connect 150-4","94% AV Level Silver Plan","93.06%","0.933770823177549","Yes","Yes","No","100%",,"$150","$20","$200","$10","$130","$400","$40","$200","$150","$30","$90","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/2018/sbc/cigna-connect-150-4-nova-va","http://www.cigna.com/2018/sob/cigna-connect-150-4-nova-va"
"2018","VA","42808","SERFF","2017-08-15 20:15:50","SHOP (Small Group)","Yes","13-5123390","42808VA0200005","Guardian Pediatric Advantage","42808VA020",,"VAN001","VAS002",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","42808VA0200005-00","Guardian Pediatric Advantage","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","VA","42808","SERFF","2017-08-15 20:15:50","Individual","Yes","13-5123390","42808VA0260002","Guardian Essentials for Families and Individuals","42808VA026",,"VAN002","VAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","42808VA0260002-00","Guardian Essentials for Families and Individuals","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/virginia/","https://dentalexchange.guardianlife.com/our-plans/virginia/"
"2018","VA","42808","SERFF","2017-08-15 20:15:50","Individual","Yes","13-5123390","42808VA0260002","Guardian Essentials for Families and Individuals","42808VA026",,"VAN002","VAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","42808VA0260002-01","Guardian Essentials for Families and Individuals","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/virginia/","https://dentalexchange.guardianlife.com/our-plans/virginia/"
"2018","VA","42808","SERFF","2017-08-15 20:15:50","SHOP (Small Group)","Yes","13-5123390","42808VA0210005","Guardian Pediatric Essentials","42808VA021",,"VAN001","VAS002",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes",,"","42808VA0210005-00","Guardian Pediatric Essentials","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","VA","42808","SERFF","2017-08-15 20:15:50","Individual","Yes","13-5123390","42808VA0270001","Guardian Select for Families and Individuals","42808VA027",,"VAN002","VAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","42808VA0270001-00","Guardian Select for Families and Individuals","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/virginia/","https://dentalexchange.guardianlife.com/our-plans/virginia/"
"2018","VA","42808","SERFF","2017-08-15 20:15:50","Individual","Yes","13-5123390","42808VA0270001","Guardian Select for Families and Individuals","42808VA027",,"VAN002","VAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","42808VA0270001-01","Guardian Select for Families and Individuals","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/virginia/","https://dentalexchange.guardianlife.com/our-plans/virginia/"
"2018","VA","42808","SERFF","2017-08-15 20:15:50","Individual","Yes","13-5123390","42808VA0280001","Guardian Basics for Families and Individuals","42808VA028",,"VAN002","VAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","42808VA0280001-00","Guardian Basics for Families and Individuals","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/virginia/","https://dentalexchange.guardianlife.com/our-plans/virginia/"
"2018","VA","42808","SERFF","2017-08-15 20:15:50","Individual","Yes","13-5123390","42808VA0280001","Guardian Basics for Families and Individuals","42808VA028",,"VAN002","VAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","No",,"Yes","Coverage is provided outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.Member.UI/WBSPaymentRedirect.aspx","","42808VA0280001-01","Guardian Basics for Families and Individuals","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/our-plans/virginia/","https://dentalexchange.guardianlife.com/our-plans/virginia/"
"2018","VA","53311","SERFF","2017-08-13 20:16:00","Individual","Yes","36-3757528","53311VA0010001","TruAssure Basic Adult or Child Dental Plan","53311VA001",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","53311VA0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=VA","https://www.truassure.com/brochure?state=VA"
"2018","VA","53311","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","36-3757528","53311VA0030001","TruAssure Dental Small Group Basic Plan","53311VA003",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","53311VA0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","VA","53311","SERFF","2017-08-13 20:16:00","Individual","Yes","36-3757528","53311VA0010001","TruAssure Basic Adult or Child Dental Plan","53311VA001",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","53311VA0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=VA","https://www.truassure.com/brochure?state=VA"
"2018","VA","53311","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","36-3757528","53311VA0040001","TruAssure Dental Small Group Preferred Plan","53311VA004",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","53311VA0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","VA","53311","SERFF","2017-08-13 20:16:00","Individual","Yes","36-3757528","53311VA0020001","TruAssure Preferred Adult or Child Dental Plan","53311VA002",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","53311VA0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","$45 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=VA","https://www.truassure.com/brochure?state=VA"
"2018","VA","53311","SERFF","2017-08-13 20:16:00","Individual","Yes","36-3757528","53311VA0020001","TruAssure Preferred Adult or Child Dental Plan","53311VA002",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","53311VA0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","$45 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=VA","https://www.truassure.com/brochure?state=VA"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0030005","Elite PPO Basic Kids","54965VA003","7962405180","VAN003","VAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030005-00","Elite PPO Basic Kids","Standard Low Off Exchange Plan","70.3%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBLINDPEDEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","54-1808292","54965VA0050004","Choice PPO Basic","54965VA005","7962405180","VAN002","VAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0050004-00","Choice PPO Basic","Standard High Off Exchange Plan","83.7%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBLSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBLSMGFAMEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","54-1808292","54965VA0050004","Choice PPO Basic","54965VA005","7962405180","VAN002","VAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0050004-01","Choice PPO Basic","Standard High On Exchange Plan","83.7%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBLSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBLSMGFAMEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0030005","Elite PPO Basic Kids","54965VA003","7962405180","VAN003","VAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030005-01","Elite PPO Basic Kids","Standard Low On Exchange Plan","70.3%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBLINDPEDEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","54-1808292","54965VA0050005","Choice PPO Premium","54965VA005","7962405180","VAN002","VAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0050005-00","Choice PPO Premium","Standard High Off Exchange Plan","83.7%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBHSMGFAMEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0030003","Elite PPO Premium Kids","54965VA003","7962405180","VAN003","VAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030003-00","Elite PPO Premium Kids","Standard High Off Exchange Plan","83.7%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBHINDPEDEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0030003","Elite PPO Premium Kids","54965VA003","7962405180","VAN003","VAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030003-01","Elite PPO Premium Kids","Standard High On Exchange Plan","83.7%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBHINDPEDEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","54-1808292","54965VA0050005","Choice PPO Premium","54965VA005","7962405180","VAN002","VAS002",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0050005-01","Choice PPO Premium","Standard High On Exchange Plan","83.7%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBHSMGFAMEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","54-1808292","54965VA0060002","Elite ePPO Premium","54965VA006","7962405180","VAN003","VAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Must receive services from a participating Elite PPO dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","54965VA0060002-00","Elite ePPO Premium","Standard High Off Exchange Plan","83.7%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18EPHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18EPHSMGFAMEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0020001","Select Plan Basic Kids","54965VA002","7962405180","VAN001","VAS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0020001-00","Select Plan Basic Kids","Standard Low Off Exchange Plan","72.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBLINDPEDEHB.PDF"
"2018","VA","69103","SERFF","2017-08-13 20:16:00","Individual","Yes","31-1185262","69103VA0040004","DentaTrust - PPO Family Low Option","69103VA004","7083617077","VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0040004-01","DentaTrust - PPO Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtva.dentalcareplus.com","http://hixpbdtva.dentalcareplus.com"
"2018","VA","72006","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","13-5581829","72006VA0160001","EHB Basic Dental Plan (Low)","72006VA016",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but when paired with one of MetLife’s group certificates, the amount paid by the Plan upon claims adjudication will be greater of either the traditional group certificate or the EHB certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","72006VA0160001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0020001","Select Plan Basic Kids","54965VA002","7962405180","VAN001","VAS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0020001-01","Select Plan Basic Kids","Standard Low On Exchange Plan","72.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBLINDPEDEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","54-1808292","54965VA0060002","Elite ePPO Premium","54965VA006","7962405180","VAN003","VAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Must receive services from a participating Elite PPO dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","54965VA0060002-01","Elite ePPO Premium","Standard High On Exchange Plan","83.7%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18EPHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18EPHSMGFAMEHB.PDF"
"2018","VA","69103","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","31-1185262","69103VA0050003","DentaSpan Family High Option","69103VA005","7083617077","VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0050003-01","DentaSpan Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsva.dentalcareplus.com","http://hixpbdsva.dentalcareplus.com"
"2018","VA","69103","SERFF","2017-08-13 20:16:00","Individual","Yes","31-1185262","69103VA0040002","DentaTrust - PPO Pediatric Low Option","69103VA004","7083617077","VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0040002-00","DentaTrust - PPO Pediatric Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtva.dentalcareplus.com","http://hixpbdtva.dentalcareplus.com"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0020005","Select Plan Premium Kids","54965VA002","7962405180","VAN001","VAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0020005-00","Select Plan Premium Kids","Standard High Off Exchange Plan","85.2%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBHINDPEDEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0020005","Select Plan Premium Kids","54965VA002","7962405180","VAN001","VAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0020005-01","Select Plan Premium Kids","Standard High On Exchange Plan","85.2%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBHINDPEDEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0020002","Select Plan Basic","54965VA002","7962405180","VAN001","VAS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0020002-00","Select Plan Basic","Standard Low Off Exchange Plan","72.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBLINDFAMEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","54-1808292","54965VA0050006","Choice PPO Plus","54965VA005","7962405180","VAN002","VAS002",,"New","PPO","High","Not Applicable",,"Off the Exchange",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0050006-00","Choice PPO Plus","Standard High Off Exchange Plan","83.7%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SB2SMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SB2SMGFAMEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0020002","Select Plan Basic","54965VA002","7962405180","VAN001","VAS001",,"Existing","EPO","Low","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0020002-01","Select Plan Basic","Standard Low On Exchange Plan","72.0%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBLINDFAMEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0020006","Select Plan Premium","54965VA002","7962405180","VAN001","VAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0020006-00","Select Plan Premium","Standard High Off Exchange Plan","85.2%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBHINDFAMEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0020006","Select Plan Premium","54965VA002","7962405180","VAN001","VAS001",,"Existing","EPO","High","Not Applicable",,"Both",,,,"Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0020006-01","Select Plan Premium","Standard High On Exchange Plan","85.2%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBHINDFAMEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0030004","Elite PPO Basic","54965VA003","7962405180","VAN003","VAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030004-00","Elite PPO Basic","Standard Low Off Exchange Plan","70.3%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBLINDFAMEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","54-1808292","54965VA0040004","Select Plan Premium","54965VA004","7962405180","VAN001","VAS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","54965VA0040004-00","Select Plan Premium","Standard High Off Exchange Plan","85.2%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBHSMGFAMEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","54-1808292","54965VA0040004","Select Plan Premium","54965VA004","7962405180","VAN001","VAS001",,"Existing","HMO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","54965VA0040004-01","Select Plan Premium","Standard High On Exchange Plan","85.2%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBHSMGFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18DBHSMGFAMEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0030004","Elite PPO Basic","54965VA003","7962405180","VAN003","VAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030004-01","Elite PPO Basic","Standard Low On Exchange Plan","70.3%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBLINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBLINDFAMEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0030006","Elite PPO Premium","54965VA003","7962405180","VAN003","VAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030006-00","Elite PPO Premium","Standard High Off Exchange Plan","83.7%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBHINDFAMEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0030006","Elite PPO Premium","54965VA003","7962405180","VAN003","VAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030006-01","Elite PPO Premium","Standard High On Exchange Plan","83.7%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBHINDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SBHINDFAMEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0030007","Elite PPO Plus","54965VA003","7962405180","VAN003","VAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030007-00","Elite PPO Plus","Standard Low Off Exchange Plan","70.3%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SB2INDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SB2INDFAMEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0030007","Elite PPO Plus","54965VA003","7962405180","VAN003","VAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030007-01","Elite PPO Plus","Standard Low On Exchange Plan","70.3%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SB2INDFAMEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA18SB2INDFAMEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0070001","Elite ePPO Basic","54965VA007","7962405180","VAN003","VAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.  Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0070001-00","Elite ePPO Basic","Standard Low Off Exchange Plan","70.3%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPLINDPEDEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0070001","Elite ePPO Basic","54965VA007","7962405180","VAN003","VAS003",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.  Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0070001-01","Elite ePPO Basic","Standard Low On Exchange Plan","70.3%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPLINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPLINDPEDEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0070002","Elite ePPO Premium","54965VA007","7962405180","VAN003","VAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.  Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0070002-00","Elite ePPO Premium","Standard High Off Exchange Plan","83.7%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPHINDPEDEHB.PDF"
"2018","VA","54965","SERFF","2017-08-14 20:15:51","Individual","Yes","54-1808292","54965VA0070002","Elite ePPO Premium","54965VA007","7962405180","VAN003","VAS003",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.  Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home zip code, up to $100","No",,"","54965VA0070002-01","Elite ePPO Premium","Standard High On Exchange Plan","83.7%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPHINDPEDEHB.PDF","https://www.dominionnational.com/files/plan/FEDVIP/DMNVA17EPHINDPEDEHB.PDF"
"2018","VA","66599","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","47-0098400","66599VA0040002","EHB High PPO","66599VA004",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66599VA0040002-00","EHB High PPO","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","VA","66599","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","47-0098400","66599VA0040001","EHB Low PPO","66599VA004",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66599VA0040001-00","EHB Low PPO","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","VA","66599","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","47-0098400","66599VA0030002","EHB High Passive","66599VA003",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66599VA0030002-00","EHB High Passive","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","VA","66599","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","47-0098400","66599VA0030001","EHB Low Passive","66599VA003",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2019-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66599VA0030001-00","EHB Low Passive","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com"
"2018","VA","69103","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","31-1185262","69103VA0050003","DentaSpan Family High Option","69103VA005","7083617077","VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0050003-00","DentaSpan Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsva.dentalcareplus.com","http://hixpbdsva.dentalcareplus.com"
"2018","VA","69103","SERFF","2017-08-13 20:16:00","Individual","Yes","31-1185262","69103VA0040001","DentaTrust - PPO Pediatric High Option","69103VA004","7083617077","VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0040001-00","DentaTrust - PPO Pediatric High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtva.dentalcareplus.com","http://hixpbdtva.dentalcareplus.com"
"2018","VA","69103","SERFF","2017-08-13 20:16:00","Individual","Yes","31-1185262","69103VA0040001","DentaTrust - PPO Pediatric High Option","69103VA004","7083617077","VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0040001-01","DentaTrust - PPO Pediatric High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtva.dentalcareplus.com","http://hixpbdtva.dentalcareplus.com"
"2018","VA","69103","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","31-1185262","69103VA0050004","DentaSpan Family Low Option","69103VA005","7083617077","VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0050004-00","DentaSpan Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsva.dentalcareplus.com","http://hixpbdsva.dentalcareplus.com"
"2018","VA","69103","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","31-1185262","69103VA0050004","DentaSpan Family Low Option","69103VA005","7083617077","VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0050004-01","DentaSpan Family Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdsva.dentalcareplus.com","http://hixpbdsva.dentalcareplus.com"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720031","Anthem HealthKeepers Bronze X 6500","88380VA072",,"VAN001","VAS003","VAF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720031-00","Anthem HealthKeepers Bronze 6500","Standard Bronze Off Exchange Plan","59.55%","0.586960882218122","Yes","Yes","Yes","70%","30%","$7,410","$2,390","$0","$4,690","$7,239","$3,952","$0","$3,232","$1,925","$1,099","$0","$826",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%","$6,500","$6500 per person","$13000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EUA","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720031","Anthem HealthKeepers Bronze X 6500","88380VA072",,"VAN001","VAS003","VAF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720031-01","Anthem HealthKeepers Bronze X 6500","Standard Bronze On Exchange Plan","59.55%","0.586960882218122","Yes","Yes","Yes","70%","30%","$7,410","$2,390","$0","$4,690","$7,239","$3,952","$0","$3,232","$1,925","$1,099","$0","$826",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%","$6,500","$6500 per person","$13000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EU8","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720031","Anthem HealthKeepers Bronze X 6500","88380VA072",,"VAN001","VAS003","VAF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720031-02","Anthem HealthKeepers Bronze X 6500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EU9","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720031","Anthem HealthKeepers Bronze X 6500","88380VA072",,"VAN001","VAS003","VAF004","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720031-03","Anthem HealthKeepers Bronze X 6500","Limited Cost Sharing Plan Variation","59.55%","0.586960882218122","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40.00%","$6,500","$6500 per person","$13000 per group","40.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EU8","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2800","88380VA072",,"VAN001","VAS003","VAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-00","Anthem HealthKeepers Silver 2800","Standard Silver Off Exchange Plan","69.03%","0.694803330879399","Yes","Yes","Yes","70%","30%","$5,490","$2,800","$150","$2,480","$5,973","$2,800","$900","$2,218","$1,925","$1,429","$0","$496",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%","$2,800","$2800 per person","$5600 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JFH","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2800","88380VA072",,"VAN001","VAS003","VAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-01","Anthem HealthKeepers Silver X 2800","Standard Silver On Exchange Plan","69.03%","0.694803330879399","Yes","Yes","Yes","70%","30%","$5,490","$2,800","$150","$2,480","$5,973","$2,800","$900","$2,218","$1,925","$1,429","$0","$496",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%","$2,800","$2800 per person","$5600 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA9","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2800","88380VA072",,"VAN001","VAS003","VAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-02","Anthem HealthKeepers Silver X 2800 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GAA","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","69103","SERFF","2017-08-13 20:16:00","Individual","Yes","31-1185262","69103VA0040002","DentaTrust - PPO Pediatric Low Option","69103VA004","7083617077","VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0040002-01","DentaTrust - PPO Pediatric Low Option","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtva.dentalcareplus.com","http://hixpbdtva.dentalcareplus.com"
"2018","VA","69103","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","31-1185262","69103VA0060003","DentaSpan Family High Option- Off Exchange","69103VA006","7083617077","VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0060003-00","DentaSpan Family High Option- Off Exchange","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsva.dentalcareplus.com","http://hiopbdsva.dentalcareplus.com"
"2018","VA","69103","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","31-1185262","69103VA0060004","DentaSpan Family Low Option- Off Exchange","69103VA006","7083617077","VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0060004-00","DentaSpan Family Low Option- Off Exchange","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsva.dentalcareplus.com","http://hiopbdsva.dentalcareplus.com"
"2018","VA","69103","SERFF","2017-08-13 20:16:00","Individual","Yes","31-1185262","69103VA0040003","DentaTrust - PPO Family High Option","69103VA004","7083617077","VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0040003-00","DentaTrust - PPO Family High Option","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtva.dentalcareplus.com","http://hixpbdtva.dentalcareplus.com"
"2018","VA","69103","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","31-1185262","69103VA0060001","DentaSpan Pediatric High Option- Off Exchange","69103VA006","7083617077","VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No",".https://hixenroll.insxcloud.com/payment","","69103VA0060001-00","DentaSpan Pediatric High Option- Off Exchange","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsva.dentalcareplus.com","http://hiopbdsva.dentalcareplus.com"
"2018","VA","69103","SERFF","2017-08-13 20:16:00","SHOP (Small Group)","Yes","31-1185262","69103VA0060002","DentaSpan Pediatric Low Option- Off Exchange","69103VA006","7083617077","VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No",".https://hixenroll.insxcloud.com/payment","","69103VA0060002-00","DentaSpan Pediatric Low Option- Off Exchange","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hiopbdsva.dentalcareplus.com","http://hiopbdsva.dentalcareplus.com"
"2018","VA","69103","SERFF","2017-08-13 20:16:00","Individual","Yes","31-1185262","69103VA0040003","DentaTrust - PPO Family High Option","69103VA004","7083617077","VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0040003-01","DentaTrust - PPO Family High Option","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtva.dentalcareplus.com","http://hixpbdtva.dentalcareplus.com"
"2018","VA","69103","SERFF","2017-08-13 20:16:00","Individual","Yes","31-1185262","69103VA0040004","DentaTrust - PPO Family Low Option","69103VA004","7083617077","VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,"Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","69103VA0040004-00","DentaTrust - PPO Family Low Option","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://hixpbdtva.dentalcareplus.com","http://hixpbdtva.dentalcareplus.com"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720020","Anthem HealthKeepers Bronze X 4900 for HSA","88380VA072",,"VAN001","VAS003","VAF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720020-00","Anthem HealthKeepers Bronze 4900 for HSA","Standard Bronze Off Exchange Plan","61.98%","0.610841831302713","Yes","Yes","Yes","70%","30%","$6,710","$2,310","$0","$4,340","$6,705","$3,818","$0","$2,832","$1,925","$1,168","$0","$757",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","35.00%","$4,900","$4900 per person","$9800 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GBR","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720020","Anthem HealthKeepers Bronze X 4900 for HSA","88380VA072",,"VAN001","VAS003","VAF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720020-01","Anthem HealthKeepers Bronze X 4900 for HSA","Standard Bronze On Exchange Plan","61.98%","0.610841831302713","Yes","Yes","Yes","70%","30%","$6,710","$2,310","$0","$4,340","$6,705","$3,818","$0","$2,832","$1,925","$1,168","$0","$757",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","35.00%","$4,900","$4900 per person","$9800 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GA2","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720020","Anthem HealthKeepers Bronze X 4900 for HSA","88380VA072",,"VAN001","VAS003","VAF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720020-02","Anthem HealthKeepers Bronze X 4900 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GA3","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720020","Anthem HealthKeepers Bronze X 4900 for HSA","88380VA072",,"VAN001","VAS003","VAF003","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720020-03","Anthem HealthKeepers Bronze X 4900 for HSA","Limited Cost Sharing Plan Variation","61.98%","0.610841831302713","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","$6,650","$6650 per person","$13300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","35.00%","$4,900","$4900 per person","$9800 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GA2","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720017","Anthem HealthKeepers Bronze X 5900","88380VA072",,"VAN001","VAS003","VAF009","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720017-00","Anthem HealthKeepers Bronze 5900","Standard Bronze Off Exchange Plan","61.37%","0.61450184152056","Yes","Yes","Yes","70%","30%","$7,410","$3,010","$0","$4,340","$7,405","$3,667","$870","$2,813","$1,925","$1,168","$0","$757",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","35.00%","$5,900","$5900 per person","$11800 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GBM","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720017","Anthem HealthKeepers Bronze X 5900","88380VA072",,"VAN001","VAS003","VAF009","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720017-01","Anthem HealthKeepers Bronze X 5900","Standard Bronze On Exchange Plan","61.37%","0.61450184152056","Yes","Yes","Yes","70%","30%","$7,410","$3,010","$0","$4,340","$7,405","$3,667","$870","$2,813","$1,925","$1,168","$0","$757",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","35.00%","$5,900","$5900 per person","$11800 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G9U","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720017","Anthem HealthKeepers Bronze X 5900","88380VA072",,"VAN001","VAS003","VAF009","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720017-02","Anthem HealthKeepers Bronze X 5900 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G9V","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720017","Anthem HealthKeepers Bronze X 5900","88380VA072",,"VAN001","VAS003","VAF009","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720017-03","Anthem HealthKeepers Bronze X 5900","Limited Cost Sharing Plan Variation","61.37%","0.61450184152056","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","5",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","35.00%","$5,900","$5900 per person","$11800 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G9U","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720015","Anthem HealthKeepers Catastrophic X 7350","88380VA072",,"VAN001","VAS003","VAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720015-00","Anthem HealthKeepers Catastrophic 7350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,410","$7,350","$0","$0","$2,981","$2,926","$0","$0","$1,925","$1,925","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GBK","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720015","Anthem HealthKeepers Catastrophic X 7350","88380VA072",,"VAN001","VAS003","VAF001","Existing","HMO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720015-01","Anthem HealthKeepers Catastrophic X 7350","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,410","$7,350","$0","$0","$2,981","$2,926","$0","$0","$1,925","$1,925","$0","$0",,"0","0","3",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G9R","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720033","Anthem HealthKeepers Gold X 1100","88380VA072",,"VAN001","VAS003","VAF006","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720033-00","Anthem HealthKeepers Gold 1100","Standard Gold Off Exchange Plan","78.01%","0.765430685732621","Yes","Yes","Yes","70%","30%","$35,710","$1,100","$110","$2,480","$3,963","$1,100","$590","$2,218","$1,596","$1,100","$0","$496",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$3300 per group","20.00%","$1,100","$1100 per person","$3300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VK3","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720033","Anthem HealthKeepers Gold X 1100","88380VA072",,"VAN001","VAS003","VAF006","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720033-01","Anthem HealthKeepers Gold X 1100","Standard Gold On Exchange Plan","78.01%","0.765430685732621","Yes","Yes","Yes","70%","30%","$35,710","$1,100","$110","$2,480","$3,963","$1,100","$590","$2,218","$1,596","$1,100","$0","$496",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$3300 per group","20.00%","$1,100","$1100 per person","$3300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VK2","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720033","Anthem HealthKeepers Gold X 1100","88380VA072",,"VAN001","VAS003","VAF006","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720033-02","Anthem HealthKeepers Gold X 1100 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VK4","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720033","Anthem HealthKeepers Gold X 1100","88380VA072",,"VAN001","VAS003","VAF006","New","HMO","Gold","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720033-03","Anthem HealthKeepers Gold X 1100","Limited Cost Sharing Plan Variation","78.01%","0.765430685732621","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,150","$7150 per person","$14300 per group","$7,150","$7150 per person","$14300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$3300 per group","20.00%","$1,100","$1100 per person","$3300 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VK2","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720018","Anthem HealthKeepers Bronze X 5250","88380VA072",,"VAN001","VAS003","VAF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720018-00","Anthem HealthKeepers Bronze 5250","Standard Bronze Off Exchange Plan","61.93%","0.619227756600901","Yes","Yes","Yes","70%","30%","$7,410","$3,010","$0","$4,340","$6,768","$3,618","$320","$2,775","$1,925","$1,168","$0","$757",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","35.00%","$5,250","$5250 per person","$10500 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GBN","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720018","Anthem HealthKeepers Bronze X 5250","88380VA072",,"VAN001","VAS003","VAF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720018-01","Anthem HealthKeepers Bronze X 5250","Standard Bronze On Exchange Plan","61.93%","0.619227756600901","Yes","Yes","Yes","70%","30%","$7,410","$3,010","$0","$4,340","$6,768","$3,618","$320","$2,775","$1,925","$1,168","$0","$757",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","35.00%","$5,250","$5250 per person","$10500 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G9W","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720018","Anthem HealthKeepers Bronze X 5250","88380VA072",,"VAN001","VAS003","VAF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720018-02","Anthem HealthKeepers Bronze X 5250 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G9X","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720018","Anthem HealthKeepers Bronze X 5250","88380VA072",,"VAN001","VAS003","VAF002","Existing","HMO","Bronze","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720018-03","Anthem HealthKeepers Bronze X 5250","Limited Cost Sharing Plan Variation","61.93%","0.619227756600901","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","35.00%","$5,250","$5250 per person","$10500 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G9W","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2800","88380VA072",,"VAN001","VAS003","VAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-03","Anthem HealthKeepers Silver X 2800","Limited Cost Sharing Plan Variation","69.03%","0.694803330879399","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%","$2,800","$2800 per person","$5600 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA9","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2800","88380VA072",,"VAN001","VAS003","VAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-04","Anthem HealthKeepers Silver X 2800 S04","73% AV Level Silver Plan","73.59%","0.722338900733868","Yes","Yes","Yes","70%","30%","$5,280","$2,600","$140","$2,480","$5,705","$2,600","$832","$2,218","$1,925","$1,429","$0","$496",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","$5,650","$5650 per person","$11300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20.00%","$2,600","$2600 per person","$5200 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAB","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2800","88380VA072",,"VAN001","VAS003","VAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-05","Anthem HealthKeepers Silver X 2800 S05","87% AV Level Silver Plan","87.90%","0.860442780088708","Yes","Yes","Yes","70%","30%","$1,960","$750","$0","$1,150","$1,955","$750","$190","$960","$1,246","$750","$0","$496",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","$1,900","$1900 per person","$3800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20.00%","$750","$750 per person","$1500 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAC","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2800","88380VA072",,"VAN001","VAS003","VAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-06","Anthem HealthKeepers Silver X 2800 S06","94% AV Level Silver Plan","94.59%","0.930856308091689","Yes","Yes","Yes","70%","30%","$810","$225","$0","$525","$805","$225","$90","$435","$721","$225","$0","$496",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$225","$225 per person","$450 per group","20.00%","$225","$225 per person","$450 per group","20.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAD","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3500","88380VA072",,"VAN001","VAS003","VAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-00","Anthem HealthKeepers Silver 3500","Standard Silver Off Exchange Plan","68.47%","0.684405280589907","Yes","Yes","Yes","70%","30%","$5,580","$3,500","$160","$1,860","$6,606","$3,500","$940","$2,111","$1,925","$1,525","$0","$400",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","15.00%","$3,500","$3500 per person","$7000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JFG","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3500","88380VA072",,"VAN001","VAS003","VAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-01","Anthem HealthKeepers Silver X 3500","Standard Silver On Exchange Plan","68.47%","0.684405280589907","Yes","Yes","Yes","70%","30%","$5,580","$3,500","$160","$1,860","$6,606","$3,500","$940","$2,111","$1,925","$1,525","$0","$400",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","15.00%","$3,500","$3500 per person","$7000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA4","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3500","88380VA072",,"VAN001","VAS003","VAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-02","Anthem HealthKeepers Silver X 3500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GA5","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3500","88380VA072",,"VAN001","VAS003","VAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-03","Anthem HealthKeepers Silver X 3500","Limited Cost Sharing Plan Variation","68.47%","0.684405280589907","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","15.00%","$3,500","$3500 per person","$7000 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA4","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3500","88380VA072",,"VAN001","VAS003","VAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-04","Anthem HealthKeepers Silver X 3500 S04","73% AV Level Silver Plan","73.97%","0.724203043389157","Yes","Yes","Yes","70%","30%","$4,840","$2,800","$120","$1,860","$5,671","$2,800","$705","$2,111","$1,925","$1,525","$0","$400",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","15.00%","$2,800","$2800 per person","$5600 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA6","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3500","88380VA072",,"VAN001","VAS003","VAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-05","Anthem HealthKeepers Silver X 3500 S05","87% AV Level Silver Plan","87.95%","0.86013863676516","Yes","Yes","Yes","70%","30%","$1,860","$900","$0","$900","$1,855","$900","$190","$710","$1,300","$900","$0","$400",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","15.00%","$900","$900 per person","$1800 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA7","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3500","88380VA072",,"VAN001","VAS003","VAF008","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-06","Anthem HealthKeepers Silver X 3500 S06","94% AV Level Silver Plan","94.81%","0.930624283735539","Yes","Yes","Yes","70%","30%","$860","$200","$0","$600","$855","$200","$90","$510","$600","$200","$0","$400",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","15.00%","$200","$200 per person","$400 per group","15.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA8","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720032","Anthem HealthKeepers Silver X 5500","88380VA072",,"VAN001","VAS003","VAF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720032-00","Anthem HealthKeepers Silver 5500","Standard Silver Off Exchange Plan","68.15%","0.681296415347045","Yes","Yes","Yes","70%","30%","$6,760","$3,600","$0","$3,100","$6,322","$3,392","$550","$2,325","$1,925","$1,332","$0","$593",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","25.00%","$5,500","$5500 per person","$11000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EUG","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720032","Anthem HealthKeepers Silver X 5500","88380VA072",,"VAN001","VAS003","VAF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720032-01","Anthem HealthKeepers Silver X 5500","Standard Silver On Exchange Plan","68.15%","0.681296415347045","Yes","Yes","Yes","70%","30%","$6,760","$3,600","$0","$3,100","$6,322","$3,392","$550","$2,325","$1,925","$1,332","$0","$593",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","25.00%","$5,500","$5500 per person","$11000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EUB","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720032","Anthem HealthKeepers Silver X 5500","88380VA072",,"VAN001","VAS003","VAF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720032-02","Anthem HealthKeepers Silver X 5500 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2EUC","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720032","Anthem HealthKeepers Silver X 5500","88380VA072",,"VAN001","VAS003","VAF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720032-03","Anthem HealthKeepers Silver X 5500","Limited Cost Sharing Plan Variation","68.15%","0.681296415347045","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","25.00%","$5,500","$5500 per person","$11000 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EUB","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720032","Anthem HealthKeepers Silver X 5500","88380VA072",,"VAN001","VAS003","VAF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720032-04","Anthem HealthKeepers Silver X 5500 S04","73% AV Level Silver Plan","72.18%","0.720746287904779","Yes","Yes","Yes","70%","30%","$5,360","$2,580","$0","$2,720","$5,355","$2,831","$490","$1,979","$1,925","$1,332","$0","$593",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","25.00%","$3,750","$3750 per person","$7500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EUD","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720032","Anthem HealthKeepers Silver X 5500","88380VA072",,"VAN001","VAS003","VAF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720032-05","Anthem HealthKeepers Silver X 5500 S05","87% AV Level Silver Plan","86.27%","0.861066047089544","Yes","Yes","Yes","70%","30%","$1,910","$750","$0","$1,100","$1,905","$750","$150","$950","$1,343","$750","$0","$593",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","$1,850","$1850 per person","$3700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","25.00%","$750","$750 per person","$1500 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EUE","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720032","Anthem HealthKeepers Silver X 5500","88380VA072",,"VAN001","VAS003","VAF005","Existing","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720032-06","Anthem HealthKeepers Silver X 5500 S06","94% AV Level Silver Plan","93.23%","0.930356705982097","Yes","Yes","Yes","70%","30%","$810","$134","$0","$616","$805","$200","$90","$460","$750","$200","$0","$550",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25.00%","$200","$200 per person","$400 per group","25.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2EUF","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720035","Anthem HealthKeepers Silver X 1800","88380VA072",,"VAN001","VAS003","VAF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720035-00","Anthem HealthKeepers Silver 1800","Standard Silver Off Exchange Plan","70.15%","0.708132756597988","Yes","Yes","Yes","70%","30%","$5,730","$1,800","$150","$3,720","$5,187","$1,800","$900","$2,431","$1,925","$1,236","$0","$689",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30.00%","$1,800","$1800 per person","$3600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VK9","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720035","Anthem HealthKeepers Silver X 1800","88380VA072",,"VAN001","VAS003","VAF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720035-01","Anthem HealthKeepers Silver X 1800","Standard Silver On Exchange Plan","70.15%","0.708132756597988","Yes","Yes","Yes","70%","30%","$5,730","$1,800","$150","$3,720","$5,187","$1,800","$900","$2,431","$1,925","$1,236","$0","$689",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30.00%","$1,800","$1800 per person","$3600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VK8","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720035","Anthem HealthKeepers Silver X 1800","88380VA072",,"VAN001","VAS003","VAF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720035-02","Anthem HealthKeepers Silver X 1800 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VKA","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720035","Anthem HealthKeepers Silver X 1800","88380VA072",,"VAN001","VAS003","VAF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720035-03","Anthem HealthKeepers Silver X 1800","Limited Cost Sharing Plan Variation","70.15%","0.708132756597988","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30.00%","$1,800","$1800 per person","$3600 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VK8","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720035","Anthem HealthKeepers Silver X 1800","88380VA072",,"VAN001","VAS003","VAF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720035-04","Anthem HealthKeepers Silver X 1800 S04","73% AV Level Silver Plan","73.60%","0.733597559807489","Yes","Yes","Yes","70%","30%","$5,570","$1,650","$140","$3,720","$4,997","$1,650","$860","$2,431","$1,925","$1,236","$0","$689",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30.00%","$1,650","$1650 per person","$3300 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VKB","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720035","Anthem HealthKeepers Silver X 1800","88380VA072",,"VAN001","VAS003","VAF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720035-05","Anthem HealthKeepers Silver X 1800 S05","87% AV Level Silver Plan","87.95%","0.861697278120204","Yes","Yes","Yes","70%","30%","$1,760","$900","$0","$800","$1,755","$900","$110","$690","$1,589","$900","$0","$689",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","30.00%","$900","$900 per person","$1800 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VKC","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720035","Anthem HealthKeepers Silver X 1800","88380VA072",,"VAN001","VAS003","VAF008","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720035-06","Anthem HealthKeepers Silver X 1800 S06","94% AV Level Silver Plan","94.30%","0.93069774970902","Yes","Yes","Yes","70%","30%","$760","$125","$0","$575","$755","$275","$70","$355","$700","$275","$0","$425",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$275","$275 per person","$550 per group","30.00%","$275","$275 per person","$550 per group","30.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VKD","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720036","Anthem HealthKeepers Silver X 6100","88380VA072",,"VAN001","VAS003","VAF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720036-00","Anthem HealthKeepers Silver 6100","Standard Silver Off Exchange Plan","68.15%","0.660900633466788","Yes","Yes","Yes","70%","30%","$7,410","$3,010","$0","$4,340","$6,517","$3,178","$745","$2,538","$1,925","$1,168","$0","$757",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","35.00%","$6,100","$6100 per person","$12200 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VKE","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720036","Anthem HealthKeepers Silver X 6100","88380VA072",,"VAN001","VAS003","VAF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720036-01","Anthem HealthKeepers Silver X 6100","Standard Silver On Exchange Plan","68.15%","0.660900633466788","Yes","Yes","Yes","70%","30%","$7,410","$3,010","$0","$4,340","$6,517","$3,178","$745","$2,538","$1,925","$1,168","$0","$757",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","35.00%","$6,100","$6100 per person","$12200 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VKF","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720036","Anthem HealthKeepers Silver X 6100","88380VA072",,"VAN001","VAS003","VAF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720036-02","Anthem HealthKeepers Silver X 6100 AI","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd2VKG","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720036","Anthem HealthKeepers Silver X 6100","88380VA072",,"VAN001","VAS003","VAF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720036-03","Anthem HealthKeepers Silver X 6100","Limited Cost Sharing Plan Variation","68.15%","0.660900633466788","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","35.00%","$6,100","$6100 per person","$12200 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VKF","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720036","Anthem HealthKeepers Silver X 6100","88380VA072",,"VAN001","VAS003","VAF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720036-04","Anthem HealthKeepers Silver X 6100 S04","73% AV Level Silver Plan","72.18%","0.720506531404963","Yes","Yes","Yes","70%","30%","$5,910","$2,236","$0","$3,614","$5,758","$2,500","$665","$2,538","$1,925","$1,168","$0","$757",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35.00%","$2,500","$2500 per person","$5000 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VKH","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720036","Anthem HealthKeepers Silver X 6100","88380VA072",,"VAN001","VAS003","VAF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720036-05","Anthem HealthKeepers Silver X 6100 S05","87% AV Level Silver Plan","86.27%","0.861492447032691","Yes","Yes","Yes","70%","30%","$1,660","$700","$0","$900","$1,655","$785","$150","$665","$1,600","$850","$0","$750",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","35.00%","$850","$850 per person","$1700 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VKJ","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","88380","SERFF","2017-09-25 20:16:04","Individual","No","54-1356687","88380VA0720036","Anthem HealthKeepers Silver X 6100","88380VA072",,"VAN001","VAS003","VAF007","New","HMO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,"2018-01-01","2018-12-31","No","Urgent/Emergency Coverage Only","No","Urgent/Emergency Coverage Only","No","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720036-06","Anthem HealthKeepers Silver X 6100 S06","94% AV Level Silver Plan","93.23%","0.93047720592569","Yes","Yes","Yes","70%","30%","$760","$116","$0","$584","$755","$250","$70","$380","$700","$250","$0","$450",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","35.00%","$250","$250 per person","$500 per group","35.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2VKK","http://editiondigital.net/view/IU65/2018/ON_HIX_VA_KIT_2018"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500001","KP VA Platinum 0/15/Dental","95185VA050",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9953",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500001-00","KP VA Platinum 0/15/Dental","Standard Platinum Off Exchange Plan",,"0.883951391959456","Yes","Yes","No","100%",,"$0","$500","$0","$50","$0","$700","$0","$50","$0","$500","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Platinum_0_15_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530001","KP VA Gold 0/20/Dental","95185VA053",,"VAN001","VAS001","VAF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530001-00","KP VA Gold 0/20/Dental","Standard Gold Off Exchange Plan",,"0.812139983273024","Yes","Yes","No","100%",,"$0","$40","$2,700","$50","$0","$1,000","$500","$50","$0","$800","$100","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Gold_0_20_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530001","KP VA Gold 0/20/Dental","95185VA053",,"VAN001","VAS001","VAF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530001-01","KP VA Gold 0/20/Dental","Standard Gold On Exchange Plan",,"0.812139983273024","Yes","Yes","No","100%",,"$0","$40","$2,700","$50","$0","$1,000","$500","$50","$0","$800","$100","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Gold_0_20_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500001","KP VA Platinum 0/15/Dental","95185VA050",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9953",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500001-01","KP VA Platinum 0/15/Dental","Standard Platinum On Exchange Plan",,"0.883951391959456","Yes","Yes","No","100%",,"$0","$500","$0","$50","$0","$700","$0","$50","$0","$500","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Platinum_0_15_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500002","KP VA Platinum 500/20/Dental","95185VA050",,"VAN001","VAS001","VAF002","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9952",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500002-00","KP VA Platinum 500/20/Dental","Standard Platinum Off Exchange Plan",,"0.879862385902619","No","Yes","No","100%",,"$500","$300","$0","$50","$0","$700","$0","$50","$500","$500","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Platinum_500_20_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530001","KP VA Gold 0/20/Dental","95185VA053",,"VAN001","VAS001","VAF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530001-02","KP VA Gold 0/20/Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$50","$0","$0","$0","$50","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Gold_0_20_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530003","KP VA Silver 2000/30/Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-04","KP VA Silver 1750/30/CSR/Dental (2000)","73% AV Level Silver Plan",,"0.738387198917723","No","Yes","No","100%",,"$1,800","$50","$2,600","$50","$800","$1,500","$600","$50","$1,500","$300","$200","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_1750_30_CSR_Dental_2000.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530003","KP VA Silver 2000/30/Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-05","KP VA Silver 0/10/CSR/Dental (2000)","87% AV Level Silver Plan",,"0.878745604876282","No","Yes","No","100%",,"$0","$0","$2,400","$50","$0","$1,100","$500","$50","$0","$200","$300","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_0_10_CSR_Dental_2000.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530001","KP VA Gold 0/20/Dental","95185VA053",,"VAN001","VAS001","VAF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530001-03","KP VA Gold 0/20/Dental","Limited Cost Sharing Plan Variation",,"0.812139983273024","Yes","Yes","No","100%",,"$0","$40","$2,700","$50","$0","$1,000","$500","$50","$0","$800","$100","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Gold_0_20_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500002","KP VA Platinum 500/20/Dental","95185VA050",,"VAN001","VAS001","VAF002","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9952",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500002-01","KP VA Platinum 500/20/Dental","Standard Platinum On Exchange Plan",,"0.879862385902619","No","Yes","No","100%",,"$500","$300","$0","$50","$0","$700","$0","$50","$500","$500","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Platinum_500_20_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500004","KP VA Gold 0/20/Dental","95185VA050",,"VAN001","VAS001","VAF003","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9951",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500004-00","KP VA Gold 0/20/Dental","Standard Gold Off Exchange Plan",,"0.783822165479412","Yes","Yes","No","100%",,"$0","$1,500","$0","$50","$0","$1,700","$0","$50","$0","$900","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Gold_0_20_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530002","KP VA Gold 1000/20/Dental","95185VA053",,"VAN001","VAS001","VAF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530002-00","KP VA Gold 1000/20/Dental","Standard Gold Off Exchange Plan",,"0.789040361730159","No","Yes","No","100%",,"$1,000","$40","$2,400","$50","$0","$1,100","$500","$50","$900","$800","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Gold_1000_20_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530002","KP VA Gold 1000/20/Dental","95185VA053",,"VAN001","VAS001","VAF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530002-01","KP VA Gold 1000/20/Dental","Standard Gold On Exchange Plan",,"0.789040361730159","No","Yes","No","100%",,"$1,000","$40","$2,400","$50","$0","$1,100","$500","$50","$900","$800","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Gold_1000_20_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530013","KP VA Silver 6000/35/Dental","95185VA053",,"VAN001","VAS001","VAF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530013-00","KP VA Silver 6000/35/Dental","Standard Silver Off Exchange Plan",,"0.670804096930016","No","Yes","No","100%",,"$6,000","$50","$1,100","$50","$800","$1,600","$600","$50","$1,500","$300","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_6000_35_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500004","KP VA Gold 0/20/Dental","95185VA050",,"VAN001","VAS001","VAF003","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9951",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500004-01","KP VA Gold 0/20/Dental","Standard Gold On Exchange Plan",,"0.783822165479412","Yes","Yes","No","100%",,"$0","$1,500","$0","$50","$0","$1,700","$0","$50","$0","$900","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Gold_0_20_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500015","KP VA Gold 500/20/Dental","95185VA050",,"VAN001","VAS001","VAF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500015-00","KP VA Gold 500/20/Dental","Standard Gold Off Exchange Plan",,"0.785901527481301","No","Yes","No","100%",,"$500","$1,500","$0","$50","$0","$1,500","$0","$50","$500","$800","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Gold_500_20_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530002","KP VA Gold 1000/20/Dental","95185VA053",,"VAN001","VAS001","VAF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530002-02","KP VA Gold 1000/20/Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$50","$0","$0","$0","$50","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Gold_1000_20_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530002","KP VA Gold 1000/20/Dental","95185VA053",,"VAN001","VAS001","VAF002","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530002-03","KP VA Gold 1000/20/Dental","Limited Cost Sharing Plan Variation",,"0.789040361730159","No","Yes","No","100%",,"$1,000","$40","$2,400","$50","$0","$1,100","$500","$50","$900","$800","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Gold_1000_20_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500015","KP VA Gold 500/20/Dental","95185VA050",,"VAN001","VAS001","VAF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500015-01","KP VA Gold 500/20/Dental","Standard Gold On Exchange Plan",,"0.785901527481301","No","Yes","No","100%",,"$500","$1,500","$0","$50","$0","$1,500","$0","$50","$500","$800","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Gold_500_20_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530014","KP VA Gold 1500/20/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530014-00","KP VA Gold 1500/20/Dental","Standard Gold Off Exchange Plan",,"0.767193095331471","No","Yes","No","100%",,"$1,500","$40","$2,300","$50","$200","$1,100","$500","$50","$1,500","$300","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Gold_1500_20_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530014","KP VA Gold 1500/20/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530014-01","KP VA Gold 1500/20/Dental","Standard Gold On Exchange Plan",,"0.767193095331471","No","Yes","No","100%",,"$1,500","$40","$2,300","$50","$200","$1,100","$500","$50","$1,500","$300","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Gold_1500_20_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530014","KP VA Gold 1500/20/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530014-02","KP VA Gold 1500/20/Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$50","$0","$0","$0","$50","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Gold_1500_20_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530014","KP VA Gold 1500/20/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530014-03","KP VA Gold 1500/20/Dental","Limited Cost Sharing Plan Variation",,"0.767193095331471","No","Yes","No","100%",,"$1,500","$40","$2,300","$50","$200","$1,100","$500","$50","$1,500","$300","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Gold_1500_20_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500005","KP VA Gold 1000/20/Dental","95185VA050",,"VAN001","VAS001","VAF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500005-00","KP VA Gold 1000/20/Dental","Standard Gold Off Exchange Plan",,"0.781295385591464","No","Yes","No","100%",,"$1,000","$1,500","$0","$50","$0","$1,500","$0","$50","$1,000","$400","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Gold_1000_20_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530003","KP VA Silver 2000/30/Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-00","KP VA Silver 2000/30/Dental","Standard Silver Off Exchange Plan",,"0.716818779970475","No","Yes","No","100%",,"$2,000","$50","$2,500","$50","$800","$1,500","$600","$50","$1,500","$300","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_2000_30_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530003","KP VA Silver 2000/30/Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-01","KP VA Silver 2000/30/Dental","Standard Silver On Exchange Plan",,"0.716818779970475","No","Yes","No","100%",,"$2,000","$50","$2,500","$50","$800","$1,500","$600","$50","$1,500","$300","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_2000_30_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500005","KP VA Gold 1000/20/Dental","95185VA050",,"VAN001","VAS001","VAF004","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500005-01","KP VA Gold 1000/20/Dental","Standard Gold On Exchange Plan",,"0.781295385591464","No","Yes","No","100%",,"$1,000","$1,500","$0","$50","$0","$1,500","$0","$50","$1,000","$400","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Gold_1000_20_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500012","KP VA Bronze 5500/50/Dental","95185VA050",,"VAN001","VAS001","VAF010","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500012-00","KP VA Bronze 5500/50/Dental","Standard Bronze Off Exchange Plan",,"0.644153846640097","No","Yes","No","100%",,"$5,500","$50","$1,100","$50","$700","$1,800","$500","$50","$1,900","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Bronze_5500_50_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530003","KP VA Silver 2000/30/Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-02","KP VA Silver 2000/30/Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$50","$0","$0","$0","$50","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_2000_30_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530003","KP VA Silver 2000/30/Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-03","KP VA Silver 2000/30/Dental","Limited Cost Sharing Plan Variation",,"0.716818779970475","No","Yes","No","100%",,"$2,000","$50","$2,500","$50","$800","$1,500","$600","$50","$1,500","$300","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_2000_30_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500012","KP VA Bronze 5500/50/Dental","95185VA050",,"VAN001","VAS001","VAF010","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500012-01","KP VA Bronze 5500/50/Dental","Standard Bronze On Exchange Plan",,"0.644153846640097","No","Yes","No","100%",,"$5,500","$50","$1,100","$50","$700","$1,800","$500","$50","$1,900","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Bronze_5500_50_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530003","KP VA Silver 2000/30/Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-06","KP VA Silver 0/5/CSR/Dental (2000)","94% AV Level Silver Plan",,"0.947579102937313","No","Yes","No","100%",,"$0","$30","$900","$50","$0","$400","$200","$50","$0","$40","$90","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_0_5_CSR_Dental_2000.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530004","KP VA Silver 3000/30/Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-00","KP VA Silver 3000/30/Dental","Standard Silver Off Exchange Plan",,"0.703947310107016","No","Yes","No","100%",,"$3,000","$50","$2,200","$50","$800","$1,500","$600","$50","$1,500","$300","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_3000_30_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530004","KP VA Silver 3000/30/Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-01","KP VA Silver 3000/30/Dental","Standard Silver On Exchange Plan",,"0.703947310107016","No","Yes","No","100%",,"$3,000","$50","$2,200","$50","$800","$1,500","$600","$50","$1,500","$300","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_3000_30_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530004","KP VA Silver 3000/30/Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-02","KP VA Silver 3000/30/Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$50","$0","$0","$0","$50","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_3000_30_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental","95185VA053",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-03","KP VA Silver 2750/20%/HSA/Dental","Limited Cost Sharing Plan Variation",,"0.699755679889423","Yes","Yes","No","100%",,"$2,750","$50","$1,300","$50","$2,750","$500","$200","$50","$1,900","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_2750_20_HSA_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental","95185VA053",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-04","KP VA Silver 1700/20%/CSR/HDHP/Dental (2750)","73% AV Level Silver Plan",,"0.738719782233908","Yes","Yes","No","100%",,"$1,700","$50","$1,500","$50","$1,700","$800","$400","$50","$1,700","$0","$50","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_1700_20_CSR_HDHP_Dental_2750.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500013","KP VA Bronze 6550/0%/ HSA/Dental","95185VA050",,"VAN001","VAS001","VAF012","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500013-00","KP VA Bronze 6550/0%/ HSA/Dental","Standard Bronze Off Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$50","$6,550","$0","$0","$50","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Bronze_6550_0_HSA_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500013","KP VA Bronze 6550/0%/ HSA/Dental","95185VA050",,"VAN001","VAS001","VAF012","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500013-01","KP VA Bronze 6550/0%/ HSA/Dental","Standard Bronze On Exchange Plan",,"0.604927814454138","Yes","Yes","No","100%",,"$6,550","$0","$0","$50","$6,550","$0","$0","$50","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Bronze_6550_0_HSA_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530004","KP VA Silver 3000/30/Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-03","KP VA Silver 3000/30/Dental","Limited Cost Sharing Plan Variation",,"0.703947310107016","No","Yes","No","100%",,"$3,000","$50","$2,200","$50","$800","$1,500","$600","$50","$1,500","$300","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_3000_30_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530004","KP VA Silver 3000/30/Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-04","KP VA Silver 1750/30/CSR/Dental (3000)","73% AV Level Silver Plan",,"0.738387198917723","No","Yes","No","100%",,"$1,800","$50","$2,600","$50","$800","$1,500","$600","$50","$1,500","$300","$200","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_1750_30_CSR_Dental_3000.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530004","KP VA Silver 3000/30/Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-05","KP VA Silver 0/10/CSR/Dental (3000)","87% AV Level Silver Plan",,"0.878745604876282","No","Yes","No","100%",,"$0","$0","$2,400","$50","$0","$1,100","$500","$50","$0","$200","$300","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_0_10_CSR_Dental_3000.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530004","KP VA Silver 3000/30/Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-06","KP VA Silver 0/5/CSR/Dental (3000)","94% AV Level Silver Plan",,"0.947579102937313","No","Yes","No","100%",,"$0","$30","$900","$50","$0","$400","$200","$50","$0","$40","$90","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_0_5_CSR_Dental_3000.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500008","KP VA Silver 1500/40/Dental","95185VA050",,"VAN001","VAS001","VAF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500008-00","KP VA Silver 1500/40/Dental","Standard Silver Off Exchange Plan",,"0.715508523255092","No","Yes","No","100%",,"$1,500","$1,500","$0","$50","$400","$1,600","$0","$50","$1,500","$300","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Silver_1500_40_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500008","KP VA Silver 1500/40/Dental","95185VA050",,"VAN001","VAS001","VAF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500008-01","KP VA Silver 1500/40/Dental","Standard Silver On Exchange Plan",,"0.715508523255092","No","Yes","No","100%",,"$1,500","$1,500","$0","$50","$400","$1,600","$0","$50","$1,500","$300","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Silver_1500_40_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530013","KP VA Silver 6000/35/Dental","95185VA053",,"VAN001","VAS001","VAF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530013-01","KP VA Silver 6000/35/Dental","Standard Silver On Exchange Plan",,"0.670804096930016","No","Yes","No","100%",,"$6,000","$50","$1,100","$50","$800","$1,600","$600","$50","$1,500","$300","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_6000_35_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530013","KP VA Silver 6000/35/Dental","95185VA053",,"VAN001","VAS001","VAF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530013-02","KP VA Silver 6000/35/Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$50","$0","$0","$0","$50","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_6000_35_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500009","KP VA Silver 2500/30/Dental","95185VA050",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9945",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500009-00","KP VA Silver 2500/30/Dental","Standard Silver Off Exchange Plan",,"0.717881129900928","No","Yes","No","100%",,"$2,500","$50","$2,000","$50","$300","$1,400","$500","$50","$1,700","$200","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Silver_2500_30_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500009","KP VA Silver 2500/30/Dental","95185VA050",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9945",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500009-01","KP VA Silver 2500/30/Dental","Standard Silver On Exchange Plan",,"0.717881129900928","No","Yes","No","100%",,"$2,500","$50","$2,000","$50","$300","$1,400","$500","$50","$1,700","$200","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Silver_2500_30_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530013","KP VA Silver 6000/35/Dental","95185VA053",,"VAN001","VAS001","VAF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530013-03","KP VA Silver 6000/35/Dental","Limited Cost Sharing Plan Variation",,"0.670804096930016","No","Yes","No","100%",,"$6,000","$50","$1,100","$50","$800","$1,600","$600","$50","$1,500","$300","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_6000_35_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530013","KP VA Silver 6000/35/Dental","95185VA053",,"VAN001","VAS001","VAF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530013-04","KP VA Silver 3500/30/CSR/Dental (6000)","73% AV Level Silver Plan",,"0.738331473609912","No","Yes","No","100%",,"$3,500","$50","$2,000","$50","$0","$1,600","$600","$50","$1,500","$300","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_3500_30_CSR_Dental_6000.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530013","KP VA Silver 6000/35/Dental","95185VA053",,"VAN001","VAS001","VAF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530013-05","KP VA Silver 0/15/CSR/Dental (6000)","87% AV Level Silver Plan",,"0.877118962313262","No","Yes","No","100%",,"$0","$0","$2,400","$50","$0","$1,200","$500","$50","$0","$200","$300","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_0_15_CSR_Dental_6000.pd","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530013","KP VA Silver 6000/35/Dental","95185VA053",,"VAN001","VAS001","VAF006","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530013-06","KP VA Silver 0/5/CSR/Dental (6000)","94% AV Level Silver Plan",,"0.946000706233523","No","Yes","No","100%",,"$0","$30","$900","$50","$0","$400","$200","$50","$0","$40","$90","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_0_5_CSR_Dental_6000.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental","95185VA053",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-00","KP VA Silver 2750/20%/HSA/Dental","Standard Silver Off Exchange Plan",,"0.699755679889423","Yes","Yes","No","100%",,"$2,750","$50","$1,300","$50","$2,750","$500","$200","$50","$1,900","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_2750_20_HSA_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500006","KP VA Gold 1400/0%/HSA/ Dental","95185VA050",,"VAN001","VAS001","VAF005","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9948",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500006-00","KP VA Gold 1400/0%/HSA/ Dental","Standard Gold Off Exchange Plan",,"0.801283384564981","Yes","Yes","No","100%",,"$1,400","$50","$0","$50","$1,400","$900","$0","$50","$1,400","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Gold_1400_0_HSA_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530009","KP VA Catastrophic 7350/0/Dental","95185VA053",,"VAN001","VAS001","VAF009","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530009-01","KP VA Catastrophic 7350/0/Dental","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$50","$7,200","$0","$0","$50","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Catastrophic_7350_0_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530010","KP VA Platinum 0/5/Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530010-00","KP VA Platinum 0/5/Dental","Standard Platinum Off Exchange Plan",,"0.882409116120677","Yes","Yes","No","100%",,"$0","$1,100","$0","$50","$0","$600","$0","$50","$0","$600","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Platinum_0_5_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480006","my Connect Blue WV PPO 6500B","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480006-02","my Connect Blue WV PPO 6500B","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480006-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010021","CareSource Low Premium Silver","50328WV001",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9965",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010021-01","CareSource Low Premium Silver","Standard Silver On Exchange Plan",,"0.6859280333684","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-lp-silver-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500006","KP VA Gold 1400/0%/HSA/ Dental","95185VA050",,"VAN001","VAS001","VAF005","Existing","HMO","Gold","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9948",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500006-01","KP VA Gold 1400/0%/HSA/ Dental","Standard Gold On Exchange Plan",,"0.801283384564981","Yes","Yes","No","100%",,"$1,400","$50","$0","$50","$1,400","$900","$0","$50","$1,400","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Gold_1400_0_HSA_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental","95185VA053",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-01","KP VA Silver 2750/20%/HSA/Dental","Standard Silver On Exchange Plan",,"0.699755679889423","Yes","Yes","No","100%",,"$2,750","$50","$1,300","$50","$2,750","$500","$200","$50","$1,900","$0","$0","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_2750_20_HSA_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental","95185VA053",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-02","KP VA Silver 2750/20%/HSA/Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$50","$0","$0","$0","$50","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_2750_20_HSA_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500016","KP VA Silver 4000/0%/HSA/Dental","95185VA050",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9944",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500016-00","KP VA Silver 4000/0%/HSA/Dental","Standard Silver Off Exchange Plan",,"0.679955733290429","Yes","Yes","No","100%",,"$4,000","$0","$0","$50","$4,000","$0","$0","$50","$1,900","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Silver_4000_0_HSA_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500016","KP VA Silver 4000/0%/HSA/Dental","95185VA050",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9944",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500016-01","KP VA Silver 4000/0%/HSA/Dental","Standard Silver On Exchange Plan",,"0.679955733290429","Yes","Yes","No","100%",,"$4,000","$0","$0","$50","$4,000","$0","$0","$50","$1,900","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Silver_4000_0_HSA_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental","95185VA053",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-05","KP VA Silver 500/10%/CSR/HDHP/Dental (2750)","87% AV Level Silver Plan",,"0.873269181694612","Yes","Yes","No","100%",,"$500","$40","$900","$50","$500","$800","$300","$50","$500","$0","$100","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_500_10_CSR_HDHP_Dental_2750.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental","95185VA053",,"VAN001","VAS001","VAF007","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-06","KP VA Silver 100/5%/CSR/HDHP/Dental (2750)","94% AV Level Silver Plan",,"0.949172505752506","Yes","Yes","No","100%",,"$100","$30","$500","$50","$100","$300","$100","$50","$100","$0","$70","$0","$250","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Silver_100_5_CSR_HDHP_Dental_2750.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530010","KP VA Platinum 0/5/Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530010-03","KP VA Platinum 0/5/Dental","Limited Cost Sharing Plan Variation",,"0.882409116120677","Yes","Yes","No","100%",,"$0","$1,100","$0","$50","$0","$600","$0","$50","$0","$600","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Platinum_0_5_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","97762","SERFF","2017-08-13 20:16:00","Individual","Yes","75-1233841","97762VA0010001","Dentegra Dental PPO Pediatric Basic Plan","97762VA001",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","97762VA0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/va/97762va0010001-18"
"2018","VA","97762","SERFF","2017-08-13 20:16:00","Individual","Yes","75-1233841","97762VA0010007","Dentegra Dental PPO Family Basic Plan","97762VA001",,"VAN001","VAS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","97762VA0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/va/97762va0010007-18"
"2018","VA","97762","SERFF","2017-08-13 20:16:00","Individual","Yes","75-1233841","97762VA0010008","Dentegra Dental PPO Family Preferred Plan","97762VA001",,"VAN001","VAS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","97762VA0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/va/97762va0010008-18"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0320001","Major Events Blue PPO 7350","31274WV032",,"WVN001","WVS001","WVF012","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0320001-00","Major Events Blue PPO 7350","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$7,350","$0","$0","$0","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530012","KP VA Standard Silver 3500/30/Dental","95185VA053",,"VAN001","VAS001","VAF005","Existing","HMO","Silver","Design 1","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530012-00","KP VA Standard Silver 3500/30/Dental","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$50","$1,100","$50","$100","$1,400","$300","$50","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Standard_Silver_3500_30_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500010","KP VA Silver 1500/30/HSA/Dental","95185VA050",,"VAN001","VAS001","VAF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500010-00","KP VA Silver 1500/30/HSA/Dental","Standard Silver Off Exchange Plan",,"0.71750035037034","Yes","Yes","No","100%",,"$1,500","$50","$1,900","$50","$1,500","$900","$300","$50","$1,500","$200","$20","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Silver_1500_30_HSA_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500010","KP VA Silver 1500/30/HSA/Dental","95185VA050",,"VAN001","VAS001","VAF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500010-01","KP VA Silver 1500/30/HSA/Dental","Standard Silver On Exchange Plan",,"0.71750035037034","Yes","Yes","No","100%",,"$1,500","$50","$1,900","$50","$1,500","$900","$300","$50","$1,500","$200","$20","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Silver_1500_30_HSA_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530012","KP VA Standard Silver 3500/30/Dental","95185VA053",,"VAN001","VAS001","VAF005","Existing","HMO","Silver","Design 1","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530012-01","KP VA Standard Silver 3500/30/Dental","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$50","$1,100","$50","$100","$1,400","$300","$50","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Standard_Silver_3500_30_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530012","KP VA Standard Silver 3500/30/Dental","95185VA053",,"VAN001","VAS001","VAF005","Existing","HMO","Silver","Design 1","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530012-02","KP VA Standard Silver 3500/30/Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$50","$0","$0","$0","$50","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Standard_Silver_3500_30_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500011","KP VA Silver 2500/30/HSA/Dental","95185VA050",,"VAN001","VAS001","VAF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500011-00","KP VA Silver 2500/30/HSA/Dental","Standard Silver Off Exchange Plan",,"0.687306543914744","Yes","Yes","No","100%",,"$2,500","$50","$1,300","$50","$2,500","$600","$200","$50","$1,800","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Silver_2500_30_HSA_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500011","KP VA Silver 2500/30/HSA/Dental","95185VA050",,"VAN001","VAS001","VAF008","Existing","HMO","Silver","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9946",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500011-01","KP VA Silver 2500/30/HSA/Dental","Standard Silver On Exchange Plan",,"0.687306543914744","Yes","Yes","No","100%",,"$2,500","$50","$1,300","$50","$2,500","$600","$200","$50","$1,800","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Silver_2500_30_HSA_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530012","KP VA Standard Silver 3500/30/Dental","95185VA053",,"VAN001","VAS001","VAF005","Existing","HMO","Silver","Design 1","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530012-03","KP VA Standard Silver 3500/30/Dental","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$50","$1,100","$50","$100","$1,400","$300","$50","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Standard_Silver_3500_30_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530012","KP VA Standard Silver 3500/30/Dental","95185VA053",,"VAN001","VAS001","VAF005","Existing","HMO","Silver","Design 1","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530012-04","KP VA Standard Silver 3000/30/CSR/Dental (3500)","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$50","$1,200","$50","$100","$1,400","$300","$50","$1,700","$200","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Standard_Silver_3000_30_CSR_Dental_3500.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530012","KP VA Standard Silver 3500/30/Dental","95185VA053",,"VAN001","VAS001","VAF005","Existing","HMO","Silver","Design 1","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530012-05","KP VA Standard Silver 700/10/CSR/Dental (3500)","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$30","$1,700","$50","$100","$600","$300","$50","$700","$80","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Standard_Silver_700_10_CSR_Dental_3500.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530012","KP VA Standard Silver 3500/30/Dental","95185VA053",,"VAN001","VAS001","VAF005","Existing","HMO","Silver","Design 1","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530012-06","KP VA Standard Silver 250/5/CSR/Dental (3500)","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$20","$400","$50","$100","$200","$90","$50","$250","$30","$50","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Standard_Silver_250_5_CSR_Dental_3500.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530006","KP VA Bronze 5500/50/Dental","95185VA053",,"VAN001","VAS001","VAF008","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530006-00","KP VA Bronze 5500/50/Dental","Standard Bronze Off Exchange Plan",,"0.625900361646883","No","Yes","No","100%",,"$5,500","$50","$1,300","$50","$1,900","$1,600","$600","$50","$1,300","$60","$200","$0","$250","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","100.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Bronze_5500_50_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500014","KP VA Bronze 5750/30/20%/HSA/Dental","95185VA050",,"VAN001","VAS001","VAF011","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500014-00","KP VA Bronze 5750/30/20%/HSA/Dental","Standard Bronze Off Exchange Plan",,"0.608593088434364","Yes","Yes","No","100%",,"$5,750","$40","$700","$50","$4,000","$0","$0","$50","$1,800","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Bronze_5750_30_20_HSA_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","SHOP (Small Group)","No","52-0954463","95185VA0500014","KP VA Bronze 5750/30/20%/HSA/Dental","95185VA050",,"VAN001","VAS001","VAF011","Existing","HMO","Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500014-01","KP VA Bronze 5750/30/20%/HSA/Dental","Standard Bronze On Exchange Plan",,"0.608593088434364","Yes","Yes","No","100%",,"$5,750","$40","$700","$50","$4,000","$0","$0","$50","$1,800","$0","$0","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2018-On-Exchange/KP_VA_Bronze_5750_30_20_HSA_Dental_ON.pdf","https://account.kp.org/static/bcssp/pdfs/shared/mid/2018/KP_VA_SG_PlanSummaryVA_2018.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530006","KP VA Bronze 5500/50/Dental","95185VA053",,"VAN001","VAS001","VAF008","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530006-01","KP VA Bronze 5500/50/Dental","Standard Bronze On Exchange Plan",,"0.625900361646883","No","Yes","No","100%",,"$5,500","$50","$1,300","$50","$1,900","$1,600","$600","$50","$1,300","$60","$200","$0","$250","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","100.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Bronze_5500_50_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530006","KP VA Bronze 5500/50/Dental","95185VA053",,"VAN001","VAS001","VAF008","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530006-02","KP VA Bronze 5500/50/Dental","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$50","$0","$0","$0","$50","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Bronze_5500_50_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530006","KP VA Bronze 5500/50/Dental","95185VA053",,"VAN001","VAS001","VAF008","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530006-03","KP VA Bronze 5500/50/Dental","Limited Cost Sharing Plan Variation",,"0.625900361646883","No","Yes","No","100%",,"$5,500","$50","$1,300","$50","$1,900","$1,600","$600","$50","$1,300","$60","$200","$0","$250","0","0","2",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","35.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","100.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Bronze_5500_50_Dental_AI_Ltd.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530009","KP VA Catastrophic 7350/0/Dental","95185VA053",,"VAN001","VAS001","VAF009","Existing","HMO","Catastrophic","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530009-00","KP VA Catastrophic 7350/0/Dental","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$50","$7,200","$0","$0","$50","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Catastrophic_7350_0_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530010","KP VA Platinum 0/5/Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530010-01","KP VA Platinum 0/5/Dental","Standard Platinum On Exchange Plan",,"0.882409116120677","Yes","Yes","No","100%",,"$0","$1,100","$0","$50","$0","$600","$0","$50","$0","$600","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Platinum_0_5_Dental.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","VA","95185","SERFF","2017-09-26 20:16:14","Individual","No","52-0954463","95185VA0530010","KP VA Platinum 0/5/Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Not Applicable","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9837",,,"2018-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530010-02","KP VA Platinum 0/5/Dental","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$50","$0","$0","$0","$50","$0","$0","$0","$0",,"4","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2018-ON-Exchange/KP_VA_Platinum_0_5_Dental_AI_0.pdf","http://info.kaiserpermanente.org//healthplans/planbrochures/2018/va2018planbrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0320001","Major Events Blue PPO 7350","31274WV032",,"WVN001","WVS001","WVF012","Existing","PPO","Catastrophic","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0320001-01","Major Events Blue PPO 7350","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$7,350","$0","$0","$0","$1,900","$0","$0","$0",,"0","3","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","0.00%",,,,,"$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0320001-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480009","my Connect Blue WV PPO 6000BQE","31274WV048",,"WVN001","WVS001","WVF011","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480009-00","my Connect Blue WV PPO 6000BQE","Standard Bronze Off Exchange Plan",,"0.608071769414274","Yes","Yes","Yes","63%","37%","$6,000","$0","$550","$0","$6,000","$0","$100","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%","$6,000","$6000 per person","$12000 per group","40.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480009","my Connect Blue WV PPO 6000BQE","31274WV048",,"WVN001","WVS001","WVF011","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480009-01","my Connect Blue WV PPO 6000BQE","Standard Bronze On Exchange Plan",,"0.608071769414274","Yes","Yes","Yes","63%","37%","$6,000","$0","$550","$0","$6,000","$0","$100","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%","$6,000","$6000 per person","$12000 per group","40.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480009-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480009","my Connect Blue WV PPO 6000BQE","31274WV048",,"WVN001","WVS001","WVF011","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480009-02","my Connect Blue WV PPO 6000BQE","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480009-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480009","my Connect Blue WV PPO 6000BQE","31274WV048",,"WVN001","WVS001","WVF011","New","PPO","Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480009-03","my Connect Blue WV PPO 6000BQE","Limited Cost Sharing Plan Variation",,"0.608071769414274","Yes","Yes","Yes","63%","37%","$6,000","$0","$550","$0","$6,000","$0","$100","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10.00%","$6,000","$6000 per person","$12000 per group","40.00%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480009-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480002","my Connect Blue WV PPO 1500G","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9993",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480002-00","my Connect Blue WV PPO 1500G","Standard Gold Off Exchange Plan",,"0.78831596481413","No","Yes","Yes","63%","37%","$1,500","$20","$2,000","$0","$1,500","$1,300","$100","$0","$800","$400","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%","$2,000","$2000 per person","$4000 per group","40.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480002","my Connect Blue WV PPO 1500G","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9993",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480002-01","my Connect Blue WV PPO 1500G","Standard Gold On Exchange Plan",,"0.78831596481413","No","Yes","Yes","63%","37%","$1,500","$20","$2,000","$0","$1,500","$1,300","$100","$0","$800","$400","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%","$2,000","$2000 per person","$4000 per group","40.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480002-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480002","my Connect Blue WV PPO 1500G","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9993",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480002-02","my Connect Blue WV PPO 1500G","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480002-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480002","my Connect Blue WV PPO 1500G","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Gold","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9993",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480002-03","my Connect Blue WV PPO 1500G","Limited Cost Sharing Plan Variation",,"0.78831596481413","No","Yes","Yes","63%","37%","$1,500","$20","$2,000","$0","$1,500","$1,300","$100","$0","$800","$400","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20.00%","$2,000","$2000 per person","$4000 per group","40.00%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480002-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480003","my Connect Blue WV PPO 2500S","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480003-00","my Connect Blue WV PPO 2500S","Standard Silver Off Exchange Plan","71.91%","0.721533940598139","No","Yes","Yes","63%","37%","$2,500","$20","$2,800","$0","$2,100","$1,400","$0","$0","$800","$800","$0","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%","$5,250","$5250 per person","$10500 per group","40.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480003","my Connect Blue WV PPO 2500S","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480003-01","my Connect Blue WV PPO 2500S","Standard Silver On Exchange Plan","71.91%","0.721533940598139","No","Yes","Yes","63%","37%","$2,500","$20","$2,800","$0","$2,100","$1,400","$0","$0","$800","$800","$0","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%","$5,250","$5250 per person","$10500 per group","40.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480003-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480003","my Connect Blue WV PPO 2500S","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480003-02","my Connect Blue WV PPO 2500S","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480003-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480003","my Connect Blue WV PPO 2500S","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480003-03","my Connect Blue WV PPO 2500S","Limited Cost Sharing Plan Variation","71.91%","0.721533940598139","No","Yes","Yes","63%","37%","$2,500","$20","$2,800","$0","$2,100","$1,400","$0","$0","$800","$800","$0","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%","$5,250","$5250 per person","$10500 per group","40.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480003-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480003","my Connect Blue WV PPO 2500S","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480003-04","my Connect Blue WV PPO 2500S","73% AV Level Silver Plan","73.95%","0.741063501785284","No","Yes","Yes","63%","37%","$2,500","$20","$2,800","$0","$2,100","$1,400","$0","$0","$800","$800","$0","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$5,850","$5850 per person","$11700 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30.00%","$5,250","$5250 per person","$10500 per group","40.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480003-04_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480003","my Connect Blue WV PPO 2500S","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480003-05","my Connect Blue WV PPO 2500S","87% AV Level Silver Plan","87.58%","0.87707082639971","No","Yes","Yes","63%","37%","$600","$20","$1,080","$0","$600","$900","$200","$0","$600","$500","$20","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","$1,700","$1700 per person","$3400 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10.00%","$1,200","$1200 per person","$2400 per group","30.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480003-05_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480003","my Connect Blue WV PPO 2500S","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480003-06","my Connect Blue WV PPO 2500S","94% AV Level Silver Plan","94.30%","0.943420659006074","No","Yes","Yes","63%","37%","$250","$20","$330","$0","$250","$200","$150","$0","$250","$300","$40","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10.00%","$350","$350 per person","$700 per group","30.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480003-06_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480004","my Connect Blue WV PPO 2800SQE","31274WV048",,"WVN001","WVS001","WVF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480004-00","my Connect Blue WV PPO 2800SQE","Standard Silver Off Exchange Plan",,"0.685637824788974","Yes","Yes","Yes","63%","37%","$2,800","$0","$2,000","$0","$2,800","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%","$2,800","$2800 per person","$5600 per group","40.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480004","my Connect Blue WV PPO 2800SQE","31274WV048",,"WVN001","WVS001","WVF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480004-01","my Connect Blue WV PPO 2800SQE","Standard Silver On Exchange Plan",,"0.685637824788974","Yes","Yes","Yes","63%","37%","$2,800","$0","$2,000","$0","$2,800","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%","$2,800","$2800 per person","$5600 per group","40.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480004-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480004","my Connect Blue WV PPO 2800SQE","31274WV048",,"WVN001","WVS001","WVF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480004-02","my Connect Blue WV PPO 2800SQE","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480004-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480004","my Connect Blue WV PPO 2800SQE","31274WV048",,"WVN001","WVS001","WVF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480004-03","my Connect Blue WV PPO 2800SQE","Limited Cost Sharing Plan Variation",,"0.685637824788974","Yes","Yes","Yes","63%","37%","$2,800","$0","$2,000","$0","$2,800","$0","$900","$0","$1,900","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20.00%","$2,800","$2800 per person","$5600 per group","40.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480004-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480004","my Connect Blue WV PPO 2800SQE","31274WV048",,"WVN001","WVS001","WVF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480004-04","my Connect Blue WV PPO 2800SQE","73% AV Level Silver Plan",,"0.735680630675318","Yes","Yes","Yes","63%","37%","$1,800","$0","$2,200","$0","$1,800","$0","$1,100","$0","$1,800","$0","$30","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20.00%","$1,800","$1800 per person","$3600 per group","40.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480004-04_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480004","my Connect Blue WV PPO 2800SQE","31274WV048",,"WVN001","WVS001","WVF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480004-05","my Connect Blue WV PPO 2800SQE","87% AV Level Silver Plan",,"0.879821872793452","Yes","Yes","Yes","63%","37%","$800","$0","$400","$0","$800","$0","$400","$0","$800","$0","$100","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","$1,200","$1200 per person","$2400 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10.00%","$800","$800 per person","$1600 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480004-05_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480004","my Connect Blue WV PPO 2800SQE","31274WV048",,"WVN001","WVS001","WVF010","Existing","PPO","Silver","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480004-06","my Connect Blue WV PPO 2800SQE","94% AV Level Silver Plan",,"0.938646514176943","Yes","Yes","Yes","63%","37%","$200","$0","$600","$0","$200","$0","$600","$0","$200","$0","$200","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","$800","$800 per person","$1600 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10.00%","$200","$200 per person","$400 per group","20.00%","$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480004-06_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480005","my Connect Blue WV PPO 4750S","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480005-00","my Connect Blue WV PPO 4750S","Standard Silver Off Exchange Plan","71.67%","0.718615020598811","No","Yes","Yes","63%","37%","$4,750","$20","$1,600","$0","$2,100","$1,400","$0","$0","$800","$600","$0","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","20.00%","$5,250","$5250 per person","$10500 per group","40.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480006","my Connect Blue WV PPO 6500B","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480006-03","my Connect Blue WV PPO 6500B","Limited Cost Sharing Plan Variation",,"0.648318564118744","No","Yes","Yes","63%","37%","$2,600","$1,900","$0","$0","$2,100","$1,000","$0","$0","$1,600","$200","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","30.00%","$6,800","$6800 per person","$13600 per group","40.00%","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480006-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010020","CareSource HSA Bronze","50328WV001",,"WVN001","WVS001","WVF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9963",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010020-00","CareSource HSA Bronze","Standard Bronze Off Exchange Plan",,"0.618651277477805","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"https://www.caresource.com/document/MP-2018-wv-hsa-bronze-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010020","CareSource HSA Bronze","50328WV001",,"WVN001","WVS001","WVF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9963",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010020-01","CareSource HSA Bronze","Standard Bronze On Exchange Plan",,"0.618651277477805","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"https://www.caresource.com/document/MP-2018-wv-hsa-bronze-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010020","CareSource HSA Bronze","50328WV001",,"WVN001","WVS001","WVF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9963",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010020-02","CareSource HSA Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-hsa-bronzezero-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010020","CareSource HSA Bronze","50328WV001",,"WVN001","WVS001","WVF004","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9963",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010020-03","CareSource HSA Bronze Limited","Limited Cost Sharing Plan Variation",,"0.618651277477805","Yes","Yes","No","100%",,"$1,720","$0","$4,830","$60","$3,234","$0","$3,316","$55","$963","$0","$963","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"https://www.caresource.com/document/MP-2018-wv-hsa-bronzeltd-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010021","CareSource Low Premium Silver","50328WV001",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9965",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010021-00","CareSource Low Premium Silver","Standard Silver Off Exchange Plan",,"0.6859280333684","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-lp-silver-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480005","my Connect Blue WV PPO 4750S","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480005-01","my Connect Blue WV PPO 4750S","Standard Silver On Exchange Plan","71.67%","0.718615020598811","No","Yes","Yes","63%","37%","$4,750","$20","$1,600","$0","$2,100","$1,400","$0","$0","$800","$600","$0","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","20.00%","$5,250","$5250 per person","$10500 per group","40.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480005-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480005","my Connect Blue WV PPO 4750S","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480005-02","my Connect Blue WV PPO 4750S","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480005-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480005","my Connect Blue WV PPO 4750S","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480005-03","my Connect Blue WV PPO 4750S","Limited Cost Sharing Plan Variation","71.67%","0.718615020598811","No","Yes","Yes","63%","37%","$4,750","$20","$1,600","$0","$2,100","$1,400","$0","$0","$800","$600","$0","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","20.00%","$5,250","$5250 per person","$10500 per group","40.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480005-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480005","my Connect Blue WV PPO 4750S","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480005-04","my Connect Blue WV PPO 4750S","73% AV Level Silver Plan","73.70%","0.737928843839074","No","Yes","Yes","63%","37%","$4,750","$20","$1,030","$0","$2,100","$1,400","$0","$0","$800","$600","$0","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","$5,800","$5800 per person","$11600 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","20.00%","$5,250","$5250 per person","$10500 per group","40.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480005-04_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480005","my Connect Blue WV PPO 4750S","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480005-05","my Connect Blue WV PPO 4750S","87% AV Level Silver Plan","87.98%","0.881047612875553","No","Yes","Yes","63%","37%","$700","$20","$930","$0","$700","$850","$100","$0","$700","$400","$10","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","10.00%","$1,200","$1200 per person","$2400 per group","30.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480005-05_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480005","my Connect Blue WV PPO 4750S","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9992",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480005-06","my Connect Blue WV PPO 4750S","94% AV Level Silver Plan","93.96%","0.940777336037707","No","Yes","Yes","63%","37%","$150","$20","$530","$0","$150","$350","$200","$0","$150","$200","$50","$0","$1,000","0","2","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","10.00%","$250","$250 per person","$500 per group","30.00%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480005-06_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480008","my Connect Blue WV PPO 5700S","31274WV048",,"WVN001","WVS001","WVF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480008-00","my Connect Blue WV PPO 5700S","Standard Silver Off Exchange Plan","66.33%","0.664347309165165","No","Yes","Yes","63%","37%","$5,700","$20","$1,630","$0","$2,100","$1,600","$0","$0","$800","$400","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","30.00%","$6,100","$6100 per person","$12200 per group","40.00%","$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480008","my Connect Blue WV PPO 5700S","31274WV048",,"WVN001","WVS001","WVF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480008-01","my Connect Blue WV PPO 5700S","Standard Silver On Exchange Plan","66.33%","0.664347309165165","No","Yes","Yes","63%","37%","$5,700","$20","$1,630","$0","$2,100","$1,600","$0","$0","$800","$400","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","30.00%","$6,100","$6100 per person","$12200 per group","40.00%","$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480008-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480008","my Connect Blue WV PPO 5700S","31274WV048",,"WVN001","WVS001","WVF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480008-02","my Connect Blue WV PPO 5700S","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","63%","37%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480008-02_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480008","my Connect Blue WV PPO 5700S","31274WV048",,"WVN001","WVS001","WVF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480008-03","my Connect Blue WV PPO 5700S","Limited Cost Sharing Plan Variation","66.33%","0.664347309165165","No","Yes","Yes","63%","37%","$5,700","$20","$1,630","$0","$2,100","$1,600","$0","$0","$800","$400","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$5,700","$5700 per person","$11400 per group","30.00%","$6,100","$6100 per person","$12200 per group","40.00%","$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480008-03_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480008","my Connect Blue WV PPO 5700S","31274WV048",,"WVN001","WVS001","WVF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480008-04","my Connect Blue WV PPO 5700S","73% AV Level Silver Plan","73.73%","0.738745990877549","No","Yes","Yes","63%","37%","$4,000","$20","$900","$0","$2,100","$1,400","$0","$0","$800","$300","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10.00%","$4,300","$4300 per person","$8600 per group","30.00%","$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480008-04_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480008","my Connect Blue WV PPO 5700S","31274WV048",,"WVN001","WVS001","WVF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480008-05","my Connect Blue WV PPO 5700S","87% AV Level Silver Plan","87.93%","0.88008289713796","No","Yes","Yes","63%","37%","$900","$200","$400","$0","$900","$500","$100","$0","$900","$200","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","10.00%","$1,100","$1100 per person","$2200 per group","30.00%","$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480008-05_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480008","my Connect Blue WV PPO 5700S","31274WV048",,"WVN001","WVS001","WVF009","New","PPO","Silver","Not Applicable","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480008-06","my Connect Blue WV PPO 5700S","94% AV Level Silver Plan","93.71%","0.937938068466923","No","Yes","Yes","63%","37%","$200","$20","$480","$0","$200","$300","$200","$0","$200","$100","$40","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10.00%","$400","$400 per person","$800 per group","30.00%","$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480008-06_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480006","my Connect Blue WV PPO 6500B","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480006-00","my Connect Blue WV PPO 6500B","Standard Bronze Off Exchange Plan",,"0.648318564118744","No","Yes","Yes","63%","37%","$2,600","$1,900","$0","$0","$2,100","$1,000","$0","$0","$1,600","$200","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","30.00%","$6,800","$6800 per person","$13600 per group","40.00%","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","31274","SERFF","2017-09-21 20:16:21","Individual","No","55-0624615","31274WV0480006","my Connect Blue WV PPO 6500B","31274WV048",,"WVN001","WVS001","WVF009","Existing","PPO","Expanded Bronze","Not Applicable","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999",,,"2018-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=6571849149","31274WV0480006-01","my Connect Blue WV PPO 6500B","Standard Bronze On Exchange Plan",,"0.648318564118744","No","Yes","Yes","63%","37%","$2,600","$1,900","$0","$0","$2,100","$1,000","$0","$0","$1,600","$200","$0","$0","$1,000","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group","$7,350","$7350 per person","$14700 per group","$14,700","$14700 per person","$29400 per group","Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","30.00%","$6,800","$6800 per person","$13600 per group","40.00%","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0.00%","$0","$0 per person","$0 per group","0.00%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://shop.highmark.com/content/sbcs/2018/WV/Individual/I_31274WV0480006-01_20180101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV2018_ProductBrochure.pdf"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010021","CareSource Low Premium Silver","50328WV001",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9965",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010021-02","CareSource Low Premium Silver Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-lp-silverzero-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010021","CareSource Low Premium Silver","50328WV001",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9965",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010021-03","CareSource Low Premium Silver Limited","Limited Cost Sharing Plan Variation",,"0.6859280333684","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-lp-silverltd-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010021","CareSource Low Premium Silver","50328WV001",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9965",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010021-04","CareSource Low Premium Silver 1","73% AV Level Silver Plan",,"0.724944892077978","Yes","Yes","No","100%",,"$4,800","$465","$516","$60","$1,582","$1,305","$279","$55","$1,387","$105","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,800","$5800 per person","$11600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,800","$4800 per person","$9600 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-lp-silver1-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010021","CareSource Low Premium Silver","50328WV001",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9965",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010021-05","CareSource Low Premium Silver 2","87% AV Level Silver Plan",,"0.87726632792384","Yes","Yes","No","100%",,"$950","$306","$344","$60","$909","$590","$101","$55","$950","$90","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-lp-silver2-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010021","CareSource Low Premium Silver","50328WV001",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9965",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010021-06","CareSource Low Premium Silver 3","94% AV Level Silver Plan",,"0.932542887793143","Yes","Yes","No","100%",,"$571","$0","$129","$60","$517","$155","$28","$55","$600","$33","$67","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-lp-silver3-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010022","CareSource Gold","50328WV001",,"WVN001","WVS001","WVF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010022-00","CareSource Gold","Standard Gold Off Exchange Plan",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-gold-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010022","CareSource Gold","50328WV001",,"WVN001","WVS001","WVF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010022-01","CareSource Gold","Standard Gold On Exchange Plan",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-gold-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010022","CareSource Gold","50328WV001",,"WVN001","WVS001","WVF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010022-02","CareSource Gold Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-goldzero-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010022","CareSource Gold","50328WV001",,"WVN001","WVS001","WVF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9974",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010022-03","CareSource Gold Limited","Limited Cost Sharing Plan Variation",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-goldltd-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010024","CareSource Bronze","50328WV001",,"WVN001","WVS001","WVF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010024-00","CareSource Bronze","Standard Bronze Off Exchange Plan",,"0.617591524943191","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-bronze-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010024","CareSource Bronze","50328WV001",,"WVN001","WVS001","WVF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010024-01","CareSource Bronze","Standard Bronze On Exchange Plan",,"0.617591524943191","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-bronze-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010024","CareSource Bronze","50328WV001",,"WVN001","WVS001","WVF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010024-02","CareSource Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-bronzezero-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010024","CareSource Bronze","50328WV001",,"WVN001","WVS001","WVF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010024-03","CareSource Bronze Limited","Limited Cost Sharing Plan Variation",,"0.617591524943191","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-bronzeltd-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010023","CareSource Silver","50328WV001",,"WVN001","WVS001","WVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9967",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010023-00","CareSource Silver","Standard Silver Off Exchange Plan",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-silver-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010023","CareSource Silver","50328WV001",,"WVN001","WVS001","WVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9967",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010023-01","CareSource Silver","Standard Silver On Exchange Plan",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-silver-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010023","CareSource Silver","50328WV001",,"WVN001","WVS001","WVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9967",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010023-02","CareSource Silver Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-silverzero-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010023","CareSource Silver","50328WV001",,"WVN001","WVS001","WVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9967",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010023-03","CareSource Silver Limited","Limited Cost Sharing Plan Variation",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-silverltd-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010023","CareSource Silver","50328WV001",,"WVN001","WVS001","WVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9967",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010023-04","CareSource Silver 1","73% AV Level Silver Plan",,"0.735310449914442","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,320","$518","$55","$970","$430","$416","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-silver1-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010023","CareSource Silver","50328WV001",,"WVN001","WVS001","WVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9967",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010023-05","CareSource Silver 2","87% AV Level Silver Plan",,"0.877634618592318","Yes","Yes","No","100%",,"$950","$591","$359","$60","$781","$980","$139","$55","$950","$145","$208","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-silver2-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0010023","CareSource Silver","50328WV001",,"WVN001","WVS001","WVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9967",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0010023-06","CareSource Silver 3","94% AV Level Silver Plan",,"0.945421805242358","Yes","Yes","No","100%",,"$205","$300","$120","$60","$244","$369","$13","$55","$325","$75","$69","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$625","$625 per person","$1250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$625","$625 per person","$1250 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$325","$325 per person","$650 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$325","$325 per person","$650 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-silver3-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020021","CareSource Low Premium Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9687",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020021-00","CareSource Low Premium Silver Dental and Vision","Standard Silver Off Exchange Plan",,"0.6859280333684","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-lp-silver-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020021","CareSource Low Premium Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9687",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020021-01","CareSource Low Premium Silver Dental and Vision","Standard Silver On Exchange Plan",,"0.6859280333684","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-lp-silver-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020021","CareSource Low Premium Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9687",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020021-02","CareSource Low Premium Silver Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-lp-silverzero-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020021","CareSource Low Premium Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9687",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020021-03","CareSource Low Premium Silver Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.6859280333684","Yes","Yes","No","100%",,"$6,150","$520","$516","$60","$1,582","$1,510","$279","$55","$1,387","$120","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,150","$6150 per person","$12300 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-lp-silverltd-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020021","CareSource Low Premium Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9687",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020021-04","CareSource Low Premium Silver 1 Dental and Vision","73% AV Level Silver Plan",,"0.724944892077978","Yes","Yes","No","100%",,"$4,800","$465","$516","$60","$1,582","$1,305","$279","$55","$1,387","$105","$245","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,800","$5800 per person","$11600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,800","$4800 per person","$9600 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-lp-silver1-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020021","CareSource Low Premium Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9687",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020021-05","CareSource Low Premium Silver 2 Dental and Vision","87% AV Level Silver Plan",,"0.87726632792384","Yes","Yes","No","100%",,"$950","$306","$344","$60","$909","$590","$101","$55","$950","$90","$163","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","10.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-lp-silver2-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020021","CareSource Low Premium Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF007","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9687",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020021-06","CareSource Low Premium Silver 3 Dental and Vision","94% AV Level Silver Plan",,"0.932542887793143","Yes","Yes","No","100%",,"$571","$0","$129","$60","$517","$155","$28","$55","$600","$33","$67","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-lp-silver3-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020022","CareSource Gold Dental and Vision","50328WV002",,"WVN001","WVS001","WVF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9765",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020022-00","CareSource Gold Dental and Vision","Standard Gold Off Exchange Plan",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-gold-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020022","CareSource Gold Dental and Vision","50328WV002",,"WVN001","WVS001","WVF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9765",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020022-01","CareSource Gold Dental and Vision","Standard Gold On Exchange Plan",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-gold-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020022","CareSource Gold Dental and Vision","50328WV002",,"WVN001","WVS001","WVF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9765",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020022-02","CareSource Gold Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-goldzero-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020022","CareSource Gold Dental and Vision","50328WV002",,"WVN001","WVS001","WVF001","New","HMO","Gold","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9765",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020022-03","CareSource Gold Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.789940406976804","Yes","Yes","No","100%",,"$1,500","$60","$2,480","$60","$1,489","$1,140","$372","$55","$1,133","$350","$283","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-goldltd-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020024","CareSource Bronze Dental and Vision","50328WV002",,"WVN001","WVS001","WVF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9647",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020024-00","CareSource Bronze Dental and Vision","Standard Bronze Off Exchange Plan",,"0.617591524943191","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-bronze-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020024","CareSource Bronze Dental and Vision","50328WV002",,"WVN001","WVS001","WVF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9647",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020024-01","CareSource Bronze Dental and Vision","Standard Bronze On Exchange Plan",,"0.617591524943191","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-bronze-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020024","CareSource Bronze Dental and Vision","50328WV002",,"WVN001","WVS001","WVF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9647",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020024-02","CareSource Bronze Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-bronzezero-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020024","CareSource Bronze Dental and Vision","50328WV002",,"WVN001","WVS001","WVF003","New","HMO","Bronze","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9647",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020024-03","CareSource Bronze Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.617591524943191","Yes","Yes","No","100%",,"$2,356","$100","$4,894","$60","$4,121","$1,015","$1,595","$55","$1,007","$220","$672","$0","$300","0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$7,250","$7250 per person","$14500 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$7,250","$7250 per person","$14500 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-bronzeltd-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020023","CareSource Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9702",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020023-00","CareSource Silver Dental and Vision","Standard Silver Off Exchange Plan",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-silver-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020023","CareSource Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9702",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020023-01","CareSource Silver Dental and Vision","Standard Silver On Exchange Plan",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-silver-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020023","CareSource Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9702",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020023-02","CareSource Silver Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-silverzero-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020023","CareSource Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9702",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020023-03","CareSource Silver Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.713211112601007","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,470","$518","$55","$970","$500","$416","$0","$400","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,300","$7300 per person","$14600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,300","$7300 per person","$14600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-silverltd-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020023","CareSource Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9702",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020023-04","CareSource Silver 1 Dental and Vision","73% AV Level Silver Plan",,"0.735310449914442","Yes","Yes","No","100%",,"$2,196","$1,785","$718","$60","$1,210","$2,320","$518","$55","$970","$430","$416","$0","$300","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-silver1-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020023","CareSource Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9702",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020023-05","CareSource Silver 2 Dental and Vision","87% AV Level Silver Plan",,"0.877634618592318","Yes","Yes","No","100%",,"$950","$591","$359","$60","$781","$980","$139","$55","$950","$145","$208","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group","15.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$950","$950 per person","$1900 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-silver2-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0020023","CareSource Silver Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","New","HMO","Silver","Not Applicable","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9702",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0020023-06","CareSource Silver 3 Dental and Vision","94% AV Level Silver Plan",,"0.945421805242358","Yes","Yes","No","100%",,"$205","$300","$120","$60","$244","$369","$13","$55","$325","$75","$69","$0","$150","5","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$625","$625 per person","$1250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$625","$625 per person","$1250 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$325","$325 per person","$650 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$325","$325 per person","$650 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-silver3-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0030004","CareSource Federal Simple Choice Silver","50328WV003",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0030004-00","CareSource Federal Simple Choice Silver","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-silver-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0030004","CareSource Federal Simple Choice Silver","50328WV003",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0030004-01","CareSource Federal Simple Choice Silver","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-silver-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0030004","CareSource Federal Simple Choice Silver","50328WV003",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0030004-02","CareSource Federal Simple Choice Silver Zero","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-silverzero-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0030004","CareSource Federal Simple Choice Silver","50328WV003",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0030004-03","CareSource Federal Simple Choice Silver Limited","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-silverltd-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0030004","CareSource Federal Simple Choice Silver","50328WV003",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0030004-04","CareSource Federal Simple Choice Silver 1","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-silver1-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0030004","CareSource Federal Simple Choice Silver","50328WV003",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0030004-05","CareSource Federal Simple Choice Silver 2","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$700","$610","$372","$55","$700","$75","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-silver2-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0030004","CareSource Federal Simple Choice Silver","50328WV003",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0030004-06","CareSource Federal Simple Choice Silver 3","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$22","$620","$60","$250","$218","$93","$55","$250","$30","$82","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-silver3-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0030005","CareSource Federal Simple Choice Bronze","50328WV003",,"WVN001","WVS001","WVF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9965",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0030005-00","CareSource Federal Simple Choice Bronze","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,445","$1,515","$1,998","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-bronze-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0030005","CareSource Federal Simple Choice Bronze","50328WV003",,"WVN001","WVS001","WVF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9965",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0030005-01","CareSource Federal Simple Choice Bronze","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,445","$1,515","$1,998","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-bronze-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0030005","CareSource Federal Simple Choice Bronze","50328WV003",,"WVN001","WVS001","WVF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9965",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0030005-02","CareSource Federal Simple Choice Bronze Zero","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-bronzezero-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0030005","CareSource Federal Simple Choice Bronze","50328WV003",,"WVN001","WVS001","WVF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9965",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0030005-03","CareSource Federal Simple Choice Bronze Limited","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,445","$1,515","$1,998","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-bronzeltd-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0050004","CareSource Federal Simple Choice Silver Dental and Vision","50328WV005",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9709",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0050004-00","CareSource Federal Simple Choice Silver Dental and Vision","Standard Silver Off Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-silver-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0050004","CareSource Federal Simple Choice Silver Dental and Vision","50328WV005",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9709",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0050004-01","CareSource Federal Simple Choice Silver Dental and Vision","Standard Silver On Exchange Plan",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-silver-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0050004","CareSource Federal Simple Choice Silver Dental and Vision","50328WV005",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9709",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0050004-02","CareSource Federal Simple Choice Silver Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-silverzero-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0050004","CareSource Federal Simple Choice Silver Dental and Vision","50328WV005",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9709",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0050004-03","CareSource Federal Simple Choice Silver Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.710476913884508","No","Yes","No","100%",,"$3,500","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group","$3,500","$3500 per person","$7000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$500","$500 per person","$1000 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-silverltd-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0050004","CareSource Federal Simple Choice Silver Dental and Vision","50328WV005",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9709",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0050004-04","CareSource Federal Simple Choice Silver 1 Dental and Vision","73% AV Level Silver Plan",,"0.739471608611116","No","Yes","No","100%",,"$3,000","$120","$2,480","$60","$1,489","$1,485","$372","$55","$1,305","$195","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,850","$5850 per person","$11700 per group","$3,000","$3000 per person","$6000 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$200","$200 per person","$400 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-silver1-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0050004","CareSource Federal Simple Choice Silver Dental and Vision","50328WV005",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9709",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0050004-05","CareSource Federal Simple Choice Silver 2 Dental and Vision","87% AV Level Silver Plan",,"0.876063218708028","No","Yes","No","100%",,"$700","$0","$1,750","$60","$700","$610","$372","$55","$700","$75","$326","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","$700","$700 per person","$1400 per group","20.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","$0","$0 per person","$0 per group","30.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-silver2-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0050004","CareSource Federal Simple Choice Silver Dental and Vision","50328WV005",,"WVN001","WVS001","WVF005","New","HMO","Silver","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9709",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0050004-06","CareSource Federal Simple Choice Silver 3 Dental and Vision","94% AV Level Silver Plan",,"0.946922790208574","No","Yes","No","100%",,"$250","$22","$620","$60","$250","$218","$93","$55","$250","$30","$82","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$250","$250 per person","$500 per group","5.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","25.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-silver3-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0050005","CareSource Federal Simple Choice Bronze Dental and Vision","50328WV005",,"WVN001","WVS001","WVF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9685",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0050005-00","CareSource Federal Simple Choice Bronze Dental and Vision","Standard Bronze Off Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,445","$1,515","$1,998","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-bronze-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0050005","CareSource Federal Simple Choice Bronze Dental and Vision","50328WV005",,"WVN001","WVS001","WVF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9685",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0050005-01","CareSource Federal Simple Choice Bronze Dental and Vision","Standard Bronze On Exchange Plan",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,445","$1,515","$1,998","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-bronze-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0050005","CareSource Federal Simple Choice Bronze Dental and Vision","50328WV005",,"WVN001","WVS001","WVF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9685",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0050005-02","CareSource Federal Simple Choice Bronze Zero Dental and Vision","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0.00%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-bronzezero-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","50328","SERFF","2017-10-31 20:15:29","Individual","No","47-3028244","50328WV0050005","CareSource Federal Simple Choice Bronze Dental and Vision","50328WV005",,"WVN001","WVS001","WVF006","New","HMO","Expanded Bronze","Design 1","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9685",,,"2018-01-01","2018-12-31","Yes","Emergency Services Only","No",,"No","https://enroll.caresource.com/","https://www.caresource.com/documents/2018-marketplace-formulary/","50328WV0050005-03","CareSource Federal Simple Choice Bronze Limited Dental and Vision","Limited Cost Sharing Plan Variation",,"0.6268275994915","Yes","Yes","No","100%",,"$2,390","$0","$4,960","$60","$3,445","$1,515","$1,998","$55","$979","$225","$653","$0",,"0","0","0",,,,,,,,,,,,,,,,,,,,,,,,,"$7,350","$7350 per person","$14700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$7,350","$7350 per person","$14700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40.00%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/document/MP-2018-wv-fedstd-bronzeltd-dv-sum","https://www.caresource.com/document/MP-2018-wv-a-broch"
"2018","WV","53843","SERFF","2017-08-09 20:15:51","Individual","Yes","75-1233841","53843WV0010001","Dentegra Dental PPO Pediatric Basic Plan","53843WV001",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","53843WV0010001-00","Dentegra Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","68.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wv/53843wv0010001-18"
"2018","WV","53843","SERFF","2017-08-09 20:15:51","Individual","Yes","75-1233841","53843WV0010007","Dentegra Dental PPO Family Basic Plan","53843WV001",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","53843WV0010007-01","Dentegra Dental PPO Family Basic Plan","Standard Low On Exchange Plan","68.60%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wv/53843wv0010007-18"
"2018","WV","53843","SERFF","2017-08-09 20:15:51","Individual","Yes","75-1233841","53843WV0010008","Dentegra Dental PPO Family Preferred Plan","53843WV001",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.dentegra.com/hx/checkout","","53843WV0010008-01","Dentegra Dental PPO Family Preferred Plan","Standard High On Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","$45 per person","per group not applicable",,,,,,"$45","$45 per person","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wv/53843wv0010008-18"
"2018","WV","72479","SERFF","2017-08-14 20:15:51","Individual","Yes","36-3757528","72479WV0010001","TruAssure Basic Adult or Child Dental Plan","72479WV001",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72479WV0010001-00","TruAssure Basic Adult or Child Dental Plan","Standard Low Off Exchange Plan","68.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WV","https://www.truassure.com/brochure?state=WV"
"2018","WV","72479","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","36-3757528","72479WV0030001","TruAssure Dental Small Group Basic Plan","72479WV003",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","72479WV0030001-00","TruAssure Dental Small Group Basic Plan","Standard High Off Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","WV","72479","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","36-3757528","72479WV0040001","TruAssure Dental Small Group Preferred Plan","72479WV004",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Estimated Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","72479WV0040001-00","TruAssure Dental Small Group Preferred Plan","Standard High Off Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2018","WV","72479","SERFF","2017-08-14 20:15:51","Individual","Yes","36-3757528","72479WV0010001","TruAssure Basic Adult or Child Dental Plan","72479WV001",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72479WV0010001-01","TruAssure Basic Adult or Child Dental Plan","Standard Low On Exchange Plan","68.40%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WV","https://www.truassure.com/brochure?state=WV"
"2018","WV","72479","SERFF","2017-08-14 20:15:51","Individual","Yes","36-3757528","72479WV0020001","TruAssure Preferred Adult or Child Dental Plan","72479WV002",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72479WV0020001-00","TruAssure Preferred Adult or Child Dental Plan","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WV","https://www.truassure.com/brochure?state=WV"
"2018","WV","72479","SERFF","2017-08-14 20:15:51","Individual","Yes","36-3757528","72479WV0020001","TruAssure Preferred Adult or Child Dental Plan","72479WV002",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01","2018-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72479WV0020001-01","TruAssure Preferred Adult or Child Dental Plan","Standard High On Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WV","https://www.truassure.com/brochure?state=WV"
"2018","WV","76526","SERFF","2017-08-09 20:15:51","Individual","Yes","55-0523124","76526WV0010001","Delta Dental PPO Pediatric Basic Plan","76526WV001",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0010001-00","Delta Dental PPO Pediatric Basic Plan","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0010001-18"
"2018","WV","76526","SERFF","2017-08-09 20:15:51","Individual","Yes","55-0523124","76526WV0010002","Delta Dental PPO Pediatric Preferred Plan","76526WV001",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2017-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0010002-00","Delta Dental PPO Pediatric Preferred Plan","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$40","$40 per person","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0010002-18"
"2018","WV","76526","SERFF","2017-08-09 20:15:51","Individual","Yes","55-0523124","76526WV0010006","Delta Dental PPO Basic Plan for Families","76526WV001",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0010006-01","Delta Dental PPO Basic Plan for Families","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0010006-18"
"2018","WV","76526","SERFF","2017-08-09 20:15:51","Individual","Yes","55-0523124","76526WV0010004","Delta Dental PPO Preferred Plan for Families","76526WV001",,"WVN001","WVS001",,"Existing","PPO","High","Not Applicable",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"No",,"Yes","Nationwide Network","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0010004-01","Delta Dental PPO Preferred Plan for Families","Standard High On Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$40","$40 per person","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0010004-18"
"2018","WV","94562","SERFF","2017-08-14 20:15:51","SHOP (Small Group)","Yes","13-5581829","94562WV0080001","EHB Basic Dental Plan (Low)","94562WV008",,"WVN001","WVS001",,"Existing","PPO","Low","Not Applicable",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"1","Guaranteed Rate","2018-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","94562WV0080001-00","EHB Basic Dental Plan (Low)","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,,,,,,"0","0","0","$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,